Bond, Carol S.

Worswick, Louise

English

Bournemouth University Research Online

Medicine 2.0 World Congress on Social Media, Mobile Apps, Internet / Web 2.0 Conference website  http://www.medicine20congress.com/ocs/index.php/med/ Author’s conference papers archive  http://www.medicine20congress.com/ocs/social/cbond  Telehealth – Participative or Paternalistic ? Carol S Bond Louise Worswick  Two of the aims of the UK health service in introducing telehealth for patients living with long term conditions are to achieve ‘more effective self care’ and to ‘increase [patients’] confidence to manage their own health’.  A 12 month evaluation into the introduction of a telehealth service for people with COPD in one area of the UK was carried out. The telehealth service supplied patients with health devices to monitor their oxygen saturation, blood pressure, temperature and weight, all managed through an ipad style device that both presented them with questions about how they were feeling and sent their readings to their nurse. The evaluation lasted 12 months, and included a questionnaire and qualitative telephone interviews with a purposive sample of 32 patients who had given prior consent. A Focus group and 1-1 interviews were held with ten nurses managing the service.  Participants in the evaluation fell into two categories; Those who felt supported and reassured by the knowledge that nurses were ‘keeping an eye on them’ such as Bill who said ‘Well they’re keeping an eye on me y’know, I know somebody’s watching all the time’. Others, such as Doris, felt that having the equipment available enabled them to better self- manage explaining ‘ I’ve been using it once a week, and transfer the details to [nurse] … but if I’ve felt unwell in the meantime then I’ve used it for my own sort of, to know what my sats are and how to deal with them, … and regulate the medication if I have to’. The nurses were generally unaware of how some patients were using the equipment to support their self management.  A few patients felt disempowered by the system, Peter explained ‘I just do the results and then I press send but that’s all I was told to do’, but then added that he would like to understand more about the readings and what they meant.  Some of the nurses descriptions suggested they ‘owned’ the system. The protocol required them to agree telehealth goals with their patients. Patients however did not consider that they had been involved, comments from the nurses support this, ‘I explain to them the reasons why they’re going on it and I say it’s for early detection of deterioration or to help us to increase the medication and make sure the medication is suiting you’. One nurse, talking about how long patients expected to stay on Telehealth explained’ I’ll say to them this is our property in a nice sort of way and it could come out at any sort of time’’  Our evaluation found that Telehealth has the potential to support participatory healthcare, some patients are able to partner healthcare professionals with minimal support, whilst others may need some assistance to learn how to use the monitoring equipment to best effect. Although the policy and the stated aims of the nurses want to achieve effective self-management the paternalistic nature of some of the Telehealth relationships is a barrier to moving this forward. 

Telehealth – Participative or Paternalistic ?

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