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Table 2 Overview of included articles

From: Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature

Author and year Purpose of study Study design (& methods) Study participants Type of telecare service/system described Source of potential risk to patient safety
Brewer et al. (2010) [ [57]] To investigate perceptions of the safety, security and privacy of a telecare monitoring system Survey 127 different stakeholders Telecare monitoring for adults with developmental disabilities Change in nature of clinical work
Brewster et al. (2014) [ [53]] To analyse the impact of telehealth implementation on front-line nursing staff Systematic review Nursing staff Telehealth technologies for the management of COPD and CHF Change in nature of clinical work
Changes to staff workload
de Lusignan et al. (2001) [ [72]] To examine the acceptability, effectiveness and reliability of home telemonitoring Controlled pilot study 20 patients Pulse and blood pressure devices, video consultation equipment Technology issues
Patient dependency
Essén & Conrick (2008) [ [71]] To explore constituents and challenges related to innovation of technology-based services in the long-term homecare sector Case study (Focus groups, interviews, observation) Home-help managers and home-help staff and 10 operational/managerial staff Sensor-based telemonitoring system Lack of user knowledge (patients and staff)
Changes to workload
Lack of guidelines
Hanley et al. (2013) [ [74]] To explore experiences of users taking part in a RCT of remote blood pressure (BP) tele-monitoring. To identify facilitators or barriers to the effectiveness and routine uptake of the intervention Qualitative interview study 25 patients, 11 nurses and 9 doctors A home BP monitor and mobile phone technology for transfer of BP readings via SMS to a secure website Patient anxiety
Patient dependency
Poor system integration
Changes to workload
Accessibility issues
Hibbert et al. (2004) [ [65]] To document responses of nurses using telehealth equipment and identify service integration issues Ethnography (observation) 12 nurses A home telehealth nursing service for COPD patients, using videophone and vital signs monitoring Technology issues
Change in nature of clinical work
Hopp et al. (2006) [ [68]] To examine staff perceptions of opportunities and barriers of home-based telemedicine services for chronic illness care Qualitative interview study 37 direct telemedicine providers, primary care providers and hospital administrators Store-and-forward devices, video conferencing devices Lack of user knowledge (patients and staff)
Technology issues
Poor patient compliance
Change in nature of clinical work
Changes to workload
Horton (2008) [ [69]] To evaluate a home telecare service for COPD patients Qualitative study (focus groups and case study) 4 home care team and social care staff and 6 patients Daily monitoring of patients’ condition via call centre with community response service Technology issues
Lack of user knowledge (patients and staff)
Lu et al. (2014) [ [70]] To describe the use of home telehealth care for chronic disease management from users’ perspective Qualitative study (focus groups and interviews) 20 patients Telemonitoring of BP and/or blood sugar, provision of health care/consultations with healthcare professionals via computer or telephone Lack of user knowledge (patients)
Mair et al. (2008) [ [60]] To perform a process evaluation of a RCT of home telecare for the management of COPD Qualitative interview study 9 patients and 11 nurses A videophone link and attachments for remote physiological monitoring of vital signs Change in nature of clinical work
Changes to workload
Marziali et al. (2005) [ [77]] To assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home healthcare programmes Systematic review 107 articles describing studies on the use of telecare, featuring a variety of staff and/or service users Medical symptom monitoring using synchronous technology Lack of guidelines
Nilsson et al. (2010) [ [73]] To describe two district nurses’ experiences of using ICT to communicate with chronically ill people in their homes Qualitative interview study 2 district nurses An electronic messaging system to communicate with patients Technology issues
Radhakrishnan et al. (2012) [ [61]] To explore perceptions on effectiveness of telehealth for heart failure management in a homecare setting Mixed-methods (focus groups, interviews and questionnaire) 44 nurses and 4 patients A centralized model of daily telemonitoring of vital signs by a telehealth nurse, with in-person follow-up if needed Patient anxiety
Patient dependency
Lack of user knowledge (patients)
Changes to workload
Change in nature of clinical work
Lack of guidelines
Roberts et al. (2012) [ [75]] To evaluate a telehealth programme for long-term conditions Mixed-methods (questionnaire and interview) Patients, carers and 10 medical, healthcare and managerial staff Home-based touch screen facilities for clinical monitoring for COPD and hypertension patients Changes to workload
Sandberg et al. (2009) [ [62]] To understand the experiences of providers and the factors perceived to contribute to the success of telehealth interventions and user satisfaction Qualitative interview study 10 telemedicine providers (nurses and dietitians) A telemedicine unit with video-conferencing, blood glucose and blood pressure readings and educational materials Technology issues
Lack of user knowledge (patients)
Change in nature of clinical work
Shea & Chamoff (2012) [ [67]] To examine the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses Descriptive, correlational study 43 patients and 9 telehomecare nurses Telemonitoring; patients interact with nurses using a telestation that collects and transfers data via telephone lines Lack of user knowledge (patients and staff)
Sicotte & Paré (2011) [ [58]] To investigate how project risk management was applied in 9 mobile computing projects and how it shaped project outcomes Case studies (mixed-methods) 57 project leaders, nurse users and nurse pilots from 9 homecare units Mobile technology software for planning and organization of homecare nursing activities Technology issues
Poor system integration
Changes to workload
Skär & Söderberg (2011) [ [63]] To describe influences, benefits, and limitations in using ICT to meet chronically ill patients’ needs when living at home A descriptive, exploratory pilot study 2 patients, 1 relative, 1 district nurse and 5 personal assistants An application for information and communication between chronically ill people and the district nurse Change in nature of clinical work
Technical issues
Wälivaara et al. (2011) [ [64]] To describe the reasoning among general practitioners about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes Qualitative interview study 17 doctors Mobile distance-spanning technology for communication and diagnostic purposes Change in nature of clinical work
Lack of user knowledge (patients)
Wälivaara et al. (2009) [ [66]] To describe how people in need of health care at home view technology Qualitative interview study 9 patients Distance-spanning technology with mobile devices to measure vital signs Poor patient compliance
Lack of user knowledge (patients)
Accessibility issues
Change in nature of clinical work
Young et al. (2011) [ [76]] To seek accurate patient perspectives about benefits and challenges of a care coordination/home telehealth program Mixed-methods (survey and interviews) 25 patients Messaging devices, monitoring and measuring devices, video-phones and PCs Accessibility issues
Zayas-Cabán & Dixon (2010) [ [59]] To analyse human factors and ergonomics issues encountered during the design and implementation of home-based consumer IT applications Case studies (analysis of documents and discussion notes) 5 home-based consumer IT application projects Various IT applications including videophone, messaging systems and health monitoring devices Technology issues
Unsafe device arrangements