title: Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned.
abstract: BACKGROUND
  Prior telemonitoring trials of blood pressure and blood glucose have shown improvements in blood pressure and glycemic targets. However, implementation of telemonitoring in primary care practices may not yield the same results as research trials with extra resources and rigid protocols. In this study we examined the process of implementing home telemonitoring of blood glucose and blood pressure for patients with diabetes in six primary care practices.
  
  
  METHODS
  Grounded theory qualitative analysis was conducted in parallel with a randomized controlled effectiveness trial of home telemonitoring. Data included semistructured interviews with 6 nurse care coordinators and 12 physicians in six participating practices and field notes from exit interviews with 93 of 108 randomized patients.
  
  
  RESULTS
  The three stakeholder groups (patients, nurse care coordinators, and physicians) exhibited some shared themes and some unique to the particular stakeholder group. Major themes were that practices should (1) understand the capabilities and limitations of the technology and the willingness of patient and physician stakeholders to use it, (2) understand the workflow, flow of information, and human factors needed to optimize use of the technology, (3) engage and prepare the physicians, and (4) involve the patient in the process. Although there was enthusiasm for a patient-centered medical home model that included between-visit telemonitoring, there was concern about the support and resources needed to provide this service to patients.
  
  
  CONCLUSIONS
  As with many technology interventions, careful consideration of workflow and information flow will help enable effective implementations.
authors.affiliation: 1 Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri School of Medicine , Columbia, Missouri.
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Koopman
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Wakefield
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Johanning
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Keplinger
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kruse
authors.forename: Marilee
authors.initials: M
authors.lastname: Bomar
authors.forename: Beth
authors.initials: B
authors.lastname: Bernt
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Wakefield
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D001795:Blood Pressure Determination; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000628:therapy; D006699:Home Care Services; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D010358:Patient Participation; D018802:Patient-Centered Care; D011320:Primary Health Care; D036301:Qualitative Research; D017216:Telemedicine; D013686:Telemetry
chemical_list: D001786:Blood Glucose