Facilitators and Barriers to Uptake of Remote Cardiac Monitoring in a Rural Setting: A Qualitative Analysis

Background When part of a comprehensive cardiac implantable electronic device care program, remote monitoring (RM) is an effective strategy for maximizing clinical and patient satisfaction outcomes. In rural settings, however, there are multilevel influences that could simultaneously make RM care less attainable. We sought to identify facilitators and barriers to effective RM as part of a cardiac implantable electronic device care program in rural areas. Methods Using a qualitative study design, semistructured interviews were conducted of patients with a cardiac implantable electronic device and physicians who treat these patients in rural New England inclusive of primary care doctors, cardiologists, and cardiac electrophysiologists. Data were analyzed using a mixed deductive and inductive approach to identify themes related to barriers and facilitators to RM. Results The final group of patient interviewees (n=23) included a combination of those who do and do not participate in RM (n=14 and n=9, respectively). There was a total of 15 physician interviewees. Analysis resulted in 5 patient themes and 4 physician themes. Overall, there was general satisfaction with RM. Facilitators included ease of integration, adequate initial education, and clear communication. Barriers included resource constraints, incomplete communication, and inadequate ongoing education. Conclusions This qualitative study of patients and physicians in rural New England identified facilitators and barriers to effective RM. Optimizing RM education, infrastructure, and staffing at local and national levels, including through policy changes, may have important and relevant applications beyond cardiac implantable electronic device care, including other emerging areas of digital health.