Examining disparities relating to service reach and patient engagement with COVID-19 remote home monitoring services in England: a mixed methods rapid evaluation

Background The adoption of remote methods of care has been accelerated by the COVID-19 pandemic, but concerns exist relating to the potential impact on health disparities. This evaluation explores the implementation of COVID-19 remote home monitoring services across England, focussing on patients’ experiences and engagement with the service. Methods The study was a rapid, multi-site, mixed methods evaluation. Data were collected between January and June 2021. We conducted qualitative interviews with staff service leads, and patients and carers receiving the service. We conducted quantitative surveys with staff delivering the service, and patients and carers receiving the service across 28 sites in England, UK. Qualitative data were analysed using thematic analysis and quantitative data were analysed using univariate and multivariate methods. Findings Many sites designed their service to be inclusive to the needs of their local population. Strategies included widening eligibility criteria, prioritising vulnerable groups, and creating referral pathways. Many sites also adapted their services according to patient needs, including providing information in different languages or more accessible formats, offering translation services, offering non-digital options, or providing face-to-face assessments. Despite these adaptions, disparities were reported across patient groups (e.g. age, health status, ethnicity, level of education) in their experience of and engagement with the service. Interpretation Services must determine how best to design and implement remote monitoring services to be of value to all populations. National guidance should play a role in supporting services to best serve the needs of their populations, and patients and staff must play an active role in service design. Funding This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSEI. NJF is an NIHR Senior Investigator. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. Evidence before this study Evidence shows COVID-19 has a disproportionate impact on certain population groups, such as ethnic minority groups, older adults and those with comorbidities. The rapid adoption and spread of remote home monitoring services in England must be accompanied by evaluations at a local level to monitor the impact on health disparities in local populations. Added value of this study This rapid mixed methods evaluation of COVID-19 home monitoring services adopted across 28 sites in England aimed to increase understanding of how services have been designed and delivered to address local population needs to increase accessibility to the service and facilitate engagement with the service. We add to the literature by identifying a range of local service adaptations which aim to increase reach and facilitate patient engagement, and consider their potential impact on health disparities. We found strategies included prioritising vulnerable groups, creating referral pathways, offering translation services, offering non-digital options, or providing face-to-face assessments. Despite efforts to adapt services to meet local needs, disparities across patient groups in their experience of, and engagement with, the service (related to age, health status, ethnicity, and level of education) were reported. Implications of the available evidence At both a national and local level, and particularly given the increasing use of remote home monitoring schemes, lessening health disparities must be a primary focus in the design and delivery of remote monitoring models for COVID-19 and other conditions. Future research should focus on how best to design and evaluate remote monitoring services, for a range of conditions, especially for patients residing in areas where significant health disparities persist, as well as addressing the effectiveness of any strategies on specific population groups. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSEI. NJF is an NIHR Senior Investigator. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The staff aspects of the evaluation were categorised as a service evaluation by the HRA decision tool and UCL/UCLH Joint Research Office and received ethical approval from the University of Birmingham Humanities and Social Sciences ethics committee (ERN_13-1085AP39). The patient aspects were reviewed and given favourable opinion by the London-Bloomsbury Research ethics committee (REC reference: 21/HRA/0155). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Due to the consent process for data collection within this evaluation, there are no data that can be shared.