EVALUATING THE IMPLEMENTATION AND ADOPTION OF TELEHOMECARE PROGRAM FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE OR HEART FAILURE PATIENTS
The purpose of the qualitative study was to evaluate factors at the micro, meso and macro levels of the Canadian healthcare system that either facilitate or impede the implementation and adoption of the Telehomecare program across Ontario.
The qualitative comparative study used a multi-level framework to analyze various factors facilitating or impeding the implementation or adoption of Telehomecare for chronic obstructive pulmonary disease (COPD) or heart failure (HF) patients in the Central West, Toronto Central and North East Local Health Integration Networks (LHINs). The team conducted over 30 hours of ethnographic fieldwork, reviewed relevant documentary sources and interviewed all types of Program users (39 patients, 16 nurses, 7 physicians, 12 administrators, 13 decision makers and 2 technicians). The semi-structured interviews were 30-60 minutes long in duration that were audio-taped and later transcribed. Data gathered from transcripts and fieldwork notes were coded using a descriptive analytic approach in constant comparison. Common patterns and themes were identified across the three LHINs.
Key results include common themes of patient motivation, confidence and willingness as critical contributors to successful implementation of the program. A major facilitator found was the patient’s ability to use the equipment for symptom management and support from an informal caregiver. Both COPD and HF patients reported Telehomecare as innovative and transformational delivery of healthcare. Common barriers across all LHINs included high caseloads and setting of unrealistic enrollment targets for program nurses. For example, a patient caseload of 60 or higher was found to be an impediment to providing quality care. The organizational culture such as better integration of program was found to be a key facilitator to the long-term success of Telehomecare.
Important facilitators and barriers affecting the implementation and adoption of Telehomecare across Ontario were identified. Despite some themes being common to the three LHINs, others were context driven and specific to each LHIN. The implementation and adoption of the program can significantly improve by strengthening identified facilitators and addressing the challenges. Continued evaluation of Telehomecare is integral to ensuring the program is accessible, effective and sustainable.