Feasibility, utility, usability and acceptance of a multimodal telemonitoring for COVID-19 patients in general practitioners practices in Germany: a mixed methods study with patients.

BACKGROUND: During the COVID-19 pandemic, infected outpatients were at risk of declining at home without themselves and their general practitioner (GP) noticing, above all due to silent hypoxemia. To support patients in quarantine, telemonitoring solutions were developed for primary care in several countries. However, evidence on patient perceptions of COVID-19 telemonitoring in primary care settings remains limited. This prospective study evaluates COVID-19 outpatients' experiences with and perception of the usability, utility and acceptance of an app-based telemonitoring in Germany, identifying key conditions for its successful implementation.

METHODS: To support home-isolated COVID-19 patients remotely, eight GP practices in Germany implemented a multimodal telemonitoring system. Telemonitoring consisted of an app with connected sensors to remotely measure vital signs and symptoms, with data transmitted to a GP telemedicine platform. Between January to December 2021, 34 COVID-19 outpatients participated in telemonitoring. Telemonitoring duration was 28 days for acute infection or up to 12 weeks for prolonged/post-acute symptoms. Afterwards, patients participated in a mixed-methods evaluation about their experiences consisting of semi-structured telephone interviews and an in-house questionnaire. Interviews were analyzed using qualitative content analysis, questionnaires were analyzed descriptively.

RESULTS: All patients (34/34) completed the study (female = 22/34, 65%; medianage=50.5 years; rangeage=19-74, comorbidities present = 13/34). Patients generally viewed telemonitoring as feasible and beneficial, with high acceptance rates and a perception of the system as valuable and reassuring support during illness. Participants, even those with limited prior experience in recording health data, successfully managed the monitoring process. Key insights included patient expectations regarding GP data access, underscoring the importance of integrating patient perspectives into the design process of future telemonitoring solutions. Connectivity issues with sensors occasionally disrupted data collection. Generally, the results emphasize the importance of comprehensive onboarding and support structures to optimize telemonitoring effectiveness.

CONCLUSIONS: This study demonstrates that app-based telemonitoring in primary care is a feasible, well-accepted intervention for COVID-19 outpatients, with patients perceiving it as valuable, supportive and reassuring. Findings emphasize the critical role of patient-centered design and strong support structures for successful telemonitoring integration into primary care. Lastly, these findings underscore the value of telemonitoring in pandemic preparedness, ensuring timely detection of patient deterioration and strengthening primary care resilience.

TRIAL REGISTRATION: The study was registered with the German Clinical Trials Register (DRKS00024604). The study was approved by the Ethics Committee of Goethe University Frankfurt (No. 20-1023, 18.01.2021), and written informed consent was obtained from all participants.