Understanding the patients' experience in Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme-a qualitative study.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) related healthcare expenditure is expected to rise drastically as the incidence of diabetes associated comorbidities increases. It is vital to maintain an optimum glycaemia for patients with diabetes to reduce the risk of diabetes complications. Given the strong predictive value for diabetes complications, HbA1c remains the gold standard to monitor glycaemic control in contemporary clinical practice. The Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme is a telehealth programme that is intended to empower low-risk patients to test their HbA1c independently at home, supported with tele-monitoring and review through teleconsultation, saving them up to three clinic visits per year. Given the programme's reliance on active patient involvement, understanding patient experiences within the programme to identify the enablers and barriers of using various PTEC HAT components is important for guiding iterative improvement and informing scale-up strategies. METHODS: A qualitative study approach was used to explore the in-depth perceptions of the patients who were enrolled into the pilot PTEC HAT programme. The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was used to guide the development of topic guide and the analysis. The emergent results were categorised into the enablers and barriers. RESULTS: Coaching by healthcare team and access to supporting materials enabled the patients to complete the programme. The proactive reminder for home HbA1c testing by the in-app chatbot, the flexibility to perform the test round the clock, instant result review and the convenience of teleconsultation following home HbA1c test saved time and reduced clinic visits. Patient characteristic which enabled successful participation included a reasonable level of digital literacy, prior experience with health monitoring, absence of needle-related distress and strong intrinsic motivation. HbA1c reagent storage, syncing results via Bluetooth device, the prolonged onboarding process and the time gap between onboarding and first home-based testing were found to be challenging. CONCLUSION: PTEC HAT programme was seen as a good alternative to routine clinic care for T2DM. Refinement in the on-boarding process and better support between onboarding and home-based independent testing could improve patient experience and satisfaction.