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

May CR, Finch TL, Cornford J, Exley C, Gately C, Kirk S, Jenkings KN, Osbourne J, Robinson AL, Rogers A, Wilson R, Mair FS - BMC Health Serv Res (2011)

Bottom Line: Telecare 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Southampton, UK.

ABSTRACT

Background: Telecare 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.

Methods: Large 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.

Results: Key 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.

Conclusion: Telecare 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.

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Related in: MedlinePlus

Uncertainty is continuously cycled through telecare domains.
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Figure 1: Uncertainty is continuously cycled through telecare domains.

Mentions: Once this qualitative integrative analysis was completed we undertook a modelling procedure [32] in which we presented these factors as 'nodes' in a network of events that could be mapped in relation to each other (see Figure 1). Its aim was to characterise organizational processes at work in terms of contingencies and their consequences and this should not be viewed as a sequential flow chart as the order of events may vary, some occurring in parallel so this is not meant to represent a step by step guide, nor are different weightings provided to different aspects.


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

May CR, Finch TL, Cornford J, Exley C, Gately C, Kirk S, Jenkings KN, Osbourne J, Robinson AL, Rogers A, Wilson R, Mair FS - BMC Health Serv Res (2011)

Uncertainty is continuously cycled through telecare domains.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116473&req=5

Figure 1: Uncertainty is continuously cycled through telecare domains.
Mentions: Once this qualitative integrative analysis was completed we undertook a modelling procedure [32] in which we presented these factors as 'nodes' in a network of events that could be mapped in relation to each other (see Figure 1). Its aim was to characterise organizational processes at work in terms of contingencies and their consequences and this should not be viewed as a sequential flow chart as the order of events may vary, some occurring in parallel so this is not meant to represent a step by step guide, nor are different weightings provided to different aspects.

Bottom Line: Telecare 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Southampton, UK.

ABSTRACT

Background: Telecare 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.

Methods: Large 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.

Results: Key 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.

Conclusion: Telecare 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.

Show MeSH
Related in: MedlinePlus