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在日常实践中实施远程眼科转诊平台:运用规范化过程理论理解数字健康干预措施的实施情况。

Implementing a teleophthalmology referral platform in routine practice: Understanding a digital health intervention implementation using normalisation process theory.

作者信息

Abdi Sarah, Patel Dilisha, Carmichael Josie, Balaskas Konstantinos, Blandford Ann

机构信息

UCL Interaction Centre, University College London, London, UK.

Global Disability Innovation Hub, University College London, London, UK.

出版信息

Digit Health. 2025 Jan 31;11:20552076241303812. doi: 10.1177/20552076241303812. eCollection 2025 Jan-Dec.


DOI:10.1177/20552076241303812
PMID:39896268
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11786278/
Abstract

OBJECTIVE: Digital health interventions have the potential to improve clinical processes and patient outcomes; however, many face challenges during the adoption and implementation stages, hindering their overall impact. Our study uses normalisation process theory (NPT) as a theoretical approach to explore the facilitators and barriers to the implementation of a teleophthalmology referral platform in the United Kingdom, as an illustrative case of the implementation of a digital health intervention in routine practice. METHODS: Semistructured interviews were conducted with 24 health professionals (18 optometrists and 6 ophthalmologists) involved in the implementation of a teleophthalmology referral platform. NPT guided data collection and analysis. RESULTS: Most participants were ready to engage with the teleophthalmology referral platform, recognising its potential value and benefits. However, during implementation, participants' perceptions varied; a major factor was whether their expectations from the technology were met, particularly regarding the feedback from the secondary eye care component of the referral platform. Several additional factors were identified that would influence the adoption of the platform. These included individual aspects (e.g. participants' IT skills), technology-related factors (e.g. the time required to complete referrals) and organisational factors (e.g. investment in community optometry services). CONCLUSIONS: To successfully implement the teleophthalmology platform into routine practice, particularly on a large scale, multiple factors at different levels must be considered. This study highlights the complexity associated with implementing digital health interventions in routine practice and the contribution of NPT in untangling some of these complexities.

摘要

目的:数字健康干预措施有改善临床流程和患者治疗效果的潜力;然而,许多措施在采用和实施阶段面临挑战,阻碍了其整体影响。我们的研究使用常态化过程理论(NPT)作为一种理论方法,以探索在英国实施远程眼科转诊平台的促进因素和障碍,作为在常规实践中实施数字健康干预措施的一个示例。 方法:对参与远程眼科转诊平台实施的24名卫生专业人员(18名验光师和6名眼科医生)进行了半结构化访谈。NPT指导数据收集和分析。 结果:大多数参与者愿意使用远程眼科转诊平台,认识到其潜在价值和益处。然而,在实施过程中,参与者的看法各不相同;一个主要因素是他们对该技术的期望是否得到满足,特别是关于转诊平台二级眼科护理部分的反馈。还确定了几个会影响该平台采用的其他因素。这些因素包括个人方面(如参与者的信息技术技能)、技术相关因素(如完成转诊所需的时间)和组织因素(如对社区验光服务的投入)。 结论:要成功将远程眼科平台纳入常规实践,尤其是大规模纳入,必须考虑不同层面的多个因素。本研究突出了在常规实践中实施数字健康干预措施的复杂性以及NPT在梳理其中一些复杂性方面的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ec8/11786278/4e541c27c241/10.1177_20552076241303812-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ec8/11786278/992719ef3987/10.1177_20552076241303812-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ec8/11786278/4e541c27c241/10.1177_20552076241303812-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ec8/11786278/992719ef3987/10.1177_20552076241303812-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ec8/11786278/4e541c27c241/10.1177_20552076241303812-fig2.jpg

相似文献

[1]
Implementing a teleophthalmology referral platform in routine practice: Understanding a digital health intervention implementation using normalisation process theory.

Digit Health. 2025-1-31

[2]
What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians.

BMJ Open. 2024-5-24

[3]
Investigating the Role of Optometrists in Teleophthalmology and the Implications of Increasing Access to Advanced Imaging Techniques and Digital Referral: A Systematic Search and Review.

Telemed J E Health. 2021-9

[4]
Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study-HERMES study report 1-study protocol.

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[5]
Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study.

BMJ Open. 2019-2-18

[6]
Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators.

BMC Med Inform Decis Mak. 2024-10-21

[7]
Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services.

BMJ Open. 2022-7-20

[8]
Implementing a digital patient feedback system: an analysis using normalisation process theory.

BMC Health Serv Res. 2020-5-7

[9]
The effectiveness of interventions for optometric referrals into the hospital eye service: A review.

Ophthalmic Physiol Opt. 2023-11

[10]
What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory.

Implement Sci. 2018-11-12

本文引用的文献

[1]
What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians.

BMJ Open. 2024-5-24

[2]
The effectiveness of interventions for optometric referrals into the hospital eye service: A review.

Ophthalmic Physiol Opt. 2023-11

[3]
Assessment of optometrists' referral accuracy and contributing factors: A review.

Ophthalmic Physiol Opt. 2023-9

[4]
Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services.

BMJ Open. 2022-7-20

[5]
Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks.

JMIR Diabetes. 2022-3-30

[6]
Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development.

Implement Sci. 2022-2-22

[7]
Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study-HERMES study report 1-study protocol.

BMJ Open. 2022-2-1

[8]
Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation.

NPJ Digit Med. 2022-1-27

[9]
A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada.

Clin Ophthalmol. 2021-10-4

[10]
A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance.

BMJ. 2021-9-30

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