Cook Erica J, Randhawa Gurch, Sharp Chloe, Ali Nasreen, Guppy Andy, Barton Garry, Bateman Andrew, Crawford-White Jane
Department of Psychology, University of Bedfordshire, Park Square, Luton, UK.
Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, UK.
BMC Health Serv Res. 2016 Apr 19;16:137. doi: 10.1186/s12913-016-1379-5.
There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare.
Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method.
This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'.
The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services.
英国存在一种政治驱动力，即使用远程医疗和远程护理等辅助技术作为一种创新且高效的医疗服务提供方式。然而，此类服务的实施成功与否仍取决于能否让更广泛的人群采用这些服务。尽管研究结果不一，但技术接受度低已被广泛认为是采用这些服务的关键障碍。此外，患者之间是否存在障碍（若存在，是哪些障碍）以及这些障碍与拒绝或停止使用这些技术的人群所面临的障碍相比情况如何，仍不明确。本研究旨在聚焦于英国剑桥郡社区服务的辅助远程医疗和远程护理服务（一种远程医疗和远程护理的综合模式）来填补这一空白。
在2014年2月1日至2014年12月1日期间进行了定性半结构化访谈，以探究使用该服务的“使用者”和“非使用者”的观点和经历。“使用者”被定义为使用该服务的患者（N = 28），“非使用者”被定义为在分配前拒绝该服务的转诊患者（N = 3）或在使用辅助远程医疗和远程护理服务后退出的患者（N = 9）。使用框架法对数据进行分析。
本研究表明，存在一系列影响采用并持续使用此类服务决策的障碍和促进因素。拥有积极态度以及认为辅助远程医疗和远程护理设备能够满足自身需求是决定采用并使用该服务的重要影响因素。对该服务的使用集中在“可用性”、“设备有用性”以及“对身份和独立性的威胁”方面。
本文描述了转诊者在决策过程中的影响作用以及在战略层面与这些机构合作的必要性。研究结果还表明，从一开始就给予安心保证对于持续使用至关重要，特别是对于那些似乎对技术有更多负面感受的老年患者。此外，显然需要持续进行产品开发和创新，不仅要提高设备的可用性和功能性，还要激励其他可能从此类服务中受益的人群。揭示这些因素对于服务如何通过应用辅助技术来改善服务可及性和患者支持具有重要的政策意义，这反过来又可以减少过度紧张的医疗服务所承受的不必要成本和负担。
