JMIR Publications

ABSTRACT

Background:

The implementation of telemonitoring (TM) has had success in the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM which targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care.

Objective:

The objective of this study was to better understand the perspective of the clinical team (both front-line clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model.

Methods:

A pragmatic, 6-month implementation study was conducted to embed multi-condition TM including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization MeAsure Development (NoMAD) questionnaires. Normalization Process Theory (NPT) guided the deductive data analysis.

Results:

Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways yet changed the process of care delivery (i.e., interactional workability subconstruct). Effective TM normalization in nurse-led care required rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the NPT’s subconstructs of skill-set workability, relational integration, and contextual integration.

Conclusions:

Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively impacted without TM. This study demonstrated smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model.