Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study (Preprint)

Abstract

BACKGROUND There is growing that telemedicine can improve access to and quality of healthcare for nursing home residents. However, it is still unclear how to best manage and guide the innovation process to ensure long-term adoption, especially in the context of a decline of telemedicine utilisation after the COVID-19 crisis. OBJECTIVE This study addresses organisational modification and practice change in the implementation process of establishing regular televisits between residents in a nursing home, their caring nurses, and their treating GP. METHODS A telemedical system with integrated medical devices was introduced in two nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use up until February 2023. Regular evaluation was based on a mixed-methods approach combining rigorous qualitative approaches with quantitative measurements. RESULTS During the COVID-19 lockdown, the implementation of televisits was successful in both nursing homes and telemedicine appreciated by the healthcare professionals. When the pandemic subsided and contact restrictions were lifted, repeated adjustments focused on reducing disruptive work processes and improving the training of the nursing staff ensured a long-term adoption of televisits outside the pandemic setting in one nursing home. Access to televisits was perceived positively by the nursing staff, improved their clinical skills and reduced work-related psychological distress. CONCLUSIONS Long-term adoption of telemedical solutions used during the COVID-19 pandemic is not automatic. Focusing on healthcare workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. CLINICALTRIAL The study was approved by the Ethics Committee of the RWTH Aachen University Hospital (EK 23-179).