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Greenhalgh T.,University of Oxford | Procter R.,Coventry University | Wherton J.,Center for Primary Care and Public Health | Sugarhood P.,East London NHS Foundation Trust | And 2 more authors.
BMC Medicine | Year: 2015

Background: We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. Methods: This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. Results: Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. Conclusions: Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and delivery. For the ARCHIE principles to be realised, the sector requires: (1) a shift in focus from product ('assistive technologies') to performance ('supporting technologies-in-use'); (2) a shift in the commissioning model from standardised to personalised home care contracts; and (3) a shift in the design model from 'walled garden', branded products to inter-operable components that can be combined and used flexibly across devices and platforms. © 2015 Greenhalgh et al.; licensee BioMed Central.

Wherton J.,Center for Primary Care and Public Health | Sugarhood P.,East London NHS Foundation Trust | Procter R.,University of Warwick | Hinder S.,Center for Primary Care and Public Health | Greenhalgh T.,University of Oxford
Implementation Science | Year: 2015

Background: The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. Method: We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Results: Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. Conclusions: The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use. © 2015 Wherton et al.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2011

Advances in technology over the last ten years have allowed for greater choice of compression therapy. Leg ulcer services need to provide up-to-date, high quality services that ensure safety, effectiveness and improvements to the patient experience. This includes monitoring and reporting on leg ulcer healing rates and prevention of recurrence. This paper discusses a redesign in a community leg ulcer service, including the introduction of RAL compression hosiery. Healing rates improved from 36% at 12 weeks to 72%, and from 40% at 24 weeks to 100%. Recurrence rates for venous leg ulcers also reduced from 18-20% to 5.8%.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2012

Leg ulcers are common and expensive to treat, with the quality of care varying widely across different areas. The introduction of nurse-led community-based clinics has shown increased ulcer healing rates and lowered rates of recurrence. The author assesses the benefits of following this model of care and explains how providers can set up a business case for service redesign.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2012

Negative pressure wound therapy (NPWT) has become more accessible and is frequently used in the management of a variety of wounds. However, disparity exists in aspects of NPWT, such as the optimal pressure and the best wound filler. Gaps also exist in the evidence base for the use of NPWT in some wound types, for example in leg ulcers. In an attempt to address this, international consensus statements have been developed by an expert panel and are being disseminated in the UK. This article discusses the recommendations and provides an insight into current thinking and practice on the use of NPWT in acute and chronic wounds.

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