Impacts of telehomecare on patients, providers, and organizations
Impacts of telehomecare on patients, providers, and organizations
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DOI：
10.1089/tmj.2006.12.363
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发表时间：
2006-06-01
期刊：
影响因子：
--
通讯作者：
Messikh, Djamel
中科院分区：
文献类型：
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作者：
Lamothe, Lise;Fortin, Jean-Paul;Messikh, Djamel
在过去的几十年里，家庭护理服务的发展是正在进行的医疗保健系统改革的重要组成部分。然而，将他们完全纳入医院或初级保健服务的工作进展缓慢。看来，家庭电话护理（THC）可以帮助建立医院和初级保健提供者之间的服务网络。尽管人们认识到这些方案有可能增加获得服务的机会，提高护理质量和保健成果，但尚未实现广泛采用。需要克服各种障碍。在本文中，我们提出了我们的比较探索性的过程分析使用THC遵循治疗老年人患有严重的慢性疾病（慢性阻塞性肺疾病[ COPD]，高血压，心功能不全）。这项技术最初是作为一个试点项目在三个地点（一个地点在魁北克，两个地点在加拿大马尼托巴）引进的。我们的研究是基于定性的方法。它包括对执行过程的纵向分析和对结果的监测。我们的分析使我们能够确定对患者和提供者的一些主要影响，并解释如何实现这些影响。此外，由于工作流程的重大变化，THC引入了新的家庭护理模式。确定了两个模型：一个专门的模型和计划的多价模型。这种深刻的变化对管理人员和供应商提出了两大挑战。首先，传统上基于预先制定的干预计划的工作组织必须适应特殊患者的需求和警报。第二，必须在提供服务的传统模式和新模式之间保持联系。
Over the last decades, development of home care services is an important component of ongoing health care systems reforms. However, their full integration into hospital or primary care services is still progressing slowly. It appears that telehomecare (THC) could help create networks of services between hospital and primary care providers. Even though their potential to increase access to services and improve quality of care and health outcomes is recognized, their widespread adoption has not yet been achieved. Various barriers need to be overcome. In this paper, we present our comparative exploratory process analysis of the use of THC to follow the treatment of elderly people suffering from severe chronic conditions ( chronic obstructive pulmonary disease [ COPD], hypertension, cardiac insufficiency). The technology was first introduced as a pilot project in three sites ( one site in Quebec and two sites in Manitoba, Canada). Our study is based on qualitative methods. It includes a longitudinal analysis of implementation processes and monitoring of results. Our analysis allows us to identify some of the major impacts on patients and providers, and explain how they may be achieved. Also, because of the major changes in work processes, THC introduces new models of home care delivery. Two models are identified: a specialized model and a planned polyvalent model. Such profound changes raise two major challenges for managers and providers. First, the organisation of work, traditionally based upon preestablished intervention plans, must adapt to respond to ad hoc patients' needs and alerts. Second, constant linkages between the traditional and new models of services delivery become mandatory.