A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients
A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients
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DOI：
10.1016/j.ijmedinf.2015.05.012
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发表时间：
2015-10-01
影响因子：
4.9
通讯作者：
Yderstraede, K. B.
中科院分区：
文献类型：
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作者：
Rasmussen, B. S. B.;Jensen, L. K.;Yderstraede, K. B.
简介：远程医疗的实施通常会给受影响的医疗保健部门带来重大的组织变革。本研究的目的是通过医疗保健专业人员对实施远程医疗干预的看法来检查组织变化。我们提出了以下研究问题：在伤口护理中实施远程医疗的关键组织因素是什么？方法：结合丹麦南部地区糖尿病足溃疡患者远程医疗干预的随机对照试验，我们进行了组织分析。该试验被设计为使用远程医疗评估模型（MAST）对结果进行多学科评估。我们进行了八次半结构化访谈，包括对领导者和 IT 专家的个人访谈以及对临床工作人员的焦点小组访谈。对访谈进行定性数据分析，以分析医疗保健专业人员和领导者对实施干预措施引起的组织变化的看法。结果：远程医疗设置增强了合作者的信心，并提高了来自市政府的上门护士的伤口护理技能。这种效果与巡诊护士和专科医生之间的直接沟通有关。强调对访问护士的培训是成功确保实施的关键因素。人们对缺乏多学科伤口护理团队、患者责任以及患者与医生缺乏互动等问题表示担忧。此外，还强调了未来实施中临床指南的必要性。结论：分析中证明了几个影响因素，包括访问护士伤口护理培训、管理重点、经济、缺勤时间和临床护理。然而，这里使用的技术可以在对患者的健康状况进行单独评估后为患者提供额外的选择。 (C) 2015 Elsevier Ireland Ltd. 保留所有权利。
Introduction: The implementation of telemedicine often introduces major organizational changes in the affected healthcare sector. The objective of this study was to examine the organizational changes through the perception of the healthcare professionals regarding the implementation of a telemedical intervention. We posed the following research question: What are the key organizational factors in the implementation of telemedicine in wound care?Methods: In connection with a randomized controlled trial of telemedical intervention for patients with diabetic foot ulcers in the region of Southern Denmark, we conducted an organizational analysis. The trial was designed as a multidisciplinary assessment of outcomes using the Model of ASsessment of Telemedicine (MAST). We conducted eight semi-structured interviews including individual interviews with leaders, and an IT specialist as well as focus group interviews with the clinical staff. A qualitative data analysis of the interviews was performed in order to analyze the healthcare professionals and leaders perception of the organizational changes caused by the implementation of the intervention.Results: The telemedical setup enhanced confidence among collaborators and improved the wound care skills of the visiting nurses from the municipality. The effect was related to the direct communication between visiting nurses and specialist doctors. Focus on the training of the visiting nurses was highlighted as a key factor in the success to securing implementation. Concerns regarding lack of multidisciplinary wound care teams, patient responsibility and lack of patient interaction with the physician were raised. Furthermore, the need for clinical guidelines in future implementation was underlined.Conclusions: Several influential factors were demonstrated in the analysis including visiting nurses wound care training, focus on management, economy, periods with absence from work and clinical care. However, the technology used here could provide an additional option to offer patients after an individual assessment of their health condition. (C) 2015 Elsevier Ireland Ltd. All rights reserved.