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OS16 - Unleashing Telehealth (ID 26)
- Event: e-Health 2019 Virtual Meeting
- Type: Oral Session
- Track: Clinical Delivery
- Presentations: 1
- Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Pod 7
OS16.02 - Designing Telemonitoring for Complex Patients in a NP-Led Clinic (ID 195)
Complex patients are becoming increasingly prevalent throughout Ontario?s healthcare system, and yet chronic care continues to be focused on single conditions treated individually, often without consideration of greater care needs. An opportunity has arisen to address the challenges that complex patients face by combining the two innovations: telemonitoring and a Nurse Practitioner (NP)-led integrated complex medical clinic. Using a telemonitoring system in the NP-led clinic, patients will be able to monitor their multiple chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patients? ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. However, very few TM programs are sustained as part of clinical care, and those programs that exist are restricted to single conditions. The objective of this work is to determine the needs and requirements of a telemonitoring system which assists self-management of multiple complex chronic conditions. The results of a qualitative needs assessment and iterative usability testing will be reported.
A qualitative needs assessment and usability evaluation were undertaken as part of a larger case study to determine how to design and implement telemonitoring as a single system for complex conditions into an NP-led integrated clinic model. Semi-structured interviews were conducted to determine the specific needs and requirements of complex patients and anticipated challenges of implementing telemonitoring in this model. Interviews were also utilized to iterate on the telemonitoring application. Patients and care team members were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their needs, perspectives and challenges around managing complex chronic conditions, as well as any technical needs and requirements for a telemonitoring system.
Eighteen patients and thirteen care team members were interviewed to reach data saturation at WOHS. Patient interviewees were particularly interested in how telemonitoring could improve access to necessary health care services, coordinate overall care needs and symptoms under more consistent monitoring by multiple health care professionals in one place. The majority of patients felt telemonitoring could be helpful for managing blood pressure, monitoring blood sugar levels, pain, and possibly even mental health concerns, such as anxiety or depression. Usability testing is ongoing and preliminary analysis has informed application development as it occured in order to be contextually relevant. Up to two rounds of formal usability testing are anticipated before the application will be operationalized in the clinic model as a pilot study in January 2019.
Based on this research, a six-month multi-method pilot study will be undertaken to determine the feasibility of implementing telemonitoring into the NP-led clinic model. The potential impact of this research includes a sustained program combining telemonitoring within this model which improves health outcomes, reduces unnecessary ED visits or hospitalizations and is scalable to other healthcare institutions for complex patients.
140 Character Summary:
Complex patients and their clinicians perceived a smartphone-based TM system in a NP led model to be an opportunity to better manage their health and care needs.
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