Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway.
Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
BMC Health Serv Res. 2024 Sep 29;24(1):1146. doi: 10.1186/s12913-024-11620-w.
The increasing use of telemedicine (TM) represents a major shift for health workers and patients alike. Thus, there is a need for more knowledge on how these interventions work and are implemented. We conducted a qualitative process-evaluation alongside a larger randomized controlled trial designed to evaluate a telemedicine follow-up intervention for patients with a leg- or foot-ulcer, who either have or do not have diabetes. Accordingly, the aim of this study was to explore how both health care professionals and patients experienced the implementation of TM follow-up in primary care.
The intervention comprised an interactive TM platform facilitating guidance and counselling regarding wound care between nurses in primary care and nurses in specialist health care in Norway. Nurses and patients from seven clusters in the intervention arm were included in the study. We conducted 26 individual interviews (14 patients and 12 nurses) in primary care between December 2021 and March 2022. Thematic analyses were conducted.
The analyses revealed the following themes: (1) enhancing professional self-efficacy for wound care, (2) a need to redesign the approach to implementing TM technology and (3) challenging to facilitate behavioral changes in relation to preventive care. As to patients' experiences with taking part in the intervention, we found the following three themes: (1) experience with TM promotes a feeling of security over time, (2) patients' preferences and individual needs on user participation in TM are not met, and (3) experiencing limited focus on prevention of re-ulceration.
TM presents both opportunities and challenges. Future implementation should focus on providing nurses with improved technological equipment and work on how to facilitate the use of TM in regular practice in order to fully capitalize on this new technology. Future TM interventions need to tailor the level of information and integrate a more systematic approach for working with preventive strategies.
NCT01710774. Registration Date 2012-10-17.
远程医疗（TM）的使用不断增加，这对医疗工作者和患者来说都是一个重大转变。因此，需要更多地了解这些干预措施的工作原理和实施方式。我们在一项针对腿部或脚部溃疡患者的远程医疗随访干预的大型随机对照试验的基础上进行了定性过程评估，这些患者患有或不患有糖尿病。因此，本研究旨在探讨医疗保健专业人员和患者在初级保健中如何体验 TM 随访的实施。
该干预措施包括一个交互式 TM 平台，在挪威的初级保健护士和专科保健护士之间促进有关伤口护理的指导和咨询。干预组的七个群组中的护士和患者都参与了研究。我们在 2021 年 12 月至 2022 年 3 月期间在初级保健中进行了 26 次单独的访谈（14 名患者和 12 名护士）。进行了主题分析。
分析揭示了以下主题：（1）增强伤口护理的专业自我效能感，（2）需要重新设计实施 TM 技术的方法，（3）促进与预防保健相关的行为改变具有挑战性。至于患者参与干预的经验，我们发现了以下三个主题：（1）随着时间的推移，TM 的体验会增强安全感，（2）患者对用户参与 TM 的偏好和个人需求得不到满足，（3）对溃疡复发预防的关注有限。
TM 带来了机遇和挑战。未来的实施应侧重于为护士提供改进的技术设备，并致力于如何促进 TM 在常规实践中的使用，以充分利用这项新技术。未来的 TM 干预措施需要根据信息水平进行调整，并整合更系统的方法来处理预防策略。
NCT01710774。注册日期 2012-10-17。
