Health System Stakeholders' Perspective on the Role of Mobile Health and Its Adoption in the Swiss Health System: Qualitative Study
Health System Stakeholders' Perspective on the Role of Mobile Health and Its Adoption in the Swiss Health System: Qualitative Study
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DOI：
10.2196/17315
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发表时间：
2020-05-11
影响因子：
5
通讯作者：
Luetschg, Verena
中科院分区：
文献类型：
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作者：
Lingg, Myriam;Luetschg, Verena
背景：数字健康解决方案具有改变医疗保健提供方式的巨大潜力，包括更好的临床结果以及改进的流程和获得医疗服务的机会。然而，在瑞士，采用移动医疗(MHealth)解决方案进行患者监控的速度相当缓慢。原因很复杂，需要更好地了解mHealth的全部潜力。目的：本研究旨在加深对mHealth对医疗系统和医疗保健提供的潜在相关性和影响，以及影响其采用的因素的理解。研究结果将被用来为可行的行动建议提供展望。方法：我们对瑞士医疗保健系统中对数字健康和医疗设备有深刻了解的不同利益相关者群体(N=50)进行了最大变异样本的定性调查。半结构访谈指南包括开放式和封闭式问题，用来回答关于移动健康的相关性及其对医疗系统的影响、选定的决定因素与移动健康采用的相关性以及重要影响因素的问题。结果：总体上，受访者认为移动健康将对瑞士的医疗系统产生有益的影响，但其应用进展缓慢。我们得出了23个关于患者和患者途径、疾病治疗以及疾病和健康状况的关键机会。受访者在疾病治疗方面的回答具有高度的一致性。利益相关者对采用mHealth的态度与23个预先选择的决定因素的相关性相对一致。然而，我们得到了关于瑞士趋势、促进者和限制因素的影响的不同态度，并将其转化为影响mHealth采用的26个关键主题。相关趋势包括患者需求和期望的变化、对有效医疗保健提供的需求日益增长、对改善门诊护理的兴趣日益增长以及新兴技术和不断进步的数字化。重要的推动因素包括对新的融资计划和激励概念的需求不断增长，对有关mHealth用例的全面信息和更强大证据的需求不断增加，以及对易于使用的替代护理方法的需求日益增长。具有挑战性的制约因素是卫生系统参与者僵化的思维和孤立的行为，改变现有法规和结构的复杂性，对mHealth的使用和临床医生角色的了解很少，以及人口进一步两极分化的风险。结论：这项研究提供了对瑞士卫生系统中mHealth的全面观察。显然，要促进可持续的数据战略并协调利益攸关方的不同利益，强有力的治理是不可避免的。MHealth的使用将增加价值，但不一定会减少新出现的社会需求和不断变化的疾病流行对系统造成的负担。
Background: Digital health solutions have great potential to change the way health care is delivered, including better clinical outcomes and improved processes and access to health services. However, the adoption of mobile health (mHealth) solutions for patient monitoring has been rather slow in Switzerland. The reasons are complex, and a better understanding is needed to leverage the full potential of mHealth.Objective: This study aimed to deepen the understanding of the potential relevance and influence of mHealth for the health system and health care provision, and factors influencing its adoption. The findings will be used to provide an outlook on feasible recommendations for action.Methods: We conducted a qualitative survey using a maximum variation sample of a heterogeneous group of stakeholders (N=50) in the Swiss health care system with a profound knowledge of digital health and medical devices. A semistructured interview guide including open- and closed-ended questions was used to address questions around mHealth relevance and its influence on the health system, the relevance of selected determinants for mHealth adoption, and important influencing factors. A content analysis method was applied.Results: Overall, respondents thought that mHealth would have a beneficial impact on the Swiss health system but that its adoption would evolve slowly. We derived 23 key opportunities regarding patient and patient pathway, treatment of disease, and diseases and health conditions. High consistency in answers among respondents was observed for treatment of disease. Stakeholders' attitudes toward mHealth adoption along the relevance of 23 preselected determinants were relatively consistent. However, we obtained diverging attitudes regarding the influence of trends, enablers, and restraints in Switzerland and translated them into 26 key themes influencing mHealth adoption. Relevant trends comprise changing needs and expectations of patients, a rising need for efficient health care delivery, growing interest in improved outpatient care, and emerging technologies and progressing digitization. Important enablers include growing demand for new financing schemes and incentive concepts, rising demand for comprehensive information on and stronger body of evidence for mHealth use cases, and increasing need for easy to use alternate care approaches. Challenging restraints are rigidness of thinking and siloed actions of health system actors, complexity of changing the existing regulations and structures, little understanding of mHealth use and the role of clinicians, and risk of further polarization of the population.Conclusions: This study provides a comprehensive look at mHealth in the Swiss health system. It becomes apparent that strong governance is inevitable to foster a sustainable data strategy and to reconcile the different interests of stakeholders. The use of mHealth will add value but will not necessarily reduce the burden on the system caused by emerging societal needs and changing disease prevalence.