title: Integrating telecare for chronic disease management in the community: what needs to be done?
abstract: BACKGROUND
  Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community.
  
  
  METHODS
  Large scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory. Drawn from telecare services in community and domestic settings in England and Scotland, 221 participants were included, consisting of health professionals and managers; patients and carers; social care professionals and managers; and service suppliers and manufacturers.
  
  
  RESULTS
  Key barriers to telecare integration were uncertainties about coherent and sustainable service and business models; lack of coordination across social and primary care boundaries, lack of financial or other incentives to include telecare within primary care services; a lack of a sense of continuity with previous service provision and self-care work undertaken by patients; and general uncertainty about the adequacy of telecare systems. These problems led to poor integration of policy and practice.
  
  
  CONCLUSIONS
  Telecare services may offer a cost effective and safe form of care for some people living with chronic illness. Slow and uneven implementation and integration do not stem from problems of adoption. They result from incomplete understanding of the role of telecare systems and subsequent adaption and embeddedness to context, and uncertainties about the best way to develop, coordinate, and sustain services that assist with chronic disease management. Interventions are therefore needed that (i) reduce uncertainty about the ownership of implementation processes and that lock together health and social care agencies; and (ii) ensure user centred rather than biomedical/service-centred models of care.
authors: University of Southampton, UK.
authors: Carl R
authors: CR
authors: May
authors: Tracy L
authors: TL
authors: Finch
authors: James
authors: J
authors: Cornford
authors: Catherine
authors: C
authors: Exley
authors: Claire
authors: C
authors: Gately
authors: Sue
authors: S
authors: Kirk
authors: K Neil
authors: KN
authors: Jenkings
authors: Janice
authors: J
authors: Osbourne
authors: A Louise
authors: AL
authors: Robinson
authors: Anne
authors: A
authors: Rogers
authors: Robert
authors: R
authors: Wilson
authors: Frances S
authors: FS
authors: Mair
references: Telemed J E Health. 2008 Sep;14(7):720-5
references: 18817503
references: BMJ. 2003 Nov 22;327(7425):1205-9
references: 14630758
references: Sociol Health Illn. 2006 Jul;28(5):513-32
references: 16910945
references: Health Policy. 2003 Apr;64(1):39-54
references: 12644327
references: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006093
references: 19160265
references: J Am Med Inform Assoc. 2003 Nov-Dec;10(6):596-604
references: 12925553
references: J Med Syst. 2012 Feb;36(1):241-77
references: 20703721
references: BMC Health Serv Res. 2011 May 27;11:131
references: 21619596
references: Nat Clin Pract Cardiovasc Med. 2007 Nov;4(11):588-9
references: 17712318
references: Eur J Heart Fail. 2009 May;11(5):506-17
references: 19332417
references: J Med Internet Res. 2007 Dec 14;9(5):e37
references: 18093904
references: J Telemed Telecare. 2007;13(4):172-9
references: 17565772
references: J Telemed Telecare. 2007;13(6):303-9
references: 17785027
references: Implement Sci. 2009 May 21;4:29
references: 19460163
references: BMJ. 2009 Aug 11;339:b2803
references: 19671932
references: Soc Sci Med. 2012 Feb;74(3):348-355
references: 21444137
references: J Med Internet Res. 2010 Jun 16;12(2):e21
references: 20554500
references: Int J Technol Assess Health Care. 2010 Apr;26(2):211-6
references: 20392326
references: Telemed J E Health. 2009 Nov;15(9):877-83
references: 19919194
references: Br J Dermatol. 2007 Mar;156(3):521-7
references: 17300243
references: Am J Manag Care. 2009 May;15(5):313-20
references: 19435399
references: Soc Sci Med. 2011 Feb;72(3):347-54
references: 20880624
references: Health Soc Care Community. 2005 Mar;13(2):170-80
references: 15717919
references: J Telemed Telecare. 2007;13 Suppl 2:1-38
references: 18005523
references: BMC Health Serv Res. 2006 Jul 07;6:86
references: 16827928
references: Implement Sci. 2007 Jul 27;2:25
references: 17662134
references: Milbank Q. 2004;82(4):581-629
references: 15595944