Integrating telecare for chronic disease management in the community: What needs to be done?

Abstract

BackgroundTelecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community.MethodsLarge scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory. Drawn from telecare services in community and domestic settings in England and Scotland, 221 participants were included, consisting of health professionals and managers; patients and carers; social care professionals and managers; and service suppliers and manufacturers.ResultsKey barriers to telecare integration were uncertainties about coherent and sustainable service and business models; lack of coordination across social and primary care boundaries, lack of financial or other incentives to include telecare within primary care services; a lack of a sense of continuity with previous service provision and self-care work undertaken by patients; and general uncertainty about the adequacy of telecare systems. These problems led to poor integration of policy and practice.ConclusionTelecare services may offer a cost effective and safe form of care for some people living with chronic illness. Slow and uneven implementation and integration do not stem from problems of adoption. They result from incomplete understanding of the role of telecare systems and subsequent adaption and embeddedness to context, and uncertainties about the best way to develop, coordinate, and sustain services that assist with chronic disease management. Interventions are therefore needed that (i) reduce uncertainty about the ownership of implementation processes and that lock together health and social care agencies; and (ii) ensure user centred rather than biomedical/service-centred models of care.

Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review

“…Enthusiasm for technological innovation around e-health among policy-makers and health officials has, however, not always been matched by uptake and utilization in practice. 1,2 Professional resistance to new technologies is cited as a major barrier to progress, although evidence for such assertions is weak. 3 Implementing and embedding new technologies of any kind involves complex processes of change at the micro level for professionals and patients and at the meso level for health-care organizations themselves.…”

“…The review set out to answer two key questions: (1) What does the published literature tell us about barriers and facilitators to e-health implementation? (2) What, if any, are the main research gaps?…”

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Individual and collective reflection of actual practice against explicit and more tacit norms, while central to the embedding of a practice, 356,[441][442][443][444] may differ markedly from formal governance procedures and standards, in some cases giving rise to a façade of legitimacy. 85 Empirical studies of patient safety have also highlighted the human barriers to incident reporting, despite its central role in organisational learning and the establishment of a stronger safety culture.…”

Exploration of information needs and development of resources to inform and support those at risk of falling

“…This could include consumer information regarding AT and where to purchase it, which may be particularly relevant where a local authority is not able to provide for a particular individual [11,17]. Such information regarding private AT is reported to be in short supply -which is a potential barrier to any consumer market, if the potential customers are unsure of where to purchase such products [2,3,15,16] [6, p.81] However, it has been recognised that currently health and social care professionals themselves are not always aware of services pertaining to their patient's needs [10,18,19] therefore the information needs of clinicians must also be considered. As well as availability of information, the type, source, accessibility, and quality of information needs to be considered -information which is available yet inaccessible does nothing to reduce barriers to AT uptake.…”