Patients' experiences with learning a complex medical device for the self-administration of nocturnal home hemodialysis.

UNLABELLED: The purpose of this study was to explore patient training experiences related to the self-administration of hemodialysis at home. Researchers used a qualitative study using semi-structured interviews and a focus group. The setting was a hospital-based patient education program in Toronto, Ontario, Canada. Qualitative interviews and focus group study were conducted with 23 patients (who had end stage renal disease) and caregivers who have participated in Toronto General Hospital's Nocturnal Home Hemodialysis training program to learn how to operate a hemodialysis machine and to administer their own treatments at home without the supervision of clinicians. RESULTS: Experience as a trainee in the Nocturnal Home Hemodialysis program was framed by 5 diverse themes: patients' perceptions of anxiety, peer support, clinician empathy and understanding learning while ill, and the compatibility of learning preferences with training practices employed. CONCLUSIONS: The study revealed the complexity of the patients' experience with being prepared for a self-treatment regime at home. Although it was anticipated that the most important barrier to patient preparation would be the challenges of managing complex medical technology, psychosocial dimensions of their experiences were the primary factors impacting on the patients' ability to learn and to take on self-care responsibility. If the trend of patient self-treatment at home continues to increase, it is important for clinician educators to be attentive to self-treatment as a socially situated activity.

Telemanagement of hypertension: a qualitative assessment of patient and physician preferences.

BACKGROUND: Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25%. Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure. Major design flaws and high operating costs, however, have hindered its adoption by physicians and patients. OBJECTIVES: In the present commentary, the field of telemedicine, as it pertains to hypertension management, is reviewed, and the investigators' experiences in developing a new telemedicine system are outlined. METHODS: An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system. Opinions were elicited separately from type 2 diabetic patients with hypertension (n=24) and family practitioners in active clinical practice (n=18). RESULTS: Physician and patient focus group meetings provided key information that led to changes in the prototype system. The low level of computer and Internet use by patients in everyday life and by physicians in practice-related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts. For patients, the mobile phone appeared to be an acceptable alternative. The only practical, automated means to disseminate reports and alerts to physicians was by fax, which was the most universally available device in a doctor's office. CONCLUSION: This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness.