title: Piloting tele-monitoring in COPD: a mixed methods  exploration of issues in design and implementation.
abstract: BACKGROUND
  In 2008 NHS Lothian implemented a COPD tele-monitoring service incorporating a touch-screen computer for daily  recording of symptoms and weekly oximetry and spirometry measurement. Data were transmitted by secure broadband link to a call  centre where trained workers monitored data and contacted clinicians according to an agreed algorithm.
  
  
  OBJECTIVE
  To explore the perceptions of patients and professionals about the pilot implementation of the COPD tele-monitoring service.
  
  
  METHODS
  In-depth interviews were undertaken with patients and professionals before and after installation of the tele-monitoring  equipment. Interviews were recorded, transcribed and thematically analysed. Data on use of healthcare resources were obtained from  primary care records.
  
  
  RESULTS
  Twenty of the 27 patients in the pilot and 25 professionals participated. (n=55 interviews and one focus group). Patients were  generally positive about the technology, which they perceived enabled earlier recognition of exacerbations and facilitated access to clinical  advice. In contrast, clinicians had concerns about false positive symptom scores, difficulties in interpreting physiological data, overtreatment  (reflected in a large increase in antibiotics and steroid prescribing), and an increased workload.
  
  
  CONCLUSIONS
  Tele-monitoring was perceived by patients as improving access to professional care, but raised concerns for clinicians about  possible over-treatment and how best to organise services to support the technology.
authors.affiliation: Midwifery and Social Care, Edinburgh Napier University School of Nursing, Edinburgh, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ure
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.forename: Gillian
authors.initials: G
authors.lastname: Kidd
authors.forename: Emily
authors.initials: E
authors.lastname: McCall Smith
authors.forename: Alex
authors.initials: A
authors.lastname: Tarling
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: William
authors.initials: W
authors.lastname: MacNee
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003201:Computers; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry / Q000379:methods; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*