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      Co-production in practice: how people with assisted living needs can help design and evolve technologies and services

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          Abstract

          Background

          The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of ‘care closer to home’ is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions.

          Method

          We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants’ perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically.

          Results

          Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual’s wider social support network. Finally, the service must support a high degree of information sharing and coordination.

          Conclusions

          The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use.

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          Most cited references38

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          Awareness and coordination in shared workspaces

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            Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial.

            To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment. Economic evaluation nested in a pragmatic, cluster randomised controlled trial. Community based telehealth intervention in three local authority areas in England. 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care. Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care. Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY). The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment. ISRCTN43002091.
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              Participatory design

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                Author and article information

                Contributors
                j.wherton@qmul.ac.uk
                Paul.Sugarhood@eastlondon.nhs.uk
                Rob.Procter@warwick.ac.uk
                suehinderraftresearch@hotmail.co.u
                trish.greenhalgh@phc.ox.ac.uk
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                26 May 2015
                26 May 2015
                2015
                : 10
                : 75
                Affiliations
                [ ]Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner St, Whitechapel London, E1 2AB UK
                [ ]East London NHS Foundation Trust, London, E1 8DE UK
                [ ]Department of Computer Science, University of Warwick, Coventry, CV4 7AL UK
                [ ]Department of Primary Care Health Sciences, University of Oxford, 2nd floor, New Radcliffe House, Walton St, Oxford, OX2 6GG UK
                Article
                271
                10.1186/s13012-015-0271-8
                4453050
                26004047
                85932127-0515-4d82-babf-1c70f9fb9d22
                © Wherton et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 24 November 2014
                : 19 May 2015
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Medicine
                assistive technology,ethnography,co-design,co-production,telehealth,telecare
                Medicine
                assistive technology, ethnography, co-design, co-production, telehealth, telecare

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