Telemed J E Health - Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned.

Tópicos

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Resumo

CKGROUND: Prior telemonitoring trials of blood pressure and blood glucose have shown improvements in blood pressure and glycemic targets. However, implementation of telemonitoring in primary care practices may not yield the same results as research trials with extra resources and rigid protocols. In this study we examined the process of implementing home telemonitoring of blood glucose and blood pressure for patients with diabetes in six primary care practices.MATERIALS AND METHODS: Grounded theory qualitative analysis was conducted in parallel with a randomized controlled effectiveness trial of home telemonitoring. Data included semistructured interviews with 6 nurse care coordinators and 12 physicians in six participating practices and field notes from exit interviews with 93 of 108 randomized patients.RESULTS: The three stakeholder groups (patients, nurse care coordinators, and physicians) exhibited some shared themes and some unique to the particular stakeholder group. Major themes were that practices should (1) understand the capabilities and limitations of the technology and the willingness of patient and physician stakeholders to use it, (2) understand the workflow, flow of information, and human factors needed to optimize use of the technology, (3) engage and prepare the physicians, and (4) involve the patient in the process. Although there was enthusiasm for a patient-centered medical home model that included between-visit telemonitoring, there was concern about the support and resources needed to provide this service to patients.CONCLUSIONS: As with many technology interventions, careful consideration of workflow and information flow will help enable effective implementations.

Resumo Limpo

ckground prior telemonitor trial blood pressur blood glucos shown improv blood pressur glycem target howev implement telemonitor primari care practic may yield result research trial extra resourc rigid protocol studi examin process implement home telemonitor blood glucos blood pressur patient diabet six primari care practicesmateri method ground theori qualit analysi conduct parallel random control effect trial home telemonitor data includ semistructur interview nurs care coordin physician six particip practic field note exit interview random patientsresult three stakehold group patient nurs care coordin physician exhibit share theme uniqu particular stakehold group major theme practic understand capabl limit technolog willing patient physician stakehold use understand workflow flow inform human factor need optim use technolog engag prepar physician involv patient process although enthusiasm patientcent medic home model includ betweenvisit telemonitor concern support resourc need provid servic patientsconclus mani technolog intervent care consider workflow inform flow will help enabl effect implement

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