Introduction
Background
Care co-creation
Demand and capacity management strategies in healthcare
Research framework
Methodology
Telecare and traditional care
Ethical consideration
Data collection and analysis
Respondents | Number of interviewees | Number of interviews | |
---|---|---|---|
Nurses | Monitoring nurse | 8 | 8 |
Coordinating nurse | 2 | 3 | |
Management | Manager in the municipality care | 4 | 6 |
Human resource manager in response center | 2 | 2 | |
General physicians (GP) | 3 | 4 | |
Distance monitoring app developer | 1 | 1 | |
Patients | 1 | 1 | |
Total | 21 | 25 |
Results
Changes in the care delivery process
Patients
“It is good to do and see my own health measures, and thus I don’t have to wonder about how my health is.” - Patient 3“You can measure your blood pressure if you are feeling strange, and that’s great!” - Patient 4
“I believe I can feel my health better. I observe the symptoms (worsening signs) much earlier.” - Patient 1
“His health assessment is always on the yellow side, but he sends us a message saying, ‘I am okay; don’t call me.” – Nurse 6
“I don’t feel like thinking about my disease every day…” – Patient 2
General physicians (GPs)
“[The] most important thing is how we include patients and which ones are to be excluded [from telecare].” – GP 1“You do not want to include someone who will not benefit from such a service option” – GP 2
“We do not deal with one disease or diagnosis but the whole person.” – GP 3“For some patients, I even know their grandparents, so I have a better overview of the patients to see if they fit [the telecare service].” – GP 2
Nurses
“I go through the [patient] log and call those patients who are not using the app one by one. Sometimes they have some technical problems, such as passwords being erased for system updates or a lost internet connection in the tab. Then, I help to solve those.” – coordinating nurse 2“It is easier to fix the technical issues, but it takes a lot of my time to find the patients and call them one by one to know why they are not using [the app].” – coordinating nurse 1
“It’s different here [in the response center] than my work at the hospital. Now I work a lot with [IT] systems.” – Monitoring nurse 3“We have to be very good at handling data now and have to switch fast from one system to the other.” – Monitoring nurse 7
“Talking to [the patient] over the phone can calm them down. Sometimes they just want to hear from you that everything is fine.” – Monitoring nurse 2“A lot of these patients are old and live most of the day by themselves. Just calling them and asking, ‘How are you doing today?’ makes a difference for them.” – Monitoring nurse 4“They become relaxed and end up sharing lots of things, like what to buy for their son’s birthday, or ‘My pet has not eaten today.’” – Monitoring nurse 5
“One must develop an ear [to understand patients’ needs].” – Monitoring nurse 6
Actors | Activities | Interactions | Identified novel roles |
---|---|---|---|
Patient | Uses the equipment and app to measure and record health data Answers questions in the app Reviews the results of health assessment using the app | Meets the coordinating nurse to learn how to use the app and equipment Sends messages to nurses via the app Talks to nurses via telephone | Proactive supplier |
General physician | Identifies and recruits suitable patients for telecare Makes first contact between the coordinating nurse and patient Develops treatment plans for individual patients | Has face-to-face interactions with patients and coordinating nurses during the recruitment process Is contacted by monitoring nurses via e-message | Patient selector |
Municipality nurse | Coordinates the recruitment process and the patient training Tracks patients not conforming to the telecare treatment Resolves technical issues Monitors data coming from the patients in real time Interprets data to make treatment decisions based on the individual treatment plan | Calls the patients to make changes in treatment and pacify him or her Sends e-messages to GPs, either to provide information or to receive further information about particular patients Ensures that treatment plans are standard documents of communication between nurses and GPs | Technical coordinator Data worker empathetic listener |
Effect of telecare service on healthcare demand management
Patient as a proactive supplier: increasing client participation
“Sometimes they forget the password or give the wrong password too many times, so the app stops working.” – coordinating nurse 1
“There is a tendency to stop using the app when a person is stable for some time.” – coordinating nurse 2.
GPs’ role as patient selectors: segmenting and rechanneling clients
Multiple roles of monitoring nurses: flexible and multiskilled workforce
Novel roles in the telecare service triad | Potential demand and capacity management strategies | Implications for the telecare service |
---|---|---|
Patients as proactive suppliers | Increasing clients’ participation | Current status: Add complexity to telecare services since the quality of patients’ contributions cannot be forecasted and controlled Potential: If the patients are adequately skilled and comply with care plans, the demand for GPs and specialized care would be reduced. Such patients would become more active in the care cocreation process. Consequently, they would have a better understanding of and greater control over their health status |
GPs as patient selectors | Rechanneling demand | Current status: To ensure meaningful contributions by patients in the care cocreation process, selecting patients with the right skills and adequate willingness is essential. Otherwise, patients could end up using resources in both telecare and traditional care channels, with the possibility of increased resource utilization Potential: A structured guideline based on empirical evidence of clinical efficacy could ensure that the patients chosen for telecare are able to exploit the services provided by nurses and thus will require fewer GP and hospital visits |
Client segmentation | Current status: Individual GPs have their own way of selecting patients for the telecare service, which does not ensure effective use of telecare Potential: Can be a useful mechanism for: (1) categorizing the patients for telecare and traditional services based on a standardized guideline; (2) choosing the right patients for telecare so that they have a reduced need for traditional care | |
Nurses as technical coordinators, data workers, and empathetic listeners | Multiskilled and flexible workforce | Current status: In addition to tending to patients, nurses also become more active in the cocreation process in telecare. Multiple roles played by nurses render telecare responsive and easily accessible. However, the need for new competencies related to technology and distant care is not recognized; thus, adequate training is lacking, which can lead to reduced quality of care Potential: Nurses’ roles are essential in rendering the treatment and support of telecare effective. However, (1) formalization and systematic evaluation of the competencies needed and (2) corresponding training are essential to make these roles, and thereby the telecare service, effective |