Hjemmemonitorering af ICD (Implantable Cardioverter Debrifillator) patienter – sundhedsinformatikkens indflydelse på interaktionen mellem patienter og sundhedsprofessionelle

Abstract

Dette projekt undersøger, hvorledes afprøvningen af et telemedicinsk pilotprojekt ved Rigshospitalet har forplantet sig. Patienter med implanteret ICD-enhed skal fremover håndtere brugen af en CareLink®Monitor til at scanne og transmittere data fra deres ICD-enhed til Rigshospitalet, frem for fysisk fremmøde til ambulant kontrol. Vores problemformulering lyder: Er det et problem for patienter med implanteret ICD-enhed, at de laver datatransmission frem for personligt fremmøde i ambulatoriet? Kan denne løsning med brug af informationsteknologi erstatte det personlige møde med den sundhedsprofessionelle for patienten med implanteret ICD-enhed? Vi har benyttet os af metodetriangulering som undersøgelsesdesign. Vores primære tilgang har været en spørgeskemaundersøgelse, som har ført hen til uddybende interview for at belyse vores problemstilling. Vores tilgang som forskere er med udgangspunkt i, at den verden vi bevæger os i er hyperkompleks jævnfør Lars Qvortrup. Herudover indeholder vores undersøgelsesgruppe en kompleksitet der gør, at vi ikke kommer udenom en tilgang som metoden Science-Technology-Society studies beriger os med i form af synet på begreberne symbolsk interaktionisme, posthumanitet samt cyborgs og feminisme. Specielt begrebet cyborgs har en interesse der har ført os hen til synet på fremtidens menneskekrop. Herudover har vi kastet vores blik på den hyperkomplekse organisation og systemteori, som unægtelig vil hænge sammen med vores undersøgelsesgruppe, som vil konsultere Rigshospitalet ved fremtidige kontroller af deres ICD-enhed. Vi har holdt vores empiri op mod vores teoretisk tilgang, og har fundet frem til, at vores emne er et meget følsomt område, hvor den menneskelige psyke spiller en stor rolle for vores patienter. Vores konklusion er, at man ikke kan sætte alle i vores undersøgelsesgruppe sammen som en stor mængde, men kan blive nødt til at graduere, så patienterne har mindre eller større tilknytning til Rigshospitalets Pacemaker-ambulatorie.

Introduction This thesis work examines how the testing of a telemedicine pilot project, including 50 patients at Rigshospitalet, Copenhagen, has been adapted by the patients. The thesis deals with how ICD-patients experience the possibility of having their ICD-unit monitored in their own homes and transmit the result by means of a CareLink ®Monitor to Rigshospitalet. Rigshospitalet has decided that patients, who have had an ICD-unit implanted, must in the future use the CareLink®Monitor to scan and transmit data from the ICD-unit to Rigshospitalet in stead of ambulant checks at the hospital. Problem statement Is it a problem for patients with an implanted ICD-unit to make the data transmission in stead of meeting in person at the ambulatory? Is it a good enough solution for all ICD-patients that the personal meetings with health professionals at the hospital have been substituted by information technology? Material and Method In this thesis the primary access has been a survey followed by elaborating interviews in order to illustrate the problem. (triangulation) The composition of the interview group constitutes a complexity, which means that the method “Science-Technology-Society” enriches the research in relation to the view on the concepts Symbolic Interaction, Post Humanity, Cyborgs and feminism. The applied theories have been selected because they deal with various aspects in relation to the fact that peoples’ lives after the implantation are dependent on the machine and on the fact that the interaction between the patients and the health professionals. The applied theories are: • the hyper-complex organization, • Luhmanns System theory • Goffman’s studies of inter-human interactions. Results ’ The survey shows that because of the CareLink ® Monitor, the patients are able to maintain contact with the health professionals, since they are only a phone call away. However, the study also shows that the main issue of the patients is not to avoid the transportation to Rigshospitalet, but rather that the check at the ambulatory did not meet the patients’ need for information. Discussion The findings of an empirical study, has been compared to the theoretical view and has revealed that the patients find the subject to be very sensitive and that the psychological factors influence highly on how the patients handle their situation. Our conclusion is that you cannot see the focus group as a whole, but that it is necessary to divide the group into those with more contact and those with less contact with the pacemaker ambulatory at Rigshospitalet. Acknowledgments Our thanks go to the persons, who have helped us through the process of making this project: Jesper Hastrup Svendsen, Helen Høgh Petersen, Ea Lorentzen, Lotte Wiehl Bønke, Marie Brask as well as the help we have received from our colleagues, friends and families. Address for correspondence Suzanne Buchardt Kongsgren SI05sba@fc.aau.dk Mie Christa Jensen Larsen SI05mcl@fc.aau.dk

A master programme thesis from Aalborg University

Hjemmemonitorering af ICD (Implantable Cardioverter Debrifillator) patienter – sundhedsinformatikkens indflydelse på interaktionen mellem patienter og sundhedsprofessionelle

[Home Monitoring of ICD- Patients (Implantable Cardioverter Defibrillator) – the Influence of Health Informatics on Interaction between Patients and Health Professionals]