title: A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients.
abstract: BACKGROUND
  The implementation of telemedicine often introduces major organizational changes in the affected healthcare sector. The objective of this study was to examine the organizational changes through the perception of the healthcare professionals regarding the implementation of a telemedical intervention. We posed the following research question: What are the key organizational factors in the implementation of telemedicine in wound care?
  
  
  METHODS
  In connection with a randomized controlled trial of telemedical intervention for patients with diabetic foot ulcers in the region of Southern Denmark, we conducted an organizational analysis. The trial was designed as a multidisciplinary assessment of outcomes using the Model of ASsessment of Telemedicine (MAST). We conducted eight semi-structured interviews including individual interviews with leaders, and an IT specialist as well as focus group interviews with the clinical staff. A qualitative data analysis of the interviews was performed in order to analyze the healthcare professionals and leaders perception of the organizational changes caused by the implementation of the intervention.
  
  
  RESULTS
  The telemedical setup enhanced confidence among collaborators and improved the wound care skills of the visiting nurses from the municipality. The effect was related to the direct communication between visiting nurses and specialist doctors. Focus on the training of the visiting nurses was highlighted as a key factor in the success to securing implementation. Concerns regarding lack of multidisciplinary wound care teams, patient responsibility and lack of patient interaction with the physician were raised. Furthermore, the need for clinical guidelines in future implementation was underlined.
  
  
  CONCLUSIONS
  Several influential factors were demonstrated in the analysis including visiting nurses wound care training, focus on management, economy, periods with absence from work and clinical care. However, the technology used here could provide an additional option to offer patients after an individual assessment of their health condition.
authors.affiliation: Department of Medical Endocrinology, Odense University Hospital, Denmark; Center for Innovative Medical Technology, Odense University Hospital, Denmark. Electronic address: bsr@rsyd.dk.
authors.forename: B S B
authors.initials: BS
authors.lastname: Rasmussen
authors.affiliation: Center for Innovative Medical Technology, Odense University Hospital, Denmark.
authors.forename: L K
authors.initials: LK
authors.lastname: Jensen
authors.affiliation: Department of Orthopaedic surgery, Odense University Hospital, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Froekjaer
authors.affiliation: Center for Innovative Medical Technology, Odense University Hospital, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Kidholm
authors.affiliation: Center for IT Innovation, University of Copenhagen, Denmark.
authors.forename: F
authors.initials: F
authors.lastname: Kensing
authors.affiliation: Department of Medical Endocrinology, Odense University Hospital, Denmark.
authors.forename: K B
authors.initials: KB
authors.lastname: Yderstraede
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D003197:Computer Literacy; D003718:Denmark; D016523:Foot Ulcer / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D017146:Models, Organizational; D018670:Monitoring, Ambulatory / Q000379:methods; D064691:Nurses, Community Health / Q000458:organization & administration*; D019114:Remote Consultation / Q000458:organization & administration*
keywords: Diabetes; Diabetes care; Evaluation; MAST; Organization; Qualitative analysis; Telemedicine; Wound