Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study
Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study
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DOI：
10.4104/pcrj.2012.00068
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发表时间：
2012-09-01
影响因子：
--
通讯作者：
McKinstry, Brian
中科院分区：
文献类型：
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作者：
Fairbrother, Peter;Pinnock, Hilary;McKinstry, Brian
背景：在长期疾病患者的管理中，连续性护理被广泛认为是质量的重要标志。新的服务，将远程监护纳入护理pathways有可能改变方面的连续性，在积极和消极的ways.Aims：慢性阻塞性肺疾病（COPD）患者的远程监护服务，在苏格兰洛锡安，在2009年。在TELESCOT COPD随机对照试验中进行了一项定性研究，以探讨患者和专业人员对远程监护的看法。感知的影响，远程监护的连续性护理进行了调查，作为research.Methods的一部分：半结构化访谈进行了38例（47%男性，平均年龄67.5岁）。招募了与年龄、性别、社会经济背景、疾病严重程度和远程监护依从性相关的最大变异样本。32个利益相关者（医疗保健专业人员和管理人员）进行了采访。转录的编码数据进行了分析，使用的框架方法的主题。解释支持多学科discussion.Results：患者和医疗保健专业人员认为，基于关系的连续性护理是重要的远程监护服务的交付。管理人员强调提高临床管理的连续性，作为降低医疗保健成本的一种手段。然而，专业人士描述了远程监护服务与现有常规护理服务的“结合”所带来的许多运营挑战，他们认为这导致了额外管理不连续性的激增。结论：管理人员和医疗保健专业人员在满足远程监护服务发展中关系连续性和临床管理连续性的需求方面面临着重大挑战。(C)2012英国初级保健呼吸学会。All rights reserved. P Fairbrother等人Prim Care Respir J 2012; 21（3）：322-328 http://dx.doi.org/10.4104/pcrj.2012.00068
Background: Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways.Aims: A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research.Methods: Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion.Results: Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities.Conclusions: Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services. (C) 2012 Primary Care Respiratory Society UK. All rights reserved. P Fairbrother et al. Prim Care Respir J 2012; 21(3): 322-328 http://dx.doi.org/10.4104/pcrj.2012.00068