Telemedicine in diabetes foot care delivery: health care professionals' experience

Beate-Christin Hope Kolltveit, Eva Gjengedal, Marit Graue, Marjolein M Iversen, Sally Thorne, Marit Kirkevold, Beate-Christin Hope Kolltveit, Eva Gjengedal, Marit Graue, Marjolein M Iversen, Sally Thorne, Marit Kirkevold

Abstract

Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals' experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers.

Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2).

Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants' attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high.

Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.

Keywords: Diabetic foot ulcer; Focus groups; Health care professionals; Interpretive Description; Telemedicine.

References

    1. Lindberg B, Nilsson C, Zotterman D, Söderberg S, Skär L. Using information and communication technology in home care for communication between patients, family members, and healthcare professionals: a systematic review. Int J Telemed Appl. 2013;2013:2.
    1. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015;9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.
    1. Rasmussen BSB, Jensen LK, Froekjaer J, Kidholm K, Kensing F, Yderstraede KB. A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients. Int J Med Inform. 2015;84(10):799–807. ISSN 1386-5056. doi.
    1. Bus S, Hazenberg C, Klein M, Van Baal J. Assessment of foot disease in the home environment of diabetic patients using a new photographic foot imaging device. J Med Eng Technol. 2010;33(1):43–50. doi: 10.3109/03091900903336894.
    1. Wilbright WA, Birke JA, Patout CA, Varnado M, Horswell R. The use of telemedicine in the management of diabetes-related foot ulceration: a pilot study. Adv Skin Wound Care. 2004;17(5):232–8. doi: 10.1097/00129334-200406000-00012.
    1. Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, et al. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabet Med. 2008;25(6):700–7. doi: 10.1111/j.1464-5491.2008.02445.x.
    1. Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed‐method systematic review. J Adv Nurs. 2014;70(1):21–33. doi: 10.1111/jan.12196.
    1. Jaana M, Paré G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract. 2007;13(2):242–53. doi: 10.1111/j.1365-2753.2006.00686.x.
    1. Joseph V, West RM, Shickle D, Keen J, Clamp S. Key challenges in the development and implementation of telehealth projects. J Telemed Telecare. 2011;17(2):71–7. doi: 10.1258/jtt.2010.100315.
    1. Wade VA, Eliott JA, Hiller JE. Clinician acceptance is the key factor for sustainable Telehealth services. Qual Health Res. 2014;24(5):682–94. doi: 10.1177/1049732314528809.
    1. Koivunen M, Niemi A, Hupli M. The use of electronic devices for communication with colleagues and other healthcare professionals–nursing professionals’ perspectives. J Adv Nurs. 2015;7(():620–31. doi: 10.1111/jan.12529.
    1. Trivedi D, Goodman C, Gage H, Baron N, Scheibl F, Iliffe S, et al. The effectiveness of inter‐professional working for older people living in the community: a systematic review. Health Soc Care Community. 2013;21(2):113–28. doi: 10.1111/j.1365-2524.2012.01067.x.
    1. Ribu L, Wahl A. How patients with diabetes who have foot and leg ulcers perceive the nursing care they receive. J Wound Care. 2004;13(2):65–8. doi: 10.12968/jowc.2004.13.2.26578.
    1. Larsen SB, Clemensen J, Ejskjaer N. A feasibility study of UMTS mobile phones for supporting nurses doing home visits to patients with diabetic foot ulcers. J Telemed Telecare. 2006;12(7):358–62. doi: 10.1258/135763306778682323.
    1. Paré G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc. 2007;14(3):269–77. doi: 10.1197/jamia.M2270.
    1. Thorne S. Interpretive description. Walnut Creek: Left Coast Press; 2008.
    1. Thorne S, Kirkham SR, MacDonald-Emes J. Focus on qualitative methods. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge. Res Nurs Health. 1997;20(2):169–77. doi: 10.1002/(SICI)1098-240X(199704)20:2<169::AID-NUR9>;2-I.
    1. Thorne SE. Applied interpretive approaches. In: Leavy P, editor. The Oxford handbook of qualitative research. Oxford: Oxford University Press; 2014. pp. 99–115.
    1. Krueger RA, Casey MA. Focus groups: A practical guide for applied research. Los Angeles, CA: Sage;2009.
    1. Buckley KM, Adelson LK, Agazio JG. Reducing the risks of wound consultation: adding digital images to verbal reports. J Wound Ostom Contin Nurs. 2009;36(2):163–70. doi: 10.1097/01.WON.0000347657.02594.36.
    1. López-Pérez MV, Pérez-López MC, Rodríguez-Ariza L. Blended learning in higher education: Students’ perceptions and their relation to outcomes. Comp Educ. 2011;56(3):818–26. doi: 10.1016/j.compedu.2010.10.023.
    1. MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract. 2014;64(624):e401–e7. doi: 10.3399/bjgp14X680485.
    1. Ernesäter A, Holmström I, Engström M. Telenurses’ experiences of working with computerized decision support: supporting, inhibiting and quality improving. J Adv Nurs. 2009;65(5):1074–83. doi: 10.1111/j.1365-2648.2009.04966.x.
    1. Clemensen J, Larsen SB, Kirkevold M, Ejskjaer N. Treatment of diabetic foot ulcers in the home: video consultations as an alternative to outpatient hospital care. Int J Telemed Appl. 2008;2008:1.
    1. Nilsson C, Skär L, Söderberg S. Swedish district nurses’ attitudes to implement information and communication technology in home nursing. Open Nurs J. 2008;2:68–72. doi: 10.2174/1874434600802010068.
    1. Engström M, Ljunggren B, Lindqvist R, Carlsson M. Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care. J Telemed Telecare. 2005;11(6):304–9. doi: 10.1258/1357633054893292.
    1. Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses’ perceptions and experiences. Br J Nurs. 2014;23(21):1133–7. doi: 10.12968/bjon.2014.23.21.1133.
    1. Sanders C, Rogers A, Bowen R, Bower P, Hirani S, Cartwright M, et al. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC Health Serv Res. 2012;12(1):220. doi: 10.1186/1472-6963-12-220.
    1. Norwegian Ministry of Health and Care Services . Samhandlingsreformen - rett behandling - på rett sted - til rett tid [Coordination reform - right treatment - right place - right time]: St.meld. 47. Oslo: Ministry; 2008. p. 47.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel