Implementation of a Multidevice Telemonitoring Program for Home-Based Nursing Care in Quebec: Qualitative Report

Home care services are under increasing pressure due to population aging, rising chronic disease prevalence, and workforce shortages. Digital health technologies, particularly home telemonitoring systems, are seen as promising tools to detect early clinical deterioration, reduce hospital use, and support continuity of care. However, real-world evidence on the implementation of such technologies in public home care systems remains limited. In 2023-2024, the Quebec Ministry of Health and Social Services funded a pilot to implement a multidevice telemonitoring intervention for older adults with heart failure across three integrated health and social services centers (CISSS). The initiative aimed to assess feasibility, acceptability, and the organizational conditions shaping implementation.

This study documents the real-world implementation of a multidevice telemonitoring program from the perspective of home care nurses, with complementary insights from managers. It identifies perceived barriers, enablers, and contextual strategies for adaptation and sustainability.

We conducted a qualitative study guided by the iCHECK-DH framework and principles of implementation science. Data sources included 30 semistructured interviews, 19 with home care nurses, and 11 with clinical and administrative managers. The intervention combined four connected devices (ie, Bluetooth scale, smartwatch, xPill adherence system, and voice-activated tablet), monitored by nurses through the Virtuose dashboard. Data were analyzed thematically, focusing on implementation processes, user experience, and organizational integration.

The intervention involved 67 patients initially recruited (34 completed the 6-mo intervention) and was implemented across three home care organizations. Qualitative findings were based on 30 semistructured interviews with home care nurses (n=19) and administrative managers (n=11). About 16/21 (76%) of nurses accessed the dashboard daily or near-daily, but challenges included alert fatigue, workflow disruption, and limited integration with clinical systems. Nurses described mixed initial reactions to telemonitoring, valued hands-on training, and emphasized the need for clearer workflows and technical support. Digital tools were seen as clinically useful but added complexity to care delivery. Sustained use required local adaptation, attention to digital literacy, and greater system integration. Relational care remained central to nursing practice, even in digitally supported contexts.

Telemonitoring programs can be successfully implemented in public home care settings when supported by strong leadership, responsive training, and adaptive workflows. This study highlights the relational, technical, and organizational dimensions of implementation and offers lessons to inform future scale-up efforts in similar public health systems.