IMPLEMENTATION AND ADOPTION OF THE TELEHOMECARE PROGRAM FOR PATIENTS WITH HEART FAILURE OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Purpose:

   The purpose of this study was to evaluate and compare different factors at the micro, meso and macro levels of the healthcare system that either facilitate or impede the implementation and adoption of the Telehomecare Program in Ontario, Canada.

Methods:

   As part of a mixed-methods program evaluation design, the qualitative comparative study used a multi-level framework to explore various facilitators and barriers to Telehomecare Program implementation and adoption in the Central West, North East and Toronto Central Local Health Integration Systems (LHINs). In addition to conducting over 30 hours of observational fieldwork and review of relevant documentary sources, the study team interviewed, in person or on telephone, a total of 89 participants across different tiers of the healthcare system.  Study participants included patients, informal caregivers, health care providers, technicians, administrators and key decision-makers. The interviews lasted 30-60 min; they were audio-taped and transcribed. Interview transcripts, notes and observation notes were coded using a descriptive content analytic approach in constant comparison, to identify the common themes and patterns arising within and across the LHINs.  

Results:

   Key findings emerging from the Qualitative Comparative Study included common themes of patient motivation, confidence and willingness as critical facilitators of successful implementation. Major facilitator found was the patient’s ability to use the equipment for symptom management and assistance from an informal caregiver. High caseloads and unrealistic enrollment targets imposed on Telehomecare nurses were found to be common barriers across all three LHINs. A patient caseload of 60 or higher was identified as a strong barrier in providing quality care. Organizational culture also emerged as a predominant theme across all LHINs, more specifically better integration of Telehomecare being a facilitator to the long-term success of the program.  Lastly, the role of an “Engagement Lead” was regarded as a critical facilitator for the implementation contributing to increased awareness and referrals to the program.

Conclusion:

   We have identified important facilitators and barriers affecting the implementation and adoption of Telehomecare Program across the province. Although some themes were common, others were context driven and specific to each LHIN. Implementation and adoption of Telehomecare can significantly improve by strengthening the facilitators and successfully addressing the identified barriers.  A continued evaluation of the Telehomecare Program is central to ensuring program is accessible, effective and sustainable.