Abstract
BackgroundTo investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare).MethodsCase-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services.ResultsThe implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT.ConclusionsThe implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
Highlights
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care
Case study sites Each Whole Systems Demonstrator (WSD) site was chosen by the Department of Health in 2006 through a competitive process because (a) they were considered the most likely to succeed in scaling up remote care as part of a whole system redesign and (b) they were considered representative of the range of local health and social care systems in the UK
Whole system redesign In the original WSD research protocol, three types of participants were to be recruited: those assessed as eligible for telecare, those assessed for telehealth, and a mixed group assessed as eligible for both [13]
Summary
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). The need for new models of integrated care that can reduce the costs of keeping people out of care homes and hospitals is an imperative for heath and social care systems around the world. The use of ‘remote care’ technologies (telecare and telehealth) as integral to new models of care is seen by the UK government as one potential solution [1]. Since the mid 2000s, a number of care professionals, to assist in the management of an existing long-term condition i.e. COPD, diabetes, heart failure), and telecare, (the remote, automatic monitoring of an individuals’ personal health and safety, i.e. mobility, and home environment). Despite the Government promoting the concept [6,8], many seemingly successful telehealth and telecare projects fade away [9,10]
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