Table 3 Relinquishing control: the healthcare professionals’ experience

A teaching tool

Oximetry and keeping a diary aid recognition of symptoms of exacerbations

“It’s about the education that goes into identifying trends, and trends when they’re well and trends when they’re less well, and if they’re gonna then be able to use the tool to, yes, be able to monitor that, but then also be able to act upon that as well”. (Physio 3)

“When I go in and say to someone ‘Okay, so when you become unwell tell me what you notice.’ What they’re describing to me is an exacerbation that actually is quite set in. They can’t pick up those signs and symptoms earlier on. Um, and that’s something that I didn’t expect the symptom diary to do. I suppose at first I was underestimating how important the symptom diary might be, but for some people it’s actually been the teaching tool”. (District Nurse 1)

“It’s telling them ‘It’s [oximetry] not a diagnostic tool.’ I always say to them ‘It’s an add-on to help yourself manage.’” (District Nurse 3)

But not for everyone

“Er, it’s not a hundred per cent of people, that will want to use technology, and we have to respect that, but we also have to be able to offer, um, in appropriate parts of the patient journey, where it will assist the patients and the staff as well, to work in new ways, to combat, um, long term conditions”. (Manager 1)

Relinquishing control (Balancing the tensions)

Fear of increased workload: monitoring impact

“Um, and we had some just early stats on that, that showed that, you know, that we were increasing our numbers of patients, but the numbers of calls were not necessarily going in the same direction, they were staying quite static, so it meant that we could manage more patients, um, on using the technology but it didn’t increase the workload for the team, as much”. (Manager 1)

Some patients need professional reassurance that they were acting correctly….

“We have the other, the other side of that where a patient will phone NHS24 [24-h telephone helpline] and say ‘These are the symptoms I’ve got, my saturations are eighty-nine’ And they [NHS-24] will phone an ambulance, and the patient doesn’t want an ambulance…they just want to tell someone ‘Is it okay for me to start my antibiotics with the symptoms I’ve got?’ So they say ‘Right, let’s get you into hospital.’ They don’t want to go to hospital, they just want to inform someone”

…. Others delayed seeking advice despite failing to respond

“And on occasions you’ll get somebody who phones to say they’ve just finished their course of antibiotics and steroids but they’re no better…I’d say ‘Well, actually I would like to know beforehand that you’re on them so that we can plan ahead, and if you’re not getting better then we need to put something in place’ Get the GP involved, um, do sputum samples, anything like that to try and sort of carry that management forward”. (Physio 4)