Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study.

OBJECTIVES: Telecare has not only brought down medical expenses, but has also become an important tool to address healthcare needs. In recent years, the Taiwanese government has been concerned about this healthcare issue. However, only a few hospitals provide telecare. This study aims at investigating the barriers that healthcare providers face while implementing home telecare in Taiwan. METHODS: A qualitative research design was employed in this study, with semi-structured in-depth interviews. The sample was obtained from five hospitals, including three medical centers and two regional hospitals. A total of 31 healthcare providers were interviewed, including case managers (n=11), administrators (n=7), physicians (n=7), and nurses (n=6). RESULTS: The results were summarized into five themes, including: (1) unsuitable laws and vague policies, (2) the policy implementation fails to meet public needs, (3) lack of organizational support, (4) lack of quality and convenience of the system, and (5) inadequate public perception and attitudes. CONCLUSIONS: Obstacles in policy and regulations are the most fundamental difficulties for telecare implementation, therefore the government should provide a clear direction by planning policies, legislate appropriate regulations, and incorporate telecare into the scope of medical insurance, in order to improve the environment and stimulate the telecare service market. In order to improve the success rate of telecare, administrators should be able to identify an appropriate cost-benefit model to build a humane system to satisfy public needs and to provide staff with resources and support.

Shared care combined with telecare improves glycemic control of diabetic patients in a rural underserved community.

OBJECTIVE: To investigate the effectiveness of shared care combined with telecare in type 2 diabetic patients in an underserved community in Asia. RESEARCH DESIGN AND METHODS: In total, 95 patients with type 2 diabetes who had a glycosylated hemoglobin (HbA1c) level of >7% were recruited from six community health centers in remote areas in Changhua County, Taiwan. All patients were randomly divided into intervention (shared care combined with telecare) and usual-care groups and followed up for 6 months. RESULTS: The decrease in HbA1c level was significantly greater in the intervention group than in the usual-care group (0.7 ± 1.3% versus 0.1 ± 1.0%, p=0.03). There were no significant differences in lipid profiles and blood pressure changes between the two groups. CONCLUSIONS: Shared care combined with telecare could significantly reduce HbA1c levels in type 2 diabetic patients with poor glycemic control in underserved rural communities. Further studies should be conducted to clarify the target users and to develop cost-effective interventions.