Integrating telecare for chronic disease management in the community: what needs to be done?

May, C.R. et al. (2011) Integrating telecare for chronic disease management in the community: what needs to be done? BMC Health Services Research, 11, p. 131. (doi:10.1186/1472-6963-11-131)

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Abstract

Background Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community.

Methods Large scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory. Drawn from telecare services in community and domestic settings in England and Scotland, 221 participants were included, consisting of health professionals and managers; patients and carers; social care professionals and managers; and service suppliers and manufacturers.

Results Key barriers to telecare integration were uncertainties about coherent and sustainable service and business models; lack of coordination across social and primary care boundaries, lack of financial or other incentives to include telecare within primary care services; a lack of a sense of continuity with previous service provision and self-care work undertaken by patients; and general uncertainty about the adequacy of telecare systems. These problems led to poor integration of policy and practice.

Conclusion Telecare services may offer a cost effective and safe form of care for some people living with chronic illness. Slow and uneven implementation and integration do not stem from problems of adoption. They result from incomplete understanding of the role of telecare systems and subsequent adaption and embeddedness to context, and uncertainties about the best way to develop, coordinate, and sustain services that assist with chronic disease management. Interventions are therefore needed that (i) reduce uncertainty about the ownership of implementation processes and that lock together health and social care agencies; and (ii) ensure user centred rather than biomedical/service-centred models of care.

Item Type:Articles
Additional Information:This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mair, Professor Frances
Authors: May, C.R., Finch, T.L., Cornford, J., Exley, C., Gately, C., Kirk, S., Jenkings, K., Osbourne, J., Robinson, A., Rogers, A., Wilson, R., and Mair, F.S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:BMC Health Services Research
Publisher:Biomed Central
ISSN:1472-6963
ISSN (Online):1472-6963
Published Online:01 January 2011
Copyright Holders:Copyright © 2011 2011 May et al ; licensee BioMed Central Ltd.
First Published:First published in BMC Health Services Research 11 : 131
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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