1C-6 MIXED METHOD PROGRAM EVALUATION OF THE TELEHOMECARE PROGRAM FOR PATIENTS WITH HEART FAILURE (HF) AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN ONTARIO, CANADA: QUALITATIVE STUDY

Monday, June 13, 2016: 12:30
Stephenson Room, 5th Floor (30 Euston Square)

Valeria E. Rac, MD, PhD1, Gemma Hunting, MA1, Nida Shahid, HBSc., MSc (c.)2, Yeva Sahakyan, MD, MPH2, Iris Fan, BA1, Crystal Moneypenny, MSc (c)3, Aleksandra Stanimirovic, MSc, PhD (candidate)2, Taylor North1, Yelena Petrosyan, MD, MPH, PhD (Candidate)1 and Murray D. Krahn, MD, MSc4, (1)Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada, (2)Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada, (3)Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada, (4)University of Toronto and University Health Network, Toronto General Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Purpose: This study discusses the qualitative component of a mixed method program evaluation of the Telehomecare Program in Ontario, Canada. The qualitative component explored barriers and facilitators to the implementation and adoption of the Program across three  Local Health Integration Networks (LHINs).

Method(s): Barriers and facilitators to Telehomecare were explored with over thirty hours of ethnographic  observation and 89 semi-structured interviews (39 patients, 16 nurses, 7 physicians, 12 administrators, 13 decision-makers and 2 technicians), which were conducted across three Local Health Integration Networks (LHINs) in Ontario, with each LHIN representing a case study. Combination of purposeful and snowball sampling was used to recruit study participants. Phone or in-person interviews were conducted and ranged from 20 minutes to 2 hours in duration. Interviews were audio-taped, transcribed, and coded inductively using a descriptive content analytic approach to identify common themes and patterns (constant comparison) within and across the LHINs and across five levels of a multi-level framework (technology, patients, providers, organizations, and structures).

Result(s): Key findings include common themes of high caseload and unrealistic enrollment targets found across the LHINs. High patient caseload such (60 or higher) was identified as a strong barrier in providing quality patient care. Common critical facilitators found were patient motivation, confidence and willingness. Organizational culture also emerged as a predominant theme across all  LHIN. More specifically, when the organizational culture is open and respectful, all levels of staff were able to connect with each other and feel their beliefs and insights were valued. Similarly, the role of an ‘Engagement Lead’ was found as a critical facilitator for program implementation contributing to increased awareness and referrals to the program.

Conclusion(s): Despite the potential of Telehomecare to strengthen models of health care provision, challenges remain. Key barriers and facilitators impacting the implementation and adoption of Telehomecare across the province were identified. Some were common across all LHINs, while others were context driven and LHIN specific. By strengthening program facilitators and successfully addressing the barriers, the implementation and adoption of Telehomecare can be significantly improved. Further implementation of Telehomecare must involve continuous assessments and dialogue (both local and broad-based) of what is working and not working with multiple stakeholders. This can inform decision-making that better reflects the needs of all program stakeholders.

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