A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients

•The most significant change was the new kind of communication between the visiting nurses and the outpatient clinical staff. This lead to direct communication between wound specialists (i.e., physicians) and visiting nurses as opposed to communication between general practitioners and visiting nurses.•Some concerns were raised as to whether the telemedical approach could reduce the hands-on skills and the multidisciplinary approach in the specialized wound healing centers.•The technology did not lead to any noteworthy difficulties. However, some practical education was needed in order to provide images of a sufficient clinical quality, and not all types of smartphones worked equally well for this purpose. The visiting nurses stated that most of the difficulties were due to image quality and poor light conditions in the patient’s home.•Participants were offered training in the use of telemedical equipment. This did not only lead to confidence in use but, due to the mixture of participants including municipalities and the outpatient clinics, it enhanced collaboration and confidence across sectors.•Participants experienced challenge during holidays or sick leaves. The number of visiting nurses trained in wound care and telemedicine in each municipality was limited, and thus in case of these situations no other visiting nurse could conduct the telemedical consultation.

IntroductionThe 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?MethodsIn 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.ResultsThe 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.ConclusionsSeveral 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.