title: Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial.
abstract: OBJECTIVE
  To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Semi-structured interviews with patients with COPD and healthcare professionals participating in a randomized controlled trial of telemonitoring in Lothian, Scotland, explored experiences of using telemonitoring, and dynamics in patient-practitioner relationships. Transcribed data were analyzed using the Framework approach.
  
  
  RESULTS
  38 patients (mean age 67.5 years) and 32 professionals provided 70 interviews. Patients considered that telemonitoring empowered self-management by enhancing their understanding of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice. Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters, but expressed concerns about promoting the sick role and creating dependence on telemonitoring.
  
  
  CONCLUSIONS
  Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered. A medical model of 'compliant self-management' may paradoxically have promoted dependence on professionals.
  
  
  CONCLUSIONS
  Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD. Care is needed, however, to minimize the risk in some patients, of telemonitoring increasing dependence on practitioner support.
authors: e-Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors: Peter
authors: P
authors: Fairbrother
authors: Hilary
authors: H
authors: Pinnock
authors: Janet
authors: J
authors: Hanley
authors: Lucy
authors: L
authors: McCloughan
authors: Aziz
authors: A
authors: Sheikh
authors: Claudia
authors: C
authors: Pagliari
authors: Brian
authors: B
authors: McKinstry
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003376:Counseling; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D011788:Quality of Life; D012606:Scotland; D012648:Self Care; D017216:Telemedicine
keywords: COPD; Primary health care; Qualitative research; Self-management; Telemonitoring