Mobile distance-spanning technology in home care : views and reasoning among persons in need of health care and general practitioners

Sammanfattning: The overall aim of this licentiate thesis was to describe views and reasoning about the use of mobile distance-spanning technology (MDST) in health care at home, from the perspectives of persons in need of health care and general practitioners (GP). A descriptive qualitative approach was chosen to achieve the overall aim. Individual qualitative research interviews and qualitative group research interviews were used for data collection. Qualitative content analysis and qualitative thematic content analysis were used for data analysis.The findings show that persons in need of health care at home recognized MDST as being similar to the technology used at hospital. They described the MDST at home as acceptable but still in its infancy. The limited experiences in using MDST led to some persons doubting the reliability of the examinations routinely carried out at home instead of at hospital. When using the MDST, more examinations can be performed at home but there was some overconfidence concerning the possibility of what MDST can achieve. They saw the staff as users of the MDST, and the MDST should not be used by the persons or their family members. The MDST was seen as possible for distance communication but personal meetings with a GP or a nurse also have to be possible. The GPs must know the person concerned before making decisions at a distance. The persons felt that as long as it is easy to go to the healthcare centre or to the hospital the examinations should be done there, but if they are in a bad condition and there are long distances, then examinations at home become relevant. In an emergency situation, going to hospital rather than staying at home was inevitable and obvious. The MDST at home was described as a part of a chain which can be efficient only when other parts of the chain are taken good care of. When the MDST was assumed to be safe and secure then it could be used on a permanent basis at home, but this decision had to be made by DNs and GPs. The GPs reasoned that the MDST should be used with caution. There is a professional caution, which is based on the GPs' professional experiences, responsibilities and skills. Human meetings were seen as important for performing secure judgments and as the basis for health care, but some meetings can be replaced by virtual meetings. A virtual meeting could be useful for the patients and their families but it depends on their expectations. It could benefit them but there is also an overconfidence concerning what MDST can do. The GPs reasoned about the MDST in general and the usability of different diagnostic tools. The MDST was described as being not yet fully developed. Sometimes the MDST could support the GPs' decisions, but when handling very complicated cases, meeting the patient and understanding his or her context was seen as highly important. Expanded access to patient records facilitates the GPs work but the patient's integrity has to be ensured. It is easy for nurses to do more during home visits, but there must be an agreement between the nurse and the GP regarding how to handle the responsibility.The results in this thesis indicate that the participants attach both positive values about MDST as well as believing that some tools have no value at all. This is important when attempting to understand what is important for persons in need of health care and for GPs benefit when planning health care at home for the future.