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Patrick Ware

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    OS26 - Telehealth in Action (ID 42)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 5
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      OS26.03 - Explaining Longitudinal Patient Adherence in a Heart Failure Telemonitoring Program (ID 117)

      Patrick Ware, Toronto/CA

      • Abstract
      • Slides

      Telemonitoring can improve heart failure outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients adhere to taking the expected physiological readings. While the literature is rich with studies exploring barriers and facilitators to patient uptake, few have studied longitudinal patient adherence to telemonitoring programs existing outside the context of clinical trials. The objective of this study was to quantify and explain longitudinal patient adherence in a heart failure telemonitoring program offered as part of the standard of care in a Toronto-based specialty heart function clinic.

      A mixed-method explanatory sequential design was used to first quantify patient adherence rates over a 12-month(m) period and subsequently explain adherence using semi-structured interviews. As patients are instructed to take readings daily before noon, monthly adherence rates were defined as the percentage of completed morning readings (weight, blood pressure, and symptoms) over each 30-day period. Generalized linear models were performed to predict adherence rates using independent variables related to demographics, disease severity, and time since program start. Semi-structured interviews containing probes based on the constructs in the Theory of Acceptance and Use of Technology 2 (UTAUT2) were conducted with a subsample of patients.

      Two years after program launch, longitudinal adherence data for 12m was available for 179 patients (mean age 58 +/-16; 80% male). Overall mean adherence over the 12m period was 70% +/-25 with average adherence rates declining from 80% +/-24 at 1m to 65%+/-35 at 12m. Time since starting the program was the only significant predictor of adherence accounting for 81% of variation in adherence over time (R2=0.81). Characteristics of interviewed patients included a range of ages (22-83), sex (70% male), time since onboarding (0-12m), and overall adherence rates (30-96%). Key themes explaining patients? motivation to adhere include: (1) perceived benefits of the program (self-management support, peace of mind, and improvement in clinical care); (2) ease of use; (3) a positive opinion of the program from family and friends; and (4) supporting services (training and technical support). Themes explaining low and imperfect adherence include: (1) technical issues that periodically prevented the transfer of readings and/or which led to patient frustration; (2) life events or circumstances that interfered with the ability to take readings; and (3) the perception that the benefits of the program were suboptimal due to the system?s inability to adequately capture additional context related to the readings.

      Despite a 15% drop in adherence after one year, an overall mean adherence of 70% is considered high given our strict definition of adherence and because the pragmatic nature of this study meant that we could not account for periods when patients were unable to take readings (e.g., travelling, inpatient stay, etc.). This limitation meant that true adherence was likely underestimated. Consistent with the UTAUT2, this study found that longitudinal adherence is not so much predicted by patients? demographic or health characteristics but rather their perception of a telemonitoring program?s benefits, its ease of use, and the presence of supportive individuals and supporting program components.

      140 Character Summary:
      Although declining over time, patient adherence to a telemonitoring program remained high and was primarily explained by patients? perceptions of the program.

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