Patient Perspectives on Remote Monitoring

Overview

Initiative type

Service Improvement

Status

Deliver

Published

June 2025

Summary

Preventative Integrated Care Service (PICS) is a rapid access, intensive outpatient program for adults with chronic disease. We explored patient perspectives on RPM. Findings and implications for practice are discussed.

Key dates

1 October 2024 - 2 February 2025

Implementation sites

West Moreton hospitals

Aim

The aim of this project is to qualitatively explore patients' perspectives and experiences in using RPM, as part of an intensive outpatient care programme for chronic disease operating in West Moreton Hospital and Health Service.

Outcomes

  • 33 patients participated in semi-structured phone interviews. Half (n = 17) were female, with 58% aged 65 years or older.
  • Patient perspectives indicate acceptability & normalisation in the expectations of the incorporation of technology into healthcare. This was true for all age groups, genders, and clinical streams.
  • RPM was viewed as a safety net when at home. Those patients who reported ambivalence, resistance, or scepticism at commencement of RPM use were swayed to positive views when experiencing proactive clinician outreach from detection of clinical deterioration.
  • RPM, when incorporated into patient education, facilitated and reinforced the therapeutic relationship and patient's chronic disease self-management.

Background

The multifaceted pressures of ageing populations, rising chronic disease, and technological advancements continue to place enormous pressure on health systems, calling for a shift towards the treatment in outpatient settings where appropriate, digitalisation of healthcare, and introduction of innovative models are required (1-5). In response to local current and anticipated high demand for health services to manage chronic disease (6), West Moreton Health implemented an intensive outpatient care programme for people living with chronic respiratory conditions, chronic cardiac conditions, and diabetes – the Preventative Integrated Care Service (PICS). The PICS aims to provide early intervention for the deteriorating patient, through a 16-day, rapid-access service supported by Remote Patient Monitoring (RPM). The service is underpinned by principles of person-centred care, operating an interdisciplinary model with Senior Medical Officers, Nursing, and Allied Health staff.

This project is a sub-study of a broader implementation evaluation of the PICS (7) and aimed to explore patients' perspectives of RPM in the context of an intensive outpatient care programme for chronic disease. This project occurred during a transition in digital platform provider and change in clinical workflow, moving from an opt-in to opt-out of RPM use. For the first two years of PICS service delivery, RPM use was relatively low. The benefits of RPM such as improved care appropriateness and efficiency and patient safety have been demonstrated in specific patient cohorts, such as geriatrics, paediatrics, acute care, and chronic disease. However, there is currently limited evidence of patient perspectives of RPM use in intensive outpatient care programmes for chronic disease such as the PICS.

This project provided insights into patients' perceptions of, and experiences with, using RPM in this intensive outpatient service. Further, it provides insights opportunities for the continual improvement of RPM adoption within the PICS, and for the scale and spread of RPM inclusion in outpatient services.

Methods

This project employed a cross-sectional study design to qualitatively explore PICS patients' perceptions and experiences with RPM and the service more broadly. Semi-structured interview guides were informed by two Implementation Science theories, models, and frameworks, to explore both characteristics of the technology and service environment and human factors - the Non-Adoption, Abandonment, Scale Up, Spread and Sustainability (NASSS) Framework (8) and Theoretical Domains Framework (TDF)(9).

Recruitment was facilitated by PICS staff between October 2024 and January 2025. Participants who completed an interview received a $60 grocery gift card. The study sample was representative of the demographic profile of the wider PICS service. Thirty-three interviews were conducted via telephone and audio recorded. Recordings were transcribed verbatim using Microsoft Word, cleaned, and analysed in QSR NVivo 14. Inductive qualitative analyses, using Interpretive Description, were employed. Coding and consensus development was carried out by two researchers. This resulted in two themes associated with RPM - acceptability and normalisation of RPM, and purposeful data collection and a safety net.

Acceptability describes the degree to which a given intervention is "agreeable, palatable, or satisfactory" (10). Normalisation describes the process in which something becomes considered normal or expected (11). Acceptability and normalisation of RPM therefore describes the perceived expectation and readiness to use RPM. Many patients described the ubiquitous nature of technology, and that both intermittent and continuous RPM was easy to engage with. Patients who reported that they did not consider themselves to be "tech savvy" were willing to try RPM, particularly when shown how to use the technology and if ongoing support was available.
"I have a problem with using technology. I, I don't do it well -I'm happy to give it a try. I'll try anything. My problem would be that I would muck it up and I might have to ring people saying: "What am I doing with this?". But happy to give it a try. "C34, Respiratory stream.

Patients described RPM as a safety net for their health, particularly post-discharge from hospital. However, some felt a sense of pessimism about the utility of engaging with RPM in the early stages of the service, communicating uncertainty about if there would be anyone reviewing the data that was being collected. These initial perceptions were overturned for several of these patients who experienced clinical deterioration. These patients received proactive contact from the PICS clinicians, which resulted in further care from PICS or escalation to emergency services.

Quotes from patients:

"At the start I was a little bit pessimistic about it all -I  think maybe three days into trialling the system I actually went downhill and I think I was the one that was looking at my numbers and she actually called QAS herself on my behalf to get me to ED...So that aspect of it all kind of blew my mind! They're monitoring you from home. All this stuff, just not actually just worthless." C19, Respiratory stream.

Discussion

This study highlights the perceptions and expectations of patients engaging in a short-term, intensive outpatient care program for chronic disease. The overarching theme of normalisation and acceptability of RPM demonstrates a key learning for the service. All patients aged below 65 years cited a readiness to engage with RPM, with very few citing any barriers or concerns to RPM use. Nearly all patients that considered themselves to not be "tech savvy" or had difficulties with technology were willing to engage with RPM, particularly if they were shown how to use the technologies and if ongoing support was available.

This study highlights several practical considerations for the implementation of RPM in clinical practice for outpatient services. In the context of the apparent normalisation and acceptability of RPM, it is imperative that clinicians do not assume that patients are not interested in using technology to support their healthcare. All patients should be engaged in a conversation about what RPM is, its purpose, and whether it is right for the patient. Further, clear communication about how the technology will be used by the treating team is essential. This includes discussion about the risks and benefits of using RPM, the procedures that will be enacted if deterioration is detected by the team, including if this may result in contacting emergency services on behalf of the patient or admission to hospital. Importantly, communication around what will happen if a patients' measures are within range, or contacting the patient to inform them that their measures are normal may assist in ongoing engagement with RPM.

The patients' onboarding process to RPM is a critical period to establishing these expectations through clear communication, and also supporting those patients who may have lower levels of digital literacy or capability. Demonstrations in both how to use the technology, and how the clinicians will use the information generated from the technology, can help support the patients' confidence in engaging with the technology and highlight its utility to their care. The use of the patients' measures during clinical interactions is recommended, as this was found to be a strong reinforcer of patient education and self-management capabilities.

These considerations in turn require adequate staff resourcing to enact. The inclusion of RPM onboarding, monitoring, response, and offboarding requires new processes to be embedded into clinical workflows. While dedicated resourcing to lead the change management process in planning and early implementation stages is beneficial, considerations for the cessation of this support indefinitely are required early. Tapering of this dedicated resourcing may help to support clinicians to consolidate these news workflows, and assist with responding to patient-initiated troubleshooting.

These findings suggest that RPM is acceptable and desirable to patients. Cohorts who could benefit from RPM include those cared for in non-traditional beds (e.g. long-stay patients requiring ongoing monitoring), post-discharge initiatives, patients experiencing mobility concerns, and patients living in rural or remote areas.

References

1. Australian Healthcare & Hospitals Association. A Blueprint for Outcomes-focused, Value-based Health Care.; 2021.
2. Boxall A. What are we doing to ensure the sustainability of the health system? ; 2011.
3. World Health Organization. Everybody's Business: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. 2007.
4 .Organization WH. Framework on integrated, people-centred health services. Report by the Secretariat. 2016.
5. Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century.  Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US). Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.
6.  West Moreton Health. (2023). West Moreton Health Local Area Needs Assessment, 2023 Refresh.
7.  Earnshaw A, Carter HE, Wallis S, McPhail SM, McGowan K, & Naicker S. (2025).  Theory-informed process evaluation protocol to assess a rapid-access outpatient model of care in South East Queensland, Australia. BMJOpen, 15:e089438. doi:10.1136/bmjopen-2024-089438
8.  Greenhalgh T, Wherton J, Papoutsi C, et al. Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 2017;19:e367.
9. Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012;7:37.
10. Nadal C, Sas C, Doherty G. Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement. J Med Internet Res 2020;22(7):e17256
11. 'Normalization'. (2025). Available at: https://www.merriam-webster.com/dictionary/normalization (Accessed 05 April 2025)

Key contact

Ashleigh Earnshaw

Principal Planning Advisor

West Moreton Hospital and Health Service

Email: ashleigh.earnshaw@health.qld.gov.au

Last updated: June 2025

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