Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Barnaby C Reeves; Robin Wickens; Sean R O'Connor; Eleanor Alma Gidman; E Ward; Charlene Treanor; Tunde Peto; Ben J L Burton; Paul C Knox; Andrew Lotery; Sobha Sivaprasad; Michael Donnelly; Chris A Rogers; Ruth E Hogg

doi:10.1136/bmjopen-2023-077196

Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Barnaby C Reeves
, Robin Wickens
, Sean R O'Connor
, Eleanor Alma Gidman
, E Ward
, Charlene Treanor
, Tunde Peto
, Ben J L Burton
, Paul C Knox
, Andrew Lotery
, Sobha Sivaprasad
, Michael Donnelly
, Chris A Rogers
, Ruth E Hogg

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

OBJECTIVES: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack).

DESIGN: Diagnostic Test Accuracy study.

SETTING: Six UK hospitals.

METHODS: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges.

RESULTS: Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.

CONCLUSIONS: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.

TRIAL REGISTRATION NUMBER: ISRCTN79058224.

Original language	English
Article number	e077196
Journal	BMJ Open
Volume	14
Issue number	3
DOIs	https://doi.org/10.1136/bmjopen-2023-077196
Publication status	Published (in print/issue) - 7 Mar 2024

Bibliographical note

Funding

NIHR Health Technology Assessment Programme (no. 15/97/02). The funder had no role in the write-up or conduct of the study. This study was designed and is being delivered in collaboration with the Clinical Trials and Evaluation Unit (CTEU), a UKCRC registered clinical trials unit which, as part of the Bristol Trials Centre, is in receipt of National Institute for Health Research CTU support funding. We thank the independent members of the MONARCH steering committee, including our public and patient representatives for their valued contribution and oversight of the study and for their attendance at the steering committee meetings both in person and virtually. We extend our thanks to all the participants who took part in the study and without whom, the study would not be possible. We are grateful to all the staff at the clinical sites that facilitated recruitment, training, and data collection and contributed to the regular study management meetings. We thank the companies and organisations who provided access to their tests for evaluation in this context. Thanks to Mark Roser and Patricia Beaton from the International Macular and Retinal Foundation for help and support with the KeepSight journal. Thanks to Mike Bartlett and Yi-Zhong Wang from Vital Art and Science LLC for access and support with MyVisionTrack device. Thanks to Lars Frisen and Bo Frisen from Visumetrics for access and support with the Multibit device. Thanks to Novartis and Roche for access to the apps for the duration of the study.

Funder number
15/97/02

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 7 Affordable and Clean Energy

Keywords

Humans
Mobile Applications
Smartphone
Telemedicine
Macular Degeneration/therapy

Access to Document

10.1136/bmjopen-2023-077196

Cite this

Reeves, B. C., Wickens, R., O'Connor, S. R., Gidman, E. A., Ward, E., Treanor, C., Peto, T., Burton, B. J. L., Knox, P. C., Lotery, A., Sivaprasad, S., Donnelly, M., Rogers, C. A., & Hogg, R. E. (2024). Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home. BMJ Open, 14(3), Article e077196. https://doi.org/10.1136/bmjopen-2023-077196

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title = "Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home",

abstract = "OBJECTIVES: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack).DESIGN: Diagnostic Test Accuracy study.SETTING: Six UK hospitals.METHODS: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges.RESULTS: Patients (n=297) in the study were familiar with technology; 252/296 (85\%) had internet at home and 197/296 (67\%) had used a smartphone. Nevertheless, 141 (46\%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10\%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44\%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.CONCLUSIONS: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.TRIAL REGISTRATION NUMBER: ISRCTN79058224.",

keywords = "Humans, Mobile Applications, Smartphone, Telemedicine, Macular Degeneration/therapy",

author = "Reeves, \{Barnaby C\} and Robin Wickens and O'Connor, \{Sean R\} and Gidman, \{Eleanor Alma\} and E Ward and Charlene Treanor and Tunde Peto and Burton, \{Ben J L\} and Knox, \{Paul C\} and Andrew Lotery and Sobha Sivaprasad and Michael Donnelly and Rogers, \{Chris A\} and Hogg, \{Ruth E\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2024",

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doi = "10.1136/bmjopen-2023-077196",

language = "English",

volume = "14",

journal = "BMJ Open",

issn = "2044-6055",

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Reeves, BC, Wickens, R, O'Connor, SR, Gidman, EA, Ward, E, Treanor, C, Peto, T, Burton, BJL, Knox, PC, Lotery, A, Sivaprasad, S, Donnelly, M, Rogers, CA & Hogg, RE 2024, 'Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home', BMJ Open, vol. 14, no. 3, e077196. https://doi.org/10.1136/bmjopen-2023-077196

TY - JOUR

T1 - Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

AU - Reeves, Barnaby C

AU - Wickens, Robin

AU - O'Connor, Sean R

AU - Gidman, Eleanor Alma

AU - Ward, E

AU - Treanor, Charlene

AU - Peto, Tunde

AU - Burton, Ben J L

AU - Knox, Paul C

AU - Lotery, Andrew

AU - Sivaprasad, Sobha

AU - Donnelly, Michael

AU - Rogers, Chris A

AU - Hogg, Ruth E

PY - 2024/3/7

Y1 - 2024/3/7

N2 - OBJECTIVES: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack).DESIGN: Diagnostic Test Accuracy study.SETTING: Six UK hospitals.METHODS: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges.RESULTS: Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.CONCLUSIONS: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.TRIAL REGISTRATION NUMBER: ISRCTN79058224.

AB - OBJECTIVES: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack).DESIGN: Diagnostic Test Accuracy study.SETTING: Six UK hospitals.METHODS: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges.RESULTS: Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.CONCLUSIONS: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.TRIAL REGISTRATION NUMBER: ISRCTN79058224.

KW - Humans

KW - Mobile Applications

KW - Smartphone

KW - Telemedicine

KW - Macular Degeneration/therapy

UR - https://www.scopus.com/pages/publications/85187151165

U2 - 10.1136/bmjopen-2023-077196

DO - 10.1136/bmjopen-2023-077196

M3 - Article

C2 - 38453199

SN - 2044-6055

VL - 14

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e077196

ER -

Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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