Lamothe Lise, Fortin Jean-Paul, Labbé Françoise, Gagnon Marie-Pierre, Messikh Djamel
Health Administration Department, Faculty of Medicine, University of Montreal, Montreal, Canada.
Telemed J E Health. 2006 Jun;12(3):363-9. doi: 10.1089/tmj.2006.12.363.
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.
在过去几十年中，居家护理服务的发展是当前医疗保健系统改革的一个重要组成部分。然而，它们全面融入医院或初级保健服务的进程仍很缓慢。远程居家护理（THC）似乎有助于在医院和初级保健提供者之间建立服务网络。尽管人们认识到其在增加服务可及性、改善护理质量和健康结果方面的潜力，但尚未得到广泛应用。需要克服各种障碍。在本文中，我们展示了对使用THC跟踪患有严重慢性病（慢性阻塞性肺疾病[COPD]、高血压、心功能不全）的老年人治疗情况的比较探索性过程分析。该技术最初作为试点项目在三个地点引入（加拿大魁北克一个地点和马尼托巴两个地点）。我们的研究基于定性方法。它包括对实施过程的纵向分析和结果监测。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引入了新的居家护理提供模式。确定了两种模式：一种是专业化模式，另一种是计划性多价模式。如此深刻的变化给管理者和提供者带来了两大挑战。首先，传统上基于预先制定的干预计划的工作组织必须进行调整，以应对患者的特殊需求和警报。其次，传统服务提供模式与新服务提供模式之间的持续联系变得至关重要。
