Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
MA&T Sell & Partner GmbH, Würselen, Germany.
JMIR Aging. 2024 Jun 6;7:e55471. doi: 10.2196/55471.
There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis.
This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice.
A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements.
In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs.
Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.
越来越多的证据表明，远程医疗可以改善养老院居民获得医疗保健的机会和质量。然而，如何最好地管理和指导实施过程，以确保长期采用，特别是在 COVID-19 危机后远程医疗使用下降的情况下，仍不清楚。
本研究旨在确定并解决养老院居民、护理护士和主治全科医生（GP）实施电视访问的主要挑战。它还评估了电视访问对护士工作量和护理实践的影响。
在德国农村的 2 家养老院及其合作的全科医生办公室引入了具有集成医疗设备的远程医疗系统。从 2019 年 11 月最初决定引入远程医疗到 2023 年 3 月长期常规使用的整个实施过程都进行了密切监测。定期评估基于混合方法，将严格的定性方法与定量测量相结合。
在 COVID-19 大流行的第一阶段，两家养老院都实现了短期采用。在大流行后期，采取行动导向的方法使确定障碍和采取控制措施实现长期采用成为可能。异步访问的实施、强有力的领导和对护士的持续培训是在 1 家养老院实现长期实施的关键要素。实施使护理人员的临床技能得到提高、专业认可度提高、心理困扰减少。与全科医生组织上门访问相比，电视访问导致护士的时间需求略有增加。
根据个人情况关注医疗保健工作流程和变革管理方面对于成功实现远程医疗的长期实施至关重要。
Zotero 插件
