Rational development of telehealth to support primary care respiratory medicine: patient distribution and organisational factors

Aims: Telehealth may offer opportunities to support primary and secondary care of patients with respiratory disease. This study examined
the potential for applying telehealth in a region of the UK by exploring the distribution of patients and examining attitudes to
implementation of telehealth.
Methods: The distribution of patients with asthma, COPD, lung cancer and obstructive sleep apnoea (OSAS) in the NHS Highland Region
(309,900 residents, 12,507 square miles) was determined from Quality and Outcomes Framework data and disease registers. Qualitative
interviews with health professionals (n=20) focussing on the potential for telehealth in respiratory medicine were analysed using the
Normalisation Process Model.
Results: The most remote general practices accounted for 40% of patients with asthma (7198/17822), 45% of those with COPD
(2145/4721), 33% of lung cancer (199/605) and 35% of OSAS (169/489) patients. Urban figures were 28% of asthma patients, 26% of
COPD patients, 25% of lung cancer and 31% of OSAS patients. Interviewees identified a range of telehealth applications they considered
potentially beneficial including management, information and communication systems. However, they also identified challenges – mainly
related to training, costs and infrastructure.
Conclusions: Tailoring telehealth to support management of respiratory diseases in primary care requires knowledge of patient
distribution, which will impact on the nature and feasibility of services. Individual and organisational capacities and attitudes are also likely
to influence successful implementation.