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Results
The RVT service was designed to support care for patients with long-term conditions. TF3 was used to monitor diabetes, respiratory conditions, hypertension or CHF, U-Tell for INR/warfarin management. A total of 242 questionnaires were issued to patients (and carers) with the TF3 system; 81 (33.5%) patient and 48 carer questionnaires were returned. In addition, 32 questionnaires were issued to patients (and carers) with the U-Tell system; 16 patients (50%) and 1 carer questionnaires were returned. There were 97 patient respondents, 83.5% of whom used the regionally commissioned TF3 service. There was an approximate gender balance of patients (49 males and 39 females, 9 did not respond). The mean age of patients was 68.8 years (69.5 years for TF3 and 64 years for U-Tell); refer to table 1.
Mean age profile of respondents by reported condition: in most cases, RVT was used with older people: maternity services and weight management engaged younger users
COPD and bronchiectasis were classified as ‘respiratory’; the service received by a patient whether they had COPD or bronchiectasis or both was the same. TF3 reported the readings via Bluetooth (wireless connection) from peripheral devices to the practitioners through a Home hub, whereas U-Tell used a web-based interface which relied on self-reporting of data from the peripheral device.
To determine if there was any perceived patient benefit, seven questions were posed; table 2 shows mean, variance and correlation as determined by SPSS. The Cronbach’s alpha statistic of over 0.70 for each question shows that the responses are consistent and may be regarded as reliable.
Reliability of each of the empowerment questions within the questionnaire
The question: ‘Has helped me manage my own condition and become involved in my healthcare’ is indicative of empowerment. Table 3 enumerates responses rating (4 being the high rating attributed to the value statement, ‘strongly agree’ and 1 being the low rating attributed to the value statement, ‘strongly disagree’).
Responses to the question: ‘Has helped me manage my own condition and become involved in my healthcare’
There were some inaccuracies in the demographic data, as well as the existence of comorbidity, so that the total number of conditions recorded exceeded the number of participants. A factor to consider was that some patients disclosed conditions for which they were not supported through RVT. Ninety-seven participants recorded 127 conditions, refer to table 3. While the care options for the conditions of dementia and renal were available in other trusts, they were not used in SET. Furthermore, the weight management service and maternity service in SET was a single service managed by a dietitian. Some patients received RVT to manage two or more long-term conditions and hence reported comorbidities. To prevent skewing of results, each participant’s rating for a question was included once. Where there were differences in opinion between patient groups, there may be a risk of comorbidity skewing findings.
Table 3 considers if the patient opinions varied according to their condition when responding to the question: ‘Has helped me manage my own condition and become involved in my healthcare’. The lowest rating of 1 was recorded by one participant, who documented a dual diagnosis including dementia; this syndrome was not supported by RVT so their rating would also be allocated against the condition for which they were prescribed RVT. Equally, one participant recorded a renal diagnosis and a rating of 4. Again, RVT for renal was not supported and so it is recognised that the rating was also attributed to the condition for which they were prescribed RVT. Such dual attribution of rating demonstrated a potential skewing of findings when mean rating is calculated against a diagnostic variable rather than against a technology, a gender or simple participant count. This is because there were more conditions recorded than patients and where comorbidity exists, there may be bias with the mean rating. Consideration of the mean rating by condition was of interest as it was used to gauge if there was a generalisable difference between the experience of people who were monitored for different conditions. No significant difference was found. There were circumstances where the number of patients reporting a condition was low . For example, two patients recorded a diagnosis of stroke where the mean rating for two participants was 1.50. These patients were referred by the stroke specialist nurse for the monitoring of their blood pressure and so equally their rating would be reflected in the mean rating for hypertension, a condition that was recorded seven times. The low rating by patients with stroke was consistent with qualitative data provided by the stroke practitioner in a separate data collection exercise. Eighteen patients reported that they had taken warfarin; but only 16 patients were managed through the U-Tell system. The mean rating was 3.67.
The distribution of responses versus score for the question: ‘Has helped me manage my own condition and become involved in my healthcare’ is shown in figure 1. For 93 valid responses, the mean value was 3.52 with a SD of 0.636.
Histogram to demonstrate frequency of responses versus score for patient responses to the question: ‘Has helped me manage my own condition and become involved in my healthcare’.
Responses given by carers were consistent with the opinions expressed by patients. The carers’ mean score of 3.72 attributed to ‘improving the level of care received’ and ‘has given peace of mind’ demonstrates carer support for RVT. The lowest mean score was 3.41 which related to perceived benefit of future use of internet-based technology.
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