Patient Characteristics Associated With Disparities in Engagement With and Experience of Covid‐19 Remote Home Monitoring Services

A Mixed‐Methods Evaluation

Bibliographic Data

ID19508455
AuthorsNadia Crellin (0000-0002-9497-5874, Research and Policy Nuffield Trust London UK, corresponding author), Lauren Herlitz (0000-0003-2497-9041, NIHR Children and Families Policy Research Unit UCL Great Ormond Street Institute of Child Health London UK), Manbinder Sidhu (0000-0001-5663-107X, School of Social Policy, Health Services Management Centre, College of Social Sciences University of Birmingham Birmingham UK), JO ELLINS (0000-0001-8138-9385, School of Social Policy, Health Services Management Centre, College of Social Sciences University of Birmingham Birmingham UK), Theo Georghiou (0000-0001-9532-876X, Research and Policy Nuffield Trust London UK), Ian Litchfield (0000-0002-1169-5392, Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham Birmingham UK), Efthalia Massou (0000-0003-0488-482X, Department of Public Health and Primary Care University of Cambridge Cambridge UK), Pei Li Ng (0000-0001-8411-220X, Department of Applied Health Research University College London Gower Street London UK), Chris Sherlaw‐Johnson (0000-0002-4851-6060, Research and Policy Nuffield Trust London UK), Sonila M Tomini (0000-0002-4241-2121, Department of Applied Health Research University College London Gower Street London UK), Cecilia Vindrola-Padros (0000-0001-7859-1646, University College London), Cecilia Vindrola‐Padros (Department of Targeted Intervention University College London London UK), Holly Walton (0000-0002-8746-059X, Department of Applied Health Research University College London Gower Street London UK), Naomi Fulop (0000-0001-5306-6140, Department of Applied Health Research University College London Gower Street London UK)
Year2024
Volume27
Issue4
Pagese14145-e14145
Publication date2024-08-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Expectations (JOURNAL)
Journal identifiersISSN: 1369-6513 • E-ISSN: 1369-7625
PublisherWiley (PUBLISHER • GB)
DOI10.1111/hex.14145
PMID39092691
OpenAlexW4401261052
LanguageEN
Citations received1
References cited49

INTRODUCTION: The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. METHODS: This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. FINDINGS: Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. CONCLUSION: Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. PATIENT OR PUBLIC CONTRIBUTION: The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript

Disease · Environmental health · Ethnic group · Family medicine · Health equity · Pandemic · Population · Public health · Qualitative property · Qualitative research · Referral · Sociology · Thematic analysis · COVID-19 and Mental Health · Medicine · Mobile Health and mHealth Applications · Nursing · Telemedicine and Telehealth Implementation

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