Jeffs Lianne, Jamieson Trevor, Saragosa Marianne, Mukerji Geetha, Jain Arsh K, Man Rachel, Desveaux Laura, Shaw James, Agarwal Payal, Hensel Jennifer M, Maione Maria, Onabajo Nike, Nguyen Megan, Bhatia R
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
JMIR Hum Factors. 2019 Apr 16;6(2):e9720. doi: 10.2196/humanfactors.9720.
Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home.
In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients' outcomes and experiences.
This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders-6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers-participated in this study.
The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case.
Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.
早期针对腹膜透析（PD）患者的虚拟护理解决方案领域的研究主要集中在评估这些解决方案的效果和影响。对于了解影响在家接受PD治疗的慢性肾脏病（CKD）患者对虚拟护理的接受度、可用性和可扩展性的因素，关注较少。
在此背景下，开展了一项研究，以（1）评估和了解影响虚拟护理解决方案接受度的因素，以及（2）为旨在改善CKD患者治疗效果和体验的虚拟护理解决方案的可扩展性提供建议。
本研究采用定性设计，采用半结构化访谈和主题分析方法。共有25名利益相关者参与了本研究，其中包括6名患者和3名护理人员、6名医疗保健提供者、2名供应商以及8名卫生系统决策者。
出现了以下三种影响虚拟护理解决方案可用性的主要机制：（1）接受支持团队的实践培训和持续沟通；（2）进行调整以满足用户需求并将其融入工作流程；（3）受到患者和护理人员特征的影响。此外，还围绕可扩展性提出了两项总体建议以供考虑：（1）在当地进行联合设计，融入日常工作流程，并逐步部署；（2）分享益处并建立案例。
关键利益相关者在未来努力提高CKD虚拟护理解决方案的实施、接受度和可扩展性以及在家管理PD时，可以利用本研究结果。
