Abstract
BackgroundAlthough digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships.MethodsThe multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. The constant comparative method was used for data analyses.ResultsAltogether, interviewed healthcare professionals reported three main technology-related impacts upon their patient-caregiver relationships. First, national and local pressure to increase efficiency had troubled their relationships with patients who suspected that municipalities have sought to lower costs by reducing and digitalising services. Participants reported having to consider such worries when introducing technologies into their services. Second, participants reported a shift towards empowering patients. Digital technology can empower patients who value their independence, whereas safety is more important for other patients. Healthcare professionals needed to ensure that replacing care tasks with technology implies safe and improved care. Third, the safety and quality of digital healthcare services continues to depend upon surveillance and control mechanisms that compensate for less face-to-face monitoring. Participants did not consider the possibility that surveillance exposes information about patients’ everyday lives to be problematic, but to constitute opportunities for adjusting services to meet patients’ needs.ConclusionsTechnologies such as digital medicine dispensers can improve the efficiency of healthcare services and enhance patients’ independence when introduced in a way that empowers patients as well as safeguards trust and service quality. Conversely, the patient-caregiver relationship can suffer if the technology does not meet patients’ needs and fails to offer safe and trustworthy services. Upon introducing technology, home healthcare professionals therefore need to carefully consider the benefits and possible disadvantages of the technology. Ethical implications for both individuals and societies need to be further discussed.
Highlights
Demographic changes towards an ageing population that lives at home for longer with complex health problems have increased the need for healthcare services [1]
Setting and technology The study was conducted in five Norwegian municipalities that had piloted the use of digital medicine dispensers in their home healthcare services, a small rural municipality (< 5.000 inhabitants; Case A), two mid-sized municipalities with mixed urban and rural areas (5.000–49.999 inhabitants; Cases B and C), and two larger municipalities with densely populated urban areas (> 50.000 inhabitants; Cases D and E)
National and local pressure to make services more efficient Participants reported that pressure from national and local authorities to maximise efficiency was a chief driver for implementing digital medicine dispensers in home healthcare services
Summary
Demographic changes towards an ageing population that lives at home for longer with complex health problems have increased the need for healthcare services [1]. Digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. In Norway, if healthcare services are responsible for assisting patients living at home with medication, national regulations require RNs and ASEs to manage all medication-related services [14], including administrating medication, reminding patients to take correct doses of medicine at certain times, contacting. In long-term healthcare at home in particular, since patients may need to receive care several times each day and meet many different professionals, trust and continuity in patient-caregiver relationships can be challenging to achieve [24]. For example, for telecare nurses to maintain good patientcaregiver relationships, when they are not meeting with patients face-to-face, they need to confirm that both they and their patients can trust the technology that they use [23, 28]
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