Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study.

Area of Science:

• Healthcare Management
• Nursing Informatics
• Chronic Disease Management

Background:

• Telemonitoring (TM) adoption is successful in single-disease models but limited for patients with multiple complex chronic conditions (CCC).
• Research on nurse-led TM implementations for CCC patients, especially from a clinical perspective in outpatient settings, is scarce.
• Understanding the clinical team's viewpoint is crucial for scaling TM to diverse patient populations.

Purpose of the Study:

• To explore the clinical team's perspective on implementing and normalizing telemonitoring (TM) for patients with complex chronic conditions (CCC) within a nurse-led clinic.
• To identify facilitators and barriers to TM integration from the viewpoint of frontline clinicians and administrators.

Main Methods:

• A 6-month pragmatic implementation study of multicondition TM (heart failure, hypertension, diabetes) in a nurse-led integrated care model.
• Qualitative interviews with clinical team members and completion of the Normalization Measure Development questionnaire.
• Deductive analysis guided by the Normalization Process Theory, incorporating observations and chart reviews.

Main Results:

• Clinicians perceived TM as valuable for meeting diverse patient needs and aligned with existing practices, though it altered care delivery processes.
• Successful TM normalization requires workflow adjustments, enhanced patient-clinician relationships, interdisciplinary communication, and clinical oversight.
• Key Normalization Process Theory constructs (skill set workability, relational integration, contextual integration) were well-represented.

Conclusions:

• Clinicians successfully integrated TM into their daily practice, with some feeling their roles would be negatively impacted without it.
• Smartphone-based TM systems effectively supported the complex clinical work involved in managing patients with CCC in a nurse-led model.
• This study highlights the potential of nurse-led TM to enhance care for patients with multiple chronic conditions.