Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study.

Christofer Rydenfält,Gudbjörg Erlingsdóttir,Veronica Milos Nymberg,Susanne Frennert,Björn Ekman,Mirella Muhic

doi:10.2196/30527

Abstract

BackgroundTraditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input.ObjectiveThis study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice.MethodsHCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis.ResultsThe analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures.ConclusionsDigital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.

Highlights

BackgroundSweden, similar to many other countries, is undergoing demographic changes, resulting in an increasing older population and a shortage of health care professionals (HCPs)
normalization process theory (NPT) describes four constructs that shape an implementation process: coherence, which is the extent to which an innovation is understood as meaningful, desirable, and practicable; cognitive participation, which is the enrollment of key individuals to drive the implementation of the innovation; collective action, which is the work that operationalizes the innovation into practice; and reflexive monitoring, which is the ongoing process of adjusting and appraising the innovation to sustain routines [17]
Our study focuses on HCPs employed at Albra, a primary health care center in Sweden

Summary

Introduction

BackgroundSweden, similar to many other countries, is undergoing demographic changes, resulting in an increasing older population and a shortage of health care professionals (HCPs). The current development in Swedish primary care is to blend digital solutions with traditional solutions This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. Methods: HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. Results: The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring The use of these constructs enabled the analysis to identify ways of supporting implementation. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice

Methods

Results

Discussion

Conclusion