Research Department of Primary Care and Population Health, University College London, London, UK
Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
BMJ Open. 2024 Nov 27;14(11):e092824. doi: 10.1136/bmjopen-2024-092824.
The potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient-facing app and a digital dashboard for clinicians providing supported self-management for long COVID to support both clinicians and patients.
Qualitative reflexive thematic analysis, mapped against Normalisation Process Theory.
Fifty-five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.
Allied health professionals, service delivery managers and members of the core team, including representatives from industry partners.
The DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working.Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face-to-face clinical input. The DHI was judged to have demonstrated the potential to affect long-established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.
NPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people's experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the 'mess' involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic).
数字健康干预（DHI）的潜在和预期效益早已被广泛讨论，但在大规模部署 DHI 方面仍存在重大挑战。本文介绍了一种 DHI 的实施情况，该 DHI 由面向患者的应用程序和面向临床医生的数字仪表盘组成，为长新冠患者提供支持性自我管理，为临床医生和患者提供支持。
定性反思主题分析，与常规化进程理论相对应。
社区和二级保健长新冠诊所的临床医生与研究团队成员之间的 55 个半小时的 zoom 会议记录。
包括来自行业合作伙伴的代表在内的辅助卫生专业人员、服务交付经理和核心团队成员。
DHI 符合环境情况，设计支持灵活性，以适应不同信托的情况。DHI 还与现有工作方式保持一致。医疗保健专业人员共同努力支持 DHI 的实施，需要灵活性来考虑当地情况。DHI 受到医疗保健专业人员的积极和消极评价。使用 DHI 被认为有可能补充护理，但不能替代面对面的临床输入。DHI 被认为有可能影响医疗保健专业人员和患者之间长期存在的接触模式和组织结构，就获得护理而言。
NPT 为考虑个人机构和组织背景提供了一个框架，使人们能够在服务结构层面以及人们的经验层面进行反思。首先考虑背景，然后考虑工作，最后考虑实际效果的学科帮助在快速开发、完善和实施 DHI 的非典型环境（大流行）中，将涉及的“混乱”有序化。
