JMIR Publications

ABSTRACT

Background:

Inequities in access to health services is a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The two tertiary pediatric hospitals in Alberta, Canada have already been operating over capacity, but the pediatric beds at regional hospitals are underutilized. Such imbalance could lead to poor patient safety, and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric healthcare providers, erode their confidence, and compel health systems to further reduce the capacity in regional sites. A “Telemedicine Rounding and Consultation for Kids” (TRaC-K) model was proposed to enable healthcare providers at the Alberta Children’s Hospital to partner with their counterparts in Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site.

Objective:

The current study is aimed at identifying perceived barriers and enablers to implementing the TRaC-K model.

Methods:

This study was guided by the Theoretical Domain Framework (TDF) and utilized qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semi-structured interviews and two focus groups. This data was thematically analysed to identify major sub-themes within each TDF domain. These sub-themes were further aggregated themes and categorized into as barriers or enablers to the TRaC-K model and were tabulated separately.

Results:

Our study identified 31 sub-themes in 14 TDF domains ranging from administrative issues to specific clinical conditions. We were able to merge these sub-themes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, and unclear processes and resources to support TRaC-K and concerns about clear roles and responsibilities. To the contrary, enablers were of healthcare providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary-regional relationships.

Conclusions:

Systematic enquiry of perceived barriers and enablers to implementation of TRaC-K helped us gain insights from various healthcare providers and family member’s perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond.