Monitoring technology allows people to track their health indicators and access their own data, either using consumer devices like Fitbits or with interventions prescribed by professionals.

While consumer devices tend to be catered towards promoting wellness and fitness, professional monitoring tools are often used to manage care for patients with chronic diseases – like diabetes or heart failure, although they can also be used to encourage behaviour change. Patients can share data with their doctor, who can help them to monitor patterns in their conditions and take action before things get worse – for example by increasing their medication dose. This also allows professionals to capture data over time, enabling them to spot trends and intervene proactively.



Strengths

  • Can make case load easier to manage
  • Good patient experience
  • Can improve patient engagement and self-management
  • May help manage demand

Weaknesses

  • Patient engagement can deteriorate
  • There may be professional resistance

  • There is some evidence that monitoring technology can improve adherence to medication, physical activity and overall responsibility - particularly when patients are empowered to adjust their own medication based on the readings. 
  •  Professional monitoring interventions can reduce heart failure-related hospitalisations by over 20 percent and lower the risk of death by nearly 35 per cent, compared to usual care. 
  •  Other studies have shown similar results for Chronic Obstructive Pulmonary Disorder and reported positive impacts on clinical outcomes in areas such as diabetes and hypertension. 
  • Some studies suggest that wearable technologies improve weight loss – although they may not be as effective as websites.
  • Little is known about the impact of consumer devices when they haven’t been professionally recommended (and therefore engagement is likely to be lower). 
  • Notably, evidence suggests professional telemonitoring does not reduce the amount of patient contact with GPs or practice nurses. 

 

Sustain patient engagement

Engagement with consumer wearable devices significantly decreases over time from initial purchase. For example, weight re-gain is a significant issue with consumer monitoring devices.

Where telemonitoring is professionally led, engagement is higher, but it can still be challenging to sustain in the long term. There are a number of things professionals can do to improve this:

o   Carefully select patients with the capacity for (and ideally interest in) self-management – particularly as monitoring can be costly.

o   Clearly communicate the commitment required from patients at the start of the intervention.

o   Where patients are asked to provide readings, send reminders at the time the readings are due and limit all other communication.

Assure patient safety

Poorly calibrated monitoring devices could increase demand on professional time and may lead to inappropriate treatment. Plans for app accreditation are underway, but until then, it is important that professionals strongly communicate to patients that they use unaccredited apps at their own risk.

Make use of the data generated by patients

There are many ways that central bodies can support professionals to make the most of patient-generated data:

  • Data reports that are easy to interpret
  •  Incentives that support professionals use of this data
  • Additional training where appropriate

Encourage professional buy-in at a regional level

Where monitoring is used to care for patients across organisations – i.e. in both general practice and the community – it is important to ensure all professionals are on board. A regional approach (supported by Local Digital Roadmaps) could help with this. 

CASE STUDY – FLO

Florence, or “Flo”, is a simple telehealth intervention originally developed within Stoke-on-Trent Clinical Commissioning Group (CCG). It allows patients to monitor a variety of conditions – including diabetes and chronic obstructive pulmonary disease (COPD) – and text the reading directly to the Flo system to be accessed by practitioners.

Flo has been formally evaluated, with positive results. It is considered to be easy to use, convenient and reassuring for people across a wide age range. Both patients and professionals have found Flo can help patients develop a better understanding of their condition, medication and lifestyle and improve condition management.

However, the evidence on reductions on professional time is mixed. Part of this depends on patient engagement – where engagement declined after a month, Flo failed to result in improved blood pressure control for the majority of patients. This highlights the importance of maintaining engagement from the patient.