Helen Sheldon joined the Health Innovation Network in 2018, working on a large mixed methods process and impact evaluation of the roll out of ESCAPE-pain in the community and leisure sectors. Since then, she has led evaluations of Remote Monitoring in Rheumatoid Arthritis, Micro-volunteering and a Whole Schools Approach to children and young people’s emotional wellbeing. She has also supported companies on the Digital Health.London Accelerator and Launchpad Programmes develop their evidence base and been part of a multi-agency collaboration to extend the work of the DH.L Evidence Generator to create a national digital evidence hub.
Helen has over twenty years’ experience of evaluating initiatives in settings across health and social care, using a broad range of techniques. She has a particular expertise in qualitative methods and in stakeholder engagement, and specialist knowledge of quality assurance and information security in managing research and evaluation projects.
Modern treat-to-target approaches to rheumatoid arthritis (RA) involve frequently monitoring disease activity via patient reported outcome measures (PROMs). Remote monitoring (RM) of PROMs can support care through more timely intervention and fewer unnecessary appointments. This study aimed to evaluate the feasibility of scaled implementation of a RM system for people with RA at three NHS trusts in London, UK.
This was a prospective mixed-methods evaluation with service user involvement throughout. We report on the patient survey and semi-structured interviews with staff and patients exploring perspectives on the RM system. Interview schedule design and analysis for clinician and patient were informed by the EPIS1 and COM-B2 frameworks, respectively.
Sixteen staff were interviewed. The system was implemented in two stages: an initial pilot at one trust then roll out to two other trusts. The four EPIS phases (Exploration, Preparation, Implementation and Sustainment) were evident in the pilot trust, but exploration and preparation were less evident at the other trusts. Adoption beyond the pilot trust was low with staff concerned about integration into clinical practice and systems.
Twenty-two patients were interviewed and 163 responded to the survey. Patients were overwhelmingly positive about the RM system. It was easy to use and required no skills beyond those used in their daily life. Patients were motivated to adopt the RM system by an interlinked set of beliefs regarding its use. A key motivator was increased responsiveness and ease of contact with the clinical service.
There was a contrast between the views of patients and staff outside of the pilot trust about RM. The lower adoption and associated concerns of staff about RM beyond the pilot site may be due to insufficient involvement at the Exploration and Preparation phases. The EPIS provides a useful framework for understanding challenges and approaches to scaling effectively.