Analysis of the OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) tele-monitoring system in primary care as perceived by healthcare professionals using the CFIR framework.

OBJECTIVE

Telemedicine has been increasingly adopted post-COVID-19 to optimise chronic disease management, improving patient outcomes. The multi-component OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) tele-monitoring (TM) system yielded favourable health outcomes and was introduced in primary care nationwide in Singapore. This study aims to understand the factors associated with its implementation during the randomised controlled trial (RCT).

DESIGN

A qualitative study was conducted using individual semi-structured interviews. Data were transcribed, audited, coded and analysed using thematic analysis. The CFIR (Consolidated Framework for Implementation Research) framework, consisting of five domains (Intervention characteristic, Outer setting, Inner setting, Characteristics of individuals and Process), was adopted as the underpinning framework.

SETTING

Primary care setting in Singapore.

PARTICIPANT: Healthcare professionals involved in the care provided to patients enrolled in the OPTIMUM RCT.

RESULTS

TM facilitated behavioural change in patients, and its robust treatment algorithm allowed continuous monitoring and personalised advice. The associated external factors were manpower, costing and data security. Measures to mitigate internal risks included managing additional healthcare professionals' burden, reducing potential adverse events and addressing medicolegal risks related to TM. While TM enhanced provider satisfaction and the patient-healthcare professional relationship, strategies to enhance user experience and streamline the TM processes are required to improve its acceptance and adoption.

CONCLUSION

The CFIR served as a useful framework to identify factors associated with successful implementation of an intervention in a real-world setting. Understanding these factors enables healthcare leaders to address the challenges before scaling up the intervention in routine clinical services.