背景:越来越多的证据表明,远程医疗可以改善养老院居民获得医疗保健的机会和质量。然而,目前尚不清楚如何最好地管理和指导实施过程,以确保长期采用,特别是在COVID-19危机后远程医疗使用下降的背景下。
目的:本研究旨在确定和解决在养老院居民中实施远程访问的主要挑战,他们有爱心的护士,以及他们治疗的全科医生(GP)。它还评估了远程访问对护士工作量及其护理实践的影响。
方法:在德国农村的2家疗养院及其合作的GP办公室中引入了具有集成医疗设备的远程医疗系统。从2019年11月引入远程医疗的最初决定到2023年3月的长期常规使用,实施过程一直受到密切监控。定期评估基于混合方法方法,将严格的定性方法与定量测量相结合。
结果:在COVID-19大流行的第一阶段,两家疗养院都获得了短期收养。在大流行后阶段,以行动为导向的方法使识别障碍并采取长期采用的控制措施成为可能。异步访问的实现,坚强的领导,对护士的持续培训是在1家疗养院实现长期实施的关键因素.实施提高了临床技能,更高的专业认可度,减少护理人员的心理困扰。与与全科医生组织面对面的家访相比,远程访问对护理人员的时间需求略有增加。
结论:专注于医疗保健工作流程和根据个人环境的变化管理方面,对于成功实现远程医疗的长期实施至关重要。
BACKGROUND: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis.
OBJECTIVE: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses\' workload and their nursing practice.
METHODS: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements.
RESULTS: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs.
CONCLUSIONS: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.