Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands.
Health Campus the Hague, Leiden University Medical Center, The Hague, 2511 DP, The Netherlands.
BMC Prim Care. 2024 Apr 20;25(1):122. doi: 10.1186/s12875-024-02355-y.
While remote patient management (RPM) has the potential to assist in achieving treatment targets for cardiovascular risk factors in primary care, its effectiveness may vary among different patient subgroups. Panel management, which involves proactive care for specific patient risk groups, could offer a promising approach to tailor RPM to these groups. This study aims to (i) assess the perception of healthcare professionals and other stakeholders regarding the adoption and (ii) identify the barriers and facilitators for successfully implementing such a panel management approach.
In total, nineteen semi-structured interviews and two focus groups were conducted in the Netherlands. Three authors reviewed the audited transcripts. The Consolidated Framework for Implementation Strategies (CFIR) domains were used for the thematic analysis.
A total of 24 participants (GPs, nurses, health insurers, project managers, and IT consultants) participated. Overall, a panel management approach to RPM in primary care was considered valuable by various stakeholders. Implementation barriers encompassed concerns about missing necessary risk factors for patient stratification, additional clinical and technical tasks for nurses, and reimbursement agreements. Facilitators included tailoring consultation frequency and early detection of at-risk patients, an implementation manager accountable for supervising project procedures and establishing agreements on assessing implementation metrics, and ambassador roles.
Panel management could enhance proactive care and accurately identify which patients could benefit most from RPM to mitigate CVD risk. For successful implementation, we recommend having clear agreements on technical support, financial infrastructure and the criteria for measuring evaluation outcomes.
远程患者管理 (RPM) 有可能帮助实现初级保健中心心血管风险因素的治疗目标，但在不同患者亚组中的效果可能有所不同。小组管理涉及针对特定患者风险群体的积极护理，可能是一种将 RPM 定制为这些群体的有前途的方法。本研究旨在：(i) 评估医疗保健专业人员和其他利益相关者对采用的看法；(ii) 确定成功实施此类小组管理方法的障碍和促进因素。
在荷兰总共进行了 19 次半结构式访谈和 2 次焦点小组讨论。三位作者对审核后的转录本进行了审查。采用实施策略综合框架 (CFIR) 领域进行主题分析。
共有 24 名参与者（全科医生、护士、健康保险公司、项目经理和 IT 顾问）参与。总体而言，各种利益相关者都认为初级保健中的 RPM 小组管理方法具有价值。实施障碍包括对患者分层所需的必要风险因素缺失的担忧、护士的额外临床和技术任务，以及报销协议。促进因素包括调整咨询频率和早期发现高危患者、负责监督项目程序和就评估实施指标达成协议的实施经理，以及大使角色。
小组管理可以增强主动护理，并准确识别最能从 RPM 中受益以降低 CVD 风险的患者。为了成功实施，我们建议就技术支持、财务基础设施以及衡量评估结果的标准达成明确协议。
