PMID- 34842546 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220125 IS - 2561-1011 (Electronic) IS - 2561-1011 (Linking) VI - 5 IP - 2 DP - 2021 Nov 25 TI - Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study. PG - e28259 LID - 10.2196/28259 [doi] LID - e28259 AB - BACKGROUND: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. OBJECTIVE: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. METHODS: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants' unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. RESULTS: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients' perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. CONCLUSIONS: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians' workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. TRIAL REGISTRATION: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19705. CI - (c)Veronica Artanian, Patrick Ware, Valeria E Rac, Heather J Ross, Emily Seto. Originally published in JMIR Cardio (https://cardio.jmir.org), 25.11.2021. FAU - Artanian, Veronica AU - Artanian V AUID- ORCID: 0000-0003-1358-6357 AD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. FAU - Ware, Patrick AU - Ware P AUID- ORCID: 0000-0002-5325-9871 AD - Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada. FAU - Rac, Valeria E AU - Rac VE AUID- ORCID: 0000-0002-0426-4594 AD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. AD - Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. AD - Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. FAU - Ross, Heather J AU - Ross HJ AUID- ORCID: 0000-0003-4384-3027 AD - Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. AD - Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Medicine, University of Toronto, Toronto, ON, Canada. FAU - Seto, Emily AU - Seto E AUID- ORCID: 0000-0002-8723-5915 AD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. AD - Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada. LA - eng SI - ClinicalTrials.gov/NCT04205513 PT - Journal Article DEP - 20211125 PL - Canada TA - JMIR Cardio JT - JMIR cardio JID - 101718325 PMC - PMC8663515 OTO - NOTNLM OT - heart failure OT - mHealth OT - mobile phone OT - monitoring OT - qualitative OT - remote OT - telemonitoring OT - titration COIS- Conflicts of Interest: Members of the research team (ES and HJR) have intellectual property rights of the Medly system. EDAT- 2021/11/30 06:00 MHDA- 2021/11/30 06:01 PMCR- 2021/11/25 CRDT- 2021/11/29 12:23 PHST- 2021/02/26 00:00 [received] PHST- 2021/09/18 00:00 [accepted] PHST- 2021/08/29 00:00 [revised] PHST- 2021/11/29 12:23 [entrez] PHST- 2021/11/30 06:00 [pubmed] PHST- 2021/11/30 06:01 [medline] PHST- 2021/11/25 00:00 [pmc-release] AID - v5i2e28259 [pii] AID - 10.2196/28259 [doi] PST - epublish SO - JMIR Cardio. 2021 Nov 25;5(2):e28259. doi: 10.2196/28259.