Roles and identities in transition: boundaries of work and inter-professional relationships at the interface between telehealth and primary care

Abstract

Shifting the balance of care towards home and community is viewed as requiring interventions which enhance or complement primary care. Technology-based interventions are seen as key to the future in this work. Telehealthcare implicates a new agenda for inter-professional working across boundaries of healthcare. One such interface is between telehealthcare professionals and professionals located in primary care. This study reports the findings from a qualitative study forming part of a broader project examining the potential of developing and implementing telehealth interventions to support patients with long-term conditions. Semi-structured interviews were undertaken with telehealth nurse care managers, practice nurses and general practitioners in their respective work settings (39 interviews with 62 participants). Observation was undertaken at a telehealth call centre. The research took place between April 2010 and March 2011. Thematic analysis of qualitative data was undertaken. Telehealth nurse care managers' interviews suggested narrative constructions of new roles and identities to fit telehealth work, combining a holistic ideal and retro-appeal with 'traditional' values of nursing, which distinguished and distanced them from counterparts in general practices. Practice nurses and general practitioners were ambivalent and often sceptical about the contribution of telehealth to long-term condition work. Practice nurses' accounts suggested a sense of protectiveness about maintaining boundaries around established remits of managing long-term conditions; general practitioners, having devolved much of the care of long-term conditions to nurses, were keen to retain their positions as gatekeepers to resources. Perceptions of shifts of professional roles, new ways of working and how they are valued form a relevant contextual element to the introduction of telehealth interventions. A pre-emptive view and response to how professionals understand and approach increasingly complex and multi-faceted roles within primary care is likely to prepare and facilitate the introduction and integration of telehealth innovations into existing patient services.

“Teleswallowing”: a case study of remote swallowing assessment

“…Some did not value the prospect of doing remote assessment; others over imagined the possible consequences, i.e. being stuck behind a computer all day (Brewster et al, 2013;Segar et al, 2013):…”

“…additional, bolt on innovations rather than being core services) (Taylor et al, 2015;Vuononvirta et al, 2011;Wade et al, 2010);  inappropriate selection of patients (Taylor et al, 2015); and  lack of staff acceptance (Brewster et al, 2013;Buck, 2009;Joseph et al, 2011;Odeh et al, 2014;Segar et al, 2013;Taylor et al, 2015;Vuononvirta et al, 2009;Vuononvirta et al, 2011;Wade et al, 2010).…”

Evaluation of a National Broadband Network-enabled Telehealth trial for older people with chronic disease

“…The THNs were able to provide advice, taking into consideration the idiosyncrasies and knowledge of the patient they acquired over time. 39,40 We suggest that this resulted in greater tailoring of health information from the THN, as well as improving participants' knowledge and understanding of the relationship between their health behaviour and their vital signs readings. The increased knowledge and understanding of their condition led to participants increasing positive behaviours, such as eating more fruit and vegetables, drinking more water and increasing physical activity.…”

“…45 Telehealth is believed to provide the opportunity to empower and motivate patients to gain greater control over disease management. 19,40,45 However, little is known about the processes by which telehealth may do this. 22 The present study provides insights into the mechanisms by which patients can be more engaged with their health care and self-management, which can lead to a better understanding of their condition, improved health behaviours and improved self-management, as perceived by the patient.…”

Self Management and Telehealth: Lessons Learnt from the Evaluation of a Dorset Telehealth Program

“…Much previous the research into telehealth has focused on operational issues such as cost effectiveness (2, 10), effective working practices (11,12) and barriers to adoption (13). Where patients' experiences were considered the focus was often on the reassurance afforded by using telehealth (14).…”