Organisational assessment of three telehealth interventions in a European multicentre study: The United4Health project

Purpose: To assess the perception of health care professionals of the organisational prerequisites for implementation of telehealth interventions in search of a generally applicable model for future use of telehealth.

Context: United4Health, a European telehealth project comprising three multicentre studies of telehealth services for patients with diabetes, COPD and chronic heart failure in 10 European countries.

Methods: Based on the Model for ASsessment of Telemedicine applications (MAST) [1], data from three multicentre observational studies of telemedicine services for patients with diabetes, COPD and chronic heart failure were analysed to assess organisational impact. Data collection was based on a shared protocol developed by the U4H evaluation team. Data were collected by means of interviews with key members of the local health care professional teams and in addition studying policy documents and descriptions of clinical pathways. Analysis of the interviews was performed by means of identifying recurring themes and subsequently using content analysis.

Results: From the assessment we were able to point out a number of key prerequisites which were needed in order to successfully implement the telehealth solutions and achieve their integration in routine health care services in care of patients with selected chronic diseases. Among the key factors for successful implementation are:

National focus on telehealth

Very careful consideration of choice of patient groups (inclusion and exclusion criteria)

Realistic expectations for time and staff resources required

IT infrastructure in place and running smoothly from the beginning

Adequate training for staff and patients involved in the trial

Discussion: Due to differences in organisational set-ups, as well as actions taken outside the project such as national health reforms and new health care policies, we were not able to point out a single model which would be suitable for all. Even though a common clinical protocol was produced including description of the content and duration of the telemedicine service, the interventions were quite similar among the sites, but the organisational set up differed widely.

Keywords: Telehealth, integrated care, organisational changes, Diabetes, COPD, CHF

References:  

1. Kidholm K et al. A model for assessment of telemedicine applications: MAST. Int J Technol Assess Health Care. 2012 Jan;28(1):44–51