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SPOTLIGHTS
Receptiveness of Tele-monitoring in Management of Chronic Health Conditions
Research study conducted by SingHealth Polyclinics (SHP) in collaboration with NUS Yong Loo Lin School of Medicine showed increasing willingness of patients in taking up tele-monitoring to manage their chronic health conditions.

Tele-monitoring by definition encompasses the transmission of medical data such as symptom scores, physiological data what include heart rate, blood pressure, oxygen saturation, and weight, through automated electronic methods or by mobile-based data entry. This method of communicating medical information is beneficial especially for patients who are less mobile. Tele-monitoring is of particular significance and relevance to patients with non-communicable diseases (NCD), such as Type 2 Diabetes Mellitus (T2DM) and hypertension, which require optimal long-term management.

Conventional model of care for NCDs is episodic and physicians would advise on the patients’ condition and clinical status during consultations. Unnoticed or unattended complications could develop during periods between clinical visits. A patient would have to wait for the next doctor’s visit before consulting on the complication. This could lead to a deterioration of the patient’s condition and result in adverse health outcomes. Early intervention could prevent such situations if the physician was able to obtain health information on that patient in real-time. Tele-monitoring allows the healthcare team to monitor the vital parameters of patients regularly so that they gain better insights into their real-time diabetes and hypertension control in relation to their treatment.

With the prevalence of NCD increasing rapidly in Singapore due to an ageing population, there is an urgent need to curb their rising morbidity and mortality. Tele-monitoring has shown benefits for chronic disease management and has been a potential tool to detect any abnormal health status trends in patients. It enables the care providers to take measures promptly to prevent any arising complications. However, the feasibility of tele-monitoring requires largely on patients’ acceptance and their proactive approach towards the model of care.

About the Study

Global prevalence of NCDs is increasing rapidly, with Singapore being no exception, there is an urgent need to mitigate the rising morbidity and mortality caused by NCDs. In Singapore, SHP has seen over 750,000 T2DM and hypertension related visits in the past three years. These patients also require long-term management. Implementing tele-monitoring technology could assist in managing these patients with chronic health conditions remotely. Using technology to deliver healthcare services over a distance would increase connectivity between patient and physician.

In a research study conducted by SHP and NUS Yong Loo Lin School of Medicine, willingness of using tele-monitoring among patients with T2DM and hypertension were accessed as well as the factors influencing them. The patients selected were those who require long-term care and management of their condition.

The study was conducted at the Pasir Ris and SengKang Polyclinics and the study design included three steps. First, patient information was collected, these include current perceptions toward medical conditions and self-monitoring behaviours. The accessibility and literacy towards technology was also accessed using the Health Information Technology Acceptance Model (HITAM). Second, patients were introduced to the concept of tele-monitoring. Lastly, a direct questionnaire on the willingness to use tele-monitoring was administered to the participants.

From this process, close to 900 multi-ethnic Asian patients with T2DM and/or hypertension between the age of 21 – 70 years old were assessed.

The study was conducted using interviewer-administered questionnaires which consisted of three segments to find out patients’ perceptions towards medical conditions, technological literacy and the understanding of tele-monitoring care model. The results revealed several factors which affected the patients’ willingness to adopt tele-monitoring to manage their health conditions.

Key Findings

Based on the findings of the study, more than 52 percent of participants were willing to take up tele-monitoring. In a previous study in 2008, only 40 percent of the study participants were receptive towards such technology for healthcare services. This current study demonstrates an increasing trend towards receptiveness of telehealth in Singapore.

Another key finding of the study were factors that were associated with the willingness or unwillingness towards tele-monitoring for management of chronic health conditions. Some key factors that affected the willingness were, age, education level, the need for financial assistance, computer literacy, and presence of caregiver.

“Through the study, we found that those without any need for financial assistance were more willing to use tele-monitoring. This factor may be associated with whether one owns a mobile phone and possesses basic technology skills. In contrast, patients who set aside more time for polyclinic visits, and those who had concerns regarding privacy violations were less willing to embark on this care model,” said Dr David Sin, Medical Officer, who is currently with the Singapore Armed Forces. Dr Sin will be joining the SingHealth Family Medicine Residency in July 2021.

Conclusions

With the government agencies launching programmes, such as the Smart Nation Singapore initiative, the prevalence of willingness is expected to increase.

SHP has launched its very first tele-monitoring programme for hypertension patients called the Primary Tech-Enhanced Care (PTEC) at Bedok Polyclinic. The researchers are targeting to recruit more than 150 patients in the next 5 months, and have close to 25 patients recruited at present.

“The government agencies have been launching programmes, such as the Smart Nation Singapore initiative to improve the technology literacy of Singaporeans, so we can expect more patients to accept and adopt tele-monitoring to manage their health. In addition, this model of care has brought convenience to many of our patients, especially during the COVID-19 period when we are advised to stay home,” said Clinical A/Prof Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).

“Ultimately, patients are often more willing to adopt tele-monitoring if there are substantial evidences of its effectiveness, which the forthcoming study will provide,” added A/Prof Tan.

References:

  • Luo N, et al. Acceptance of information and communication technologies for healthcare delivery: a SingHealth polyclinics study. Ann Acad Med Singapore. 2009;38(6):529–8.
  • Losiouk E, et al. Parental evaluation of a telemonitoring service for children with type 1 diabetes. J Telemed Telecare. 2018;24(3):230–7.
  • Tucker KL, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14(9):e1002389.

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