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How the Integration of Telehealth and Coordinated Care Approaches Impact Health Care Service Organization Structure and Ethos: Mixed Methods Study

Davidson, Rosemary; Barrett, David Ian; Rixon, Lorna; Newman, Stanton; ACT Program; Bescos, Cristina; Westerteicher, Christoph; Pauws, Steffen; Schonenberg, Helen; Natsiavas, Pantelis; Filos, Dimitris; Maramis, Christos; Chouvarda, Ioanna; Maglaveras, Nicos; Nabb, Samantha; Roca, Josep; Escarrabill, Joan; Moharra, Montserrat; Cleland, John; Hart, Nicholas; Monterde, David; Mora, Joana; Keenoy, Esteban de Manuel; Ponce, Sara; Buskens, Erik; Lahr, Maarten M.H.; Romano, Maria; Nalin, Marco; Baroni, Ilaria; Pavlickova, Andrea; Rasmussen, Jill; Störk, Stefan; Wahl, Chris


Rosemary Davidson

David Ian Barrett

Lorna Rixon

Stanton Newman

ACT Program

Cristina Bescos

Christoph Westerteicher

Steffen Pauws

Helen Schonenberg

Pantelis Natsiavas

Dimitris Filos

Christos Maramis

Ioanna Chouvarda

Nicos Maglaveras

Samantha Nabb

Josep Roca

Joan Escarrabill

Montserrat Moharra

John Cleland

Nicholas Hart

David Monterde

Joana Mora

Esteban de Manuel Keenoy

Sara Ponce

Erik Buskens

Maarten M.H. Lahr

Maria Romano

Marco Nalin

Ilaria Baroni

Andrea Pavlickova

Jill Rasmussen

Stefan Störk

Chris Wahl


Background: Coordinated care and telehealth services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximize the delivery of clinical services. Such services require new behaviors, routines, and ways of working to improve health outcomes, administrative efficiency, cost-effectiveness, and user (patient and health professional) experience. Objective: The aim of this study was to assess how health care organization setup influences the perceptions and experience of service managers and frontline staff during the development and deployment of integrated care with and without telehealth. Methods: As part of a multinational project exploring the use of coordinated care and telehealth, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organizational issues in the implementation of coordinated care and telehealth. Three analytical stages were followed: (1) preliminary analysis for a direct comparison of the responses of service managers and frontline staff to a range of organizational issues, (2) secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires, and (3) thematic analysis of free-text responses of service managers and frontline staff. Results: Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organization and the pace of change. Conclusions: The data provide evidence that the setup of health care services is positively associated with outcomes in several areas, particularly tailored staff training, rewards for good service, staff satisfaction, and patient involvement.


Davidson, R., Barrett, D. I., Rixon, L., Newman, S., ACT Program, Bescos, C., …Wahl, C. (2020). How the Integration of Telehealth and Coordinated Care Approaches Impact Health Care Service Organization Structure and Ethos: Mixed Methods Study. JMIR Nursing, 3(1), Article e20282.

Journal Article Type Article
Acceptance Date Aug 27, 2020
Online Publication Date Oct 9, 2020
Publication Date Jan 1, 2020
Deposit Date Feb 2, 2021
Publicly Available Date Feb 3, 2021
Journal JMIR Nursing
Print ISSN 2562-7600
Electronic ISSN 2562-7600
Publisher JMIR Publications
Peer Reviewed Peer Reviewed
Volume 3
Issue 1
Article Number e20282
Keywords Coordinated care; Telehealth; Health care organization; Staff engagement; staff training
Public URL
Publisher URL


Published article (138 Kb)

Copyright Statement
© Rosemary Davidson, David Ian Barrett, Lorna Rixon, Stanton Newman, ACT Program. Originally published in JMIR Nursing
Informatics (, 09.10.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly
cited. The complete bibliographic information, a link to the original publication on, as well as this copyright
and license information must be included.

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