Abstract
BackgroundTelecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community.MethodsLarge scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory. Drawn from telecare services in community and domestic settings in England and Scotland, 221 participants were included, consisting of health professionals and managers; patients and carers; social care professionals and managers; and service suppliers and manufacturers.ResultsKey barriers to telecare integration were uncertainties about coherent and sustainable service and business models; lack of coordination across social and primary care boundaries, lack of financial or other incentives to include telecare within primary care services; a lack of a sense of continuity with previous service provision and self-care work undertaken by patients; and general uncertainty about the adequacy of telecare systems. These problems led to poor integration of policy and practice.ConclusionTelecare services may offer a cost effective and safe form of care for some people living with chronic illness. Slow and uneven implementation and integration do not stem from problems of adoption. They result from incomplete understanding of the role of telecare systems and subsequent adaption and embeddedness to context, and uncertainties about the best way to develop, coordinate, and sustain services that assist with chronic disease management. Interventions are therefore needed that (i) reduce uncertainty about the ownership of implementation processes and that lock together health and social care agencies; and (ii) ensure user centred rather than biomedical/service-centred models of care.
Highlights
Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited
Since the beginning of the 1990s, telecare systems information and communications technologies that link people to health and social care services - have been promoted as a technological solution for problems of equity and access to care, and as a means of support for self-care in the community
Using contacts made in earlier studies, we recruited a sample of managers in primary care (n = 9) and social care (n = 13), who played a policy role in commissioning, organizing and delivering telecare services, and representatives of the service supply and manufacturing sector (n = 11) who sought to promote telecare systems to health and social care providers
Summary
Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. Telecare systems are attractive to health and welfare generic systems aimed at ensuring the safety and security of frail older people have been intensively promoted as a response to the anticipated increasing demands of such people on health and social care services, and as a means of controlling the costs of such services. These systems have come to be incorporated in policy in the UK as a means of combining self-care, symptoms surveillance, and social support [5,6,7]. There remains much to understand about how such systems reconfigure existing practices and relationships [11], and how best to translate trial results into routine practice remains unclear [12]
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