Impacts of telehomecare on patients, providers, and organizations.

Over the last decades, development of home care services is an important component of ongoing health care systems reforms. However, their full integration into hospital or primary care services is still progressing slowly. It appears that telehomecare (THC) could help create networks of services between hospital and primary care providers. Even though their potential to increase access to services and improve quality of care and health outcomes is recognized, their widespread adoption has not yet been achieved. Various barriers need to be overcome. In this paper, we present our comparative exploratory process analysis of the use of THC to follow the treatment of elderly people suffering from severe chronic conditions (chronic obstructive pulmonary disease [COPD], hypertension, cardiac insufficiency). The technology was first introduced as a pilot project in three sites (one site in Quebec and two sites in Manitoba, Canada). Our study is based on qualitative methods. It includes a longitudinal analysis of implementation processes and monitoring of results. Our analysis allows us to identify some of the major impacts on patients and providers, and explain how they may be achieved. Also, because of the major changes in work processes, THC introduces new models of home care delivery. Two models are identified: a specialized model and a planned polyvalent model. Such profound changes raise two major challenges for managers and providers. First, the organisation of work, traditionally based upon preestablished intervention plans, must adapt to respond to ad hoc patients' needs and alerts. Second, constant linkages between the traditional and new models of services delivery become mandatory.