BackgroundAlthough digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships.MethodsThe multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. The constant comparative method was used for data analyses.ResultsAltogether, interviewed healthcare professionals reported three main technology-related impacts upon their patient-caregiver relationships. First, national and local pressure to increase efficiency had troubled their relationships with patients who suspected that municipalities have sought to lower costs by reducing and digitalising services. Participants reported having to consider such worries when introducing technologies into their services. Second, participants reported a shift towards empowering patients. Digital technology can empower patients who value their independence, whereas safety is more important for other patients. Healthcare professionals needed to ensure that replacing care tasks with technology implies safe and improved care. Third, the safety and quality of digital healthcare services continues to depend upon surveillance and control mechanisms that compensate for less face-to-face monitoring. Participants did not consider the possibility that surveillance exposes information about patients’ everyday lives to be problematic, but to constitute opportunities for adjusting services to meet patients’ needs.ConclusionsTechnologies such as digital medicine dispensers can improve the efficiency of healthcare services and enhance patients’ independence when introduced in a way that empowers patients as well as safeguards trust and service quality. Conversely, the patient-caregiver relationship can suffer if the technology does not meet patients’ needs and fails to offer safe and trustworthy services. Upon introducing technology, home healthcare professionals therefore need to carefully consider the benefits and possible disadvantages of the technology. Ethical implications for both individuals and societies need to be further discussed.
Background: Implementing digital technology in home care services challenges care arrangements built on faceto-face encounters. Digital welfare technology has been suggested as a solution to increasing demands on health care services from an ageing population. Medication delivery is a major task for home care services, and digital medication devices could lessen the need for resources. But technology has scripts based on how designers picture its use, and these might not fit with users' needs and practices. New technology must go through processes of domestication among its users. In the present study, we investigate how health professionals experienced the implementation of a digital medication dispenser into home care services in Norway. Methods: This was a qualitative interview study with 26 health professionals from home care services in five municipalities. Results: All five municipalities had implemented a digital medication dispenser in home care services. Prior to the introduction of the dispenser, medication practices had been based on home visits. The safety of medication practices was the main concern of health professionals who had to negotiate the technological script in order to make it work in a new care arrangement. Rationalities of effectiveness collided with rationalities of care, symbolized by warm hands. Professionals who had been used to working independently became dependent on technical support. Being unfamiliar with the new medication arrangement led to resistance towards the digital dispenser, but more direct experiences changed the focus from technology to new care arrangements. Negotiating practical and organizational arrangements led health professionals to trust the digital medication dispenser to contribute to safe and good care for service users.
<p><em>Cooperation between third sector and municipal health care services – a qualitative study</em></p><p><em>Municipal health care services are facing challenges due to an increasing number of individuals in need of care, combined with demographic change. More unpaid voluntary work within health care services has been put forward as a solution. Cooperation between volunteers and municipal health authorities can be challenging. This qualitative interview study with seven volunteers and six health care service managers explore experiences with cooperation between third sector and health care services in seven Norwegian regional municipalities. Facilitators for cooperation were predictable economy, municipal coordination, recruitment of volunteers and personal engagement among cooperating parties. Lack of these factors hampered cooperation. Professional expectations towards volunteers were another challenge. In small communities local networks may contribute to recruitment of volunteers and simplify communication between parties. Cooperation towards a common goal may reinforce local identity. This article shows how such cooperation develops in-between formal and informal structures. </em></p>
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