Experiences and Perceptions of Patient Watch, a Rural Telehealth Case Management Model, for Frequent Presenters to the Emergency Department: A Longitudinal Mixed Methods Study.

چکیده اصلی

OBJECTIVE: To evaluate: (1) patient experiences and perceptions of Patient Watch; and (2) the effect on emergency department (ED) presentations, healthcare use, quality of life and chronic illness care. DESIGN: A prospective longitudinal cohort study using a convergent-parallel mixed methods study design combining: (1) qualitative semi-structured interviews analysed using reflexive thematic analysis and (2) quantitative assessment of Quality of Life-8D, Patient Assessment of Chronic Illness, routinely collected ED clinical data and Patient Watch programme data. SETTING: A large public health service delivering care across the home, community, aged care and hospital, serving a regional centre and small, medium and large rural towns in Western Victoria, Australia. PARTICIPANTS: Forty-five participants were enrolled in the study. A subsample who completed all study requirements enabled baseline and 6-month follow-up analysis (n = 37). INTERVENTION: Patient Watch, a telehealth case management model of care adapted from a metropolitan to a rural context, to manage the care of frequent presenters to the emergency department. RESULTS: Before enrolment, patients reported health system, medical and situational complexity hindered effective care and contributed to high treatment burden, with acute exacerbations leading to increased healthcare use and negative care experiences. Patient Watch improved perceived care coordination, healthcare access and helped participants manage acute exacerbations. ED presentations (p < 0.001), hospital admissions (p < 0.001), general practitioner (p = 0.02) and specialist visits (p = 0.01) decreased at follow-up. CONCLUSIONS: Cohort heterogeneity challenged the effectiveness of a standardised care model, and the evolving nature of Patient Watch complicated impact evaluation. Frequent presenters showed diverse clinical and demographic profiles with high treatment burdens, highlighting the need for tailored care.

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