Telemedicine in diabetes foot care delivery: health care professionals' experience.
BACKGROUND
Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals' experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers.


METHODS
Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2).


RESULTS
The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants' attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high.


CONCLUSIONS
Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.
Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway. bchk@hib.no.
Beate-Christin Hope
BC
Kolltveit
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Faculty of Health and Social Care, Molde University College, Molde, Norway.
Eva
E
Gjengedal
Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.
Marit
M
Graue
Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.|Departement of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
Marjolein M
MM
Iversen
School of Nursing, University of British Columbia, Vancouver, Canada.
Sally
S
Thorne
Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.|Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
Marit
M
Kirkevold
D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006699:Home Care Services; D006801:Humans; D008297:Male; D011320:Primary Health Care; D017216:Telemedicine
Diabetic foot ulcer; Focus groups; Health care professionals; Interpretive Description; Telemedicine