Patients’ and nurses’ experiences with telehomecare: results of a research study Lynda Atack, R.N.,Ph.D Centennial College Diane Duff, R.N., Ph.D York University CST Conference, September 2005 Manitoba

CANARIE Ontario Innovation Trust Acknowledgements

East York Telehomecare Project A video-based THC program to improve health outcomes for patients with chronic illness

 Centennial College and York University: project management, research  East York Access Centre: patient referral; funding for nursing care  Comcare Health Services: nursing service provider  Toronto East General Hospital and Family Physicians:referral and medical follow-up  American TeleCare Inc: technology provider Partners

Research question and method  What are patients’ and providers’ experiences with telehomecare?  Grounded theory design  Patient interviews conducted until data saturation reached (n = 25)

Demographic profile  Ages ranged from 64 to 87  67% women  Most >15 years with multiple, chronic illness

Patients’ experiences “ Living confidently with illness” -health situation -focused on norms -exploring S+S -stabilizing -community care -understanding norms -connecting with -exploring capacity -provider and variations directives + limitations -technology -identifying potential -integrating -becoming proactive for change medications - Fewer ER visits Making a connectionFocusing on vitals Understanding illnessTaking control

Patient’s experience I noticed my heart rate started to go up about five weeks ago and was watching it warily…I wasn’t that surprised when the defibrillator [defibrillator implant] kicked in. I called my GP the week before the defib went on…just because I was concerned about my heart rate and trouble breathing. I’d had heart failure before which was like drowning on the inside… and I was concerned I was sliding into that space… but with the THC equipment I had enough ammunition to say I’ve got to do something.” “I had a serious problem last week and with this defibrillator thing I got a shock at 1 a.m. And it was very reassuring to go downstairs and do my BP test, take my pulse and oxygen thing. To know that in spite of the shock I was still alive…

Patients’ experiences  “It may have kept me from going crazy with not having enough information. This gives you good information.”  “I do this [vital signs ] first thing in the morning. If it’s a bit high I can usually hit the nail on the head about what’s come along and triggered it…and I do adjust like my fluid intake or activity…then I can take it the next day or later in the day just to see if it’s up…it gives me a comfort zone.”

Nurses’ experiences  N = 5  Two hospital clinic nurses  Three community nurses

Nurses’ experiences with telehomecare  Clinical impact: more flexible and responsive  Impact on patient health: improved decision- making regarding daily activities, increased confidence in self-managing health and improved compliance and accountability with medications  Experiences with technology: easy to learn, easy to use, reliable  Impact on practice: increased focus on patient education, monitoring and support.

Nurses’ experiences “This is the future and I’m glad to be doing it” “I’ve seen a lot of people become empowered to care for themselves more and make more informed decisions for themselves about when to go to the hospital, when to go to the doctor, when to call and ask for advice. For those who are ‘frequent flyers…those people, if they use the equipment comfortably on their own, then there’s a much greater chance of keeping them out of the hospital or ER for little or no reason.”

Nurses’ problems  Community nurses: Insufficient numbers of patients on THC = mixed caseload of THC + community  Hospital nurses: limited to THC three days per week

 Patients and nurses learned THC processes quickly and were very satisfied with care delivery  THC enabled patients to live with increased confidence, security, engage in disease management, improve quality of life  THC enabled nurses to deliver more timely patient care, provided patients with a decision- making tool regarding daily activities and disease management  In the absence of providing physical care, nurses’ focus turned to patient education, monitoring and support. Conclusion

 Expand urban partners and include rural sites  Expand care to include interdisciplinary team  Measure satisfaction, health service utilization and system costs and examine work processes to support THC implementation Next steps

Project website: Lynda Atack, R.N., Ph.D, Diane Duff, R.N.,Ph.D York University Contact information