Chronic diseases are a leading health concern worldwide and the Basque Country (Spain) has recently adopted a whitepaper in order to foster an integrated chronic care strategy. Telemonitoring systems are increasingly implemented for the follow-up of chronic diseases because they allow capturing patients’ clinical parameters (e.g. heart rate, blood pressure, blood oxygen saturation, blood glucose, electrocardiograph, respiratory flow, etc.) easily and in a continuous or intermittent pace. Telemonitoring also enhances self-management where patients are often in charge of transferring self-measured clinical data through the system either to primary care professionals or to a specialised care centre where the received parameters can be integrated with other relevant information related to the state of the patient.
A systematic review showed that data transmitted through telemonitoring systems demonstrated a high level of accuracy and reliability. Furthermore, the processes of data transfer of various telemonitoring systems has proven to be effective, and limited technical problems and errors were detected. With respect to patients’ attitudes and behaviours, telemonitoring technologies have generally been well received and accepted. Studies also report that home telemonitoring is cost-effective for the follow-up of high-risk pregnant women, patients suffering from heart failure and those with chronic obstructive pulmonary disease (COPD).
Telemonitoring has been found to reduce rates of hospitalisation and emergency department visits for COPD patients[7–9]. Telemonitoring of diabetic patients is associated with a significant improvement in glycemic control[10, 11]. In the case of asthma, telemonitoring has shown significant improvements in patients’ peak expiratory flows, considerable reductions in symptoms related to the disease, and improvements in perceived quality of life.
With respect to telemonitoring interventions for patients with heart failure, previous studies report their effectiveness in reducing the risk of all-cause mortality, heart failure-related hospitalisations, emergency department visits, as well as improving patient self-care, perceived quality of life, evidence-based prescribing and overall control of the disease[8, 12–16]. In the UK a recent evaluation of the Whole System Demonstrator project, a large pragmatic cluster-randomized trial of telemonitoring for chronic disease, shows decreased hospital admission and mortality among patients receiving the telemonitoring intervention. However, recent large-scale trials of telemonitoring for patients with heart failure found no clinical benefit[18, 19].
Patient acceptance of telemonitoring systems is essential in order to ensure the success of this new care modality. However, healthcare professionals are also pivotal for the success of a telehealth program because this requires important changes in their usual practice.
While physician acceptance of telemedicine has been extensively studied[22–27], only a few studies have specifically explored healthcare providers’ acceptance of telemonitoring systems. In the United Kingdom, Sharma and colleagues investigated clinicians’ perceptions toward telemonitoring of patients with chronic conditions using the concepts of Giddens’s Structuration Theory and Consequence of Modernity[29, 30]. Their findings showed that trust and sense of security emerged as the two concepts that determined clinicians’ adoption of telemonitoring. A study conducted in Quebec (Canada) evaluated non-physician healthcare professionals' adoption of elder home care telemonitoring[31, 32]. This study was based on Triandis’ Theory of Interpersonal Behavior but employed a qualitative research design. Habits and perceived barriers in clinical practice were identified as the main determinants of healthcare professionals’ adoption of elder home care telemonitoring.
Our team has conducted a previous study on healthcare professionals’ adoption of a hospital-based telemonitoring system at the Donostia University Hospital (Gipuzkoa, Basque Country). Using a modified version of the Technology Acceptance Model (TAM) proposed by Davis, we found that facilitating conditions were the most important predictor of hospital physicians’ and nurses’ intention to use a telemonitoring system. This previous work allowed us to suggest modifications to the theoretical model and to develop an enhanced instrument that could better capture the factors influencing healthcare professionals’ acceptance of telemonitoring.
The aim of this study was twofold: 1) to evaluate the determinants of healthcare professionals’ acceptance of a telemonitoring system for the management of chronic patients in primary care; and 2) to apply an adapted theory-based instrument to assess healthcare professionals’ acceptance of telemonitoring.