Table 1 Application of the Normalization process model to telehealthcare services
From: A rational model for assessing and evaluating complex interventions in health care
Telemedicine intervention | Interactional workability | Relational integration | Skill-set workability | Contextual integration |
|---|---|---|---|---|
Video-conferencing system for psychiatric consultations in primary care [37, 91] | Low: poor quality of mediated interpersonal communications interfered with extant frame of professional-patient interaction. | Low: uncertainty about meaning of expressed symptoms and about interpersonal responses undermined embedded trust relations. | Low: uncertainty about how to distribute different modes of teleconsultation across team members from multiple professional groups, including psychologists, nurses and occupational therapists. | Low: added complexity to inter-professional relationships across interface between primary and secondary care. Lack of flexible integration into primary care service delivery. |
Remote diagnosis for non-urgent dermatological conditions [7, 92] | Moderate: focus of professional-patient interaction was divided between the apparatus (digital camera) and a computer-driven protocol. | High: trust relations between patients and nurses administering intervention maintained. Trust relations between patients, referring primary care physicians and hospital based dermatologists were undisturbed. | High: intervention was appropriate to nurses administering intervention, and enhanced their skills. It led to specialist nurses operationalizing high level clinical knowledge that overlapped with medical specialists. | Low: service added complexity and workload to specialist physicians. Set up in parallel to existing services it added complexity to the funding, organization and delivery of outpatients' clinics. |
Nurse-led home telecare for people with COPD [93, 94] | Moderate: Health professionals and patients are able to communicate effectively. Nurses were concerned about risks attached to distal care of people in danger of sudden exacerbation events. | High: trust relations between patients and nurses remain high. Confidence in service provision across primary-secondary interface is undisturbed. | High: intervention is well suited to provision by specialist nurses. | Moderate: service adds complexity and workload to secondary care. |