Transition of face-to-face care to telecare in a homecare organisation: a new way of caring

Transition of face-to-face care to telecare in a homecare organisationA new way of caring

Thijs van Houwelingen MSc, Ansam Barakat MSc, Prof. Dr. Helianthe Kort, Holder Faculty Chair Demand Driven Care05/11/13

This project is part of the strategic area ‘Healthcare & Technology’ ,University of Applied Sciences Utrecht

Research Centre forInnovations in Health Carewww.kenniscentrumivz.hu.nl

BackgroundMatter of transition

Objective of project: Obtain insight into

telecare possibilities for homecare organisations

that did not yet implement telecare

• Growing number of older adults & decreasing number of care professionals

• Telehomecare can offer a potential solution by supporting older adults to age-in-place [Pountney, 2009] by substituting more efficient e-visits for in-person

• Some Dutch homecare organisations are dealing with the question: how can we integrate telecare in our care pathways?

• Homecare organisations experience barriers to implementation (Kort, Van Hoof, 2012).

Background Background Project

GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)

Discussion Self-manag.

DiscussionNursing pract.

Conclusion


BackgroundProject – partners involved

Collaboration between

Research Centre Innovations in Health Care [coordination]

Education - Students, Bachelor of Nursing & Students Management in Health Care

[carried out the research]

Practice - Health Care Organisation Rivas Zorggroep [facilitator]

“Which telecare providers do we

have to select for our pilot?”

“Which nursing tasks can be

substituted by telecare?”


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


Goals Project

• Phase 1: Comparison of four telecare providers, aiming to advice Rivas which two telecare providers to include in their pilot


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


MethodPhase 1 – Comparison of telecare devices

1. Exploration of vision and values of healthcare organisation and demands with regard to telecare

2. Exploration of possibilities of four different telecare devices

3. Scoring of telecare providers

• Interviews• Nurses• Managers• Project manager

• Analyses of • Outcome of workshops • Vision of organisation

Assesment of devices: Comparison of demands of organisation with possibilities devices, resulting in a scoring list

Interviews with telecare providers


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


ResultsPhase 1 – Comparison of telecare devices (a)

Examples of demands of homecare organisation with regard to telecare

Functions• Connection with other

platforms • Additional possibilities,

non-care related, such as: gaming, grocery shopping service

Service• Security criteria

(requirement of Dutch health insurance)

• Service desk, in case of emergency

Application of device• Possibility to monitor

• Puff inhalation COPD patients

• Wound care• Medication intake • Communication with

dietician at distance

Offer of education Completeness of the course


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


Results Phase 1 – Comparison of telecare devices (b)

Demands and requirements / Telecare supplier

Application of device(maximum score = 56 points)

Functions of device (maximum score = 21 points)

Service of device (maximum score = 42 points)

Offer of training (maximum score 14)

Total score (maximum score133 points)

Device a ++ (55) ++ (19) +/- (25) ++ (13) 112

Device b ++ (53) ++ (20) +/- (28) ++ (12) 112

Device c ++ (55) ++ (20) - (24) + (11) 110

Device d +/- (38) +/- (14) -- (14) + (10) 76

Table 1. Comparison of (a) demands and (b) possibilities of devices

Conclusion (phase 1)

• Three of the four telecare providers showed a comparable level of quality

• One telecare providers failed in particular on ‘functions’ and ‘service’


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


Goals Project

• Phase 2: Exploration of care tasks that can be substituted by telecare


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


MethodPhase 2 – Exploration of telecare tasks

1. Development of a complete list of care tasks, provides by the homecare organisation

2. Estimation of time required for each task

3. Assessment of care tasks: which tasks can be provided via telecare?

4. Estimation of time for each possible telecare task

5. Reach consensus of tasks that can be substituted and times that can be saved in this particular organisation

According to:• Representatives of the two

selected devices• Homecare organistions that already

use telecare

Interviews with district nurses of Rivas

Based on experience of nurses and their managers

In collaboration with district nurses of Rivas


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


Results Phase 2 – Exploration of telecare tasks (a)

• Inhalation with nebuliser• Subcutaneous injection• Stoma care• Medication intake monitoring• Structuring conversations• Blood pressure measurement • Glucose value measurement• Et cetera

In total 55% of the 97 care tasks can be done trough telecare…

Care tasks that can be substituted by telecare /e-visits


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


Results Phase 2 – Exploration of telecare tasks (b)

and 67% when combining telecare and family carers

However…

Managing 55% of the care tasks instead of providing them directly, sets high demands on older adults’ willingness to play an active role in their care process


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


DiscussionImplications for self-management

At the same time, recently (2013) a Dutch survey observed that “few Dutch older adults choose to use self-management tools” [Krijgsman et al., 2013]

So, the transition of face-to-face care to telecare has great implications for self-management of patients

On of the reasons that UUAS in 2011 already started the PETZ-project: Predictors for the Use of eHealth by Older Adults and Professionals (www.petz.hu.nl)


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion

http://www.petz.hu.nl/


DiscussionImplications for nursing practice

New eHealth competencies are required [Barakat et al., 2013], for example• Have basic skills for using technology and hardware• Ability to treat and diagnose effectively at a distance• Know and be able to translate the benifits of eHealth

technologies to end users (http://www.medicine20.com/2013/2/e10/)

A changing role: less providing care directly, more coaching Coordinating care, carried out by the patient himself or his family carers (self-management)

Barakat et al., (2013). eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop. Medicine 2.0.


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion

http://www.medicine20.com/2013/2/e10/




ConclusionFuture challenges for research and nursing education

Nursing education Nursing schools should take the responsibility to offer an adequate preparation for the rapidly changing health care sector:

• Education on eHealth• Education on self-management

Future research– More evidence on competencies required for telecare /

eHealth [Van Houwelingen et al., 2013]

– More evidence on competencies required for self-management support

Van Houwelingen et al., (2013). Using the Unified Theory of Acceptance and Use of Technology to Explore Predictors for the Use of Telehomecare by Care Professional. Assistive Technology Research Series, 33: Assistive Technology: From Research to Practice.


GoalsPhase 1

MethodPhase 1

Results Phase 1 (a)

Results Phase 1 (b)

GoalsPhase 2

Method Phase 2

Results Phase 2 (a)

Results Phase 2 (b)



Conclusion


date05/11/13

Transition of face-to-face care to telecare in a homecare organizationA new way of caring

Thank you for your attention!

/

Thijs van Houwelingenthijs.vanhouwelingen@hu.nlwww.innovationsinhealthcare.research.hu.nl

A special acknowledgment goes to Angela van Ark, Maartje van Oorschot, students Management in Healthcare, and Maria-Lotte Haagsman, Romy van Ruitenbeek, Sharron Jalimsing, Conny van Ruitenbeek, students Bachelor Studies of Nursing, University of Applied Sciences Utrecht. We are thankful for the effort they have put into this research.

References [1] Pountney, D. (2009). Telecare and telehealth: enabling independent living. Nursing & Residential Care, vol. 11, p. 158.[2] Krijgsman, Johan, Jolanda de Bie, Arina Burghouts, Judith de Jong, Geert-Jan Cath, Lies van Gennip, Roland Friele. eHealth, verder dan je denkt: eHealth-monitor 2013. Den Haag: Nictiz en NIVEL, 2013. url https://www.zorgkennis.net/downloads/kennisbank/ZK-kennisbank-eHealth-monitor-2013-1928.pdf [3] Barakat A., R.D. Woolrych, A. Sixsmith, W.D. Kearns, H.S.M. Kort. eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop. Medicine 2.0, 2013, 2, e10. doi:10.2196/med20.2711. [4] Houwelingen, T. van, A. Barakat, A. Antonietti & H. Kort (2013). Using the Unified Theory of Acceptance and Use of Technology to Explore Predictors for the Use of Telehomecare by Care Professionals. In: P. Encarnação et al. (Eds.), Assistive Technology Research Series, 33: Assistive Technology: From Research to Practice (pp. 1223 - 1228). IOS Press, Amsterdam. doi: 10.3233/978-1-61499-304-9-1223[5] Kort, H.S.M., J. van Hoof (2012). Telehomecare in The Netherlands: Barriers to Implementation. International Journal of Ambient Computing and Intelligence, 4(2), 64-73. doi: 10.4018/jaci.2012040105

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https://www.zorgkennis.net/downloads/kennisbank/zk-kennisbank-ehealth-monitor-2013-1928.pdf



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Transition of face-to-face care to telecare in a homecare organisation: a new way of caring