title: Continuity, but at what cost? The impact of telemonitoring  COPD on continuities of care: a qualitative study.
abstract: BACKGROUND
  Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term  conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive  and negative ways.
  
  
  OBJECTIVE
  A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in  2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients  and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the  research.
  
  
  METHODS
  Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample  in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two  stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the  framework approach. Interpretation was supported by multidisciplinary discussion.
  
  
  RESULTS
  Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of  telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs.  However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care  provision which, they considered, resulted in the proliferation of additional managerial discontinuities.
  
  
  CONCLUSIONS
  Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity  of clinical management in the development of telemonitoring services.
authors.affiliation: eHealth Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK. peter.fairbrother@nhs.net
authors.forename: Peter
authors.initials: P
authors.lastname: Fairbrother
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.forename: Lucy
authors.initials: L
authors.lastname: McCloughan
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D036301:Qualitative Research; D017216:Telemedicine