Abstract
Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% (n = 265) were conducted for general practice, 29% (n = 172) for wound care, 11% (n = 62) for diabetes management, 8% (n = 47) with gerontologist and 6% (n = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; p = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; p = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients’ and treating physicians’ needs; and (3) it’s specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.
Highlights
People older than 65 account for 16.5% and 20.3% of the US population and the European population, respectively [1,2]
The urban nursing homes were located an average of 3 ± 1.6 km from the hospital, eight of which were located in the same city of 61,000 inhabitants as the hospital
(480 on 590), three rural nursing homes conducted 80% of the teleconsultation conducted by all the rural nursing homes (367 on 463), and five urban nursing homes did the same
Summary
People older than 65 account for 16.5% and 20.3% of the US population and the European population, respectively [1,2]. Living (ACL) estimates that 35% of US citizens older than 65 will become nursing home residents [5]. The availability of physicians in nursing homes is often limited notably because of less advantageous work conditions [6,7], which forces staff to hospitalize residents despite associated medical risks [8,9]. Restricted due to technical limitations, telemedicine use has been increasing which has allowed for improved access to healthcare, patient management, and education while reducing costs (mostly associated with transportation) [12,13,14,15,16,17,18,19,20,21]. In the context of the COVID-19 pandemic, telemedicine use in nursing homes is clearly relevant in that it limits interruptions in care and reduces nursing home residents’ exposure to COVID-19 in hospitals [22]
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