Social Policy Research Unit (SPRU), University of York, Heslington, York, YO10 5DD, UK.
Centre for Assistive Technology and Connected Healthcare and School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
BMC Med Inform Decis Mak. 2021 Jan 6;21(1):13. doi: 10.1186/s12911-020-01372-y.
Videoconferencing has been proposed as a way of improving access to healthcare for older adults in care homes. Despite this, effective uptake of videoconferencing remains varied. This study evaluates a videoconferencing service for care home staff seeking support from healthcare professionals for the care of residents. The aim was to explore factors affecting the uptake and sustainability of videoconferencing in care homes, to establish what works for whom, in which circumstances and respects. The findings informed recommendations for commissioners and strategic managers on how best to implement videoconferencing for remote healthcare provision in care homes for older adults.
Realist evaluation was used to develop, refine and test theories around the uptake and maintenance of videoconferencing in three care homes across Yorkshire and the Humber, England. The care homes were selected using maximum variation sampling regarding the extent to which they used videoconferencing. A developmental inquiry framework and realist interviews were used to identify Context, Mechanism and Outcome Configurations (CMOCs) regarding uptake and sustainability of the service. Participants included care home residents (aged > 65) and staff, relatives and strategic managers of care home chains. The interviews were an iterative process conducted alongside data analysis. Transcripts of audio recordings were entered into NVIVO 12, initially coded into themes, then hypotheses developed, refined and tested.
Outcomes were generated in relation to two main contextual factors, these were: (1) communication culture in the home and (2) the prior knowledge and experience that staff have of videoconferencing. The key facilitators identified were aspects of leadership, social links within the home and psychological safety which promoted shared learning and confidence in using the technology.
Videoconferencing is a valuable tool, but successful implementation and sustainability are dependent on care home culture and staff training to promote confidence through positive and supported experiences.
视频会议被提议作为改善养老院老年人获得医疗保健的一种方式。尽管如此，视频会议的有效采用仍然存在差异。本研究评估了一种视频会议服务，为养老院工作人员寻求医疗专业人员的支持，以照顾居民。目的是探索影响养老院视频会议采用和可持续性的因素，确定哪些因素对谁有效，在哪些情况下有效。研究结果为决策者和战略经理提供了有关如何在养老院中最好地实施视频会议以提供远程医疗服务的建议。
使用现实主义评估方法，在英格兰约克郡和亨伯地区的三家养老院中，针对视频会议的采用和维护问题，开发、改进和测试理论。这些养老院是根据他们使用视频会议的程度，采用最大变化抽样法选择的。使用发展性查询框架和现实主义访谈，确定与服务采用和可持续性相关的背景、机制和结果配置（CMOCs）。参与者包括养老院居民（年龄>65 岁）和工作人员、亲属以及养老院连锁的战略经理。访谈是一个迭代过程，与数据分析同时进行。录音的文字记录被输入到 NVIVO 12 中，最初按主题进行编码，然后提出、改进和测试假设。
与两个主要背景因素有关的结果如下：（1）养老院内部的沟通文化，（2）员工对视频会议的先验知识和经验。确定的主要促进因素包括领导力的各个方面、养老院内部的社交联系以及促进共同学习和对使用技术有信心的心理安全。
视频会议是一种有价值的工具，但成功的实施和可持续性取决于养老院的文化和员工培训，以通过积极和支持的体验来增强信心。
