Exploring an Innovative Care Model and Telemonitoring for Complex Patient Management: A Qualitative Description Study
ABSTRACT
Background:
The growing number of patients with complex chronic conditions presents an urgent challenge across Canadian health care. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population.
Objective:
The objective of this qualitative study was to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs requirements for telemonitoring of patients with complex chronic conditions. Furthermore, we explored how new telemonitoring technologies could be successfully embedded to support this novel model of complex chronic care.
Methods:
A qualitative description approach was utilized to conduct and analyze 29 semi-structured interviews with patients (n=16) and care team members (n=13) involved in developing the model of care in an ambulatory care facility in southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo to gain insights from examining multiple perspectives of different participants on complex chronic care needs.
Results:
Analysis revealed 3 themes and 13 subthemes including: (1) an adequate healthcare delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for telemonitoring in an integrated model of care. Participants identified continued challenges accessing, and navigating care in a fragmented, and disconnected delivery system but also identified the need for more self-management support. Patients and care team members described the structure of an integrated model of care including: the need for a clear referral and triage processes, and composing a tight-knit circle of collaborating interdisciplinary providers, led by a nurse practitioner. Finally, opportunities for telemonitoring in an integrated model of care were identified including: increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around telemonitoring-enabled care.
Conclusions:
Despite entrenched healthcare service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs. Nurse practitioners are in a unique position to lead telemonitoring-enabled integrated models of care. Telemonitoring could facilitate frequent and necessary monitoring of complex patients with more than one condition in integrated models of care.
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