Adopting Cloud-Based Mobile Pharmaceutical Care Systems in Nursing Homes Running Head: Adopting CM-Pharm in Nursing Homes

探究長照機構護理人員對雲端藥事照護系統之使用意願

劉孟基(Meng-Chi Liu) ； 李慶章(Ching-Chang Lee) ； 張晴翔(Ching-Hsiang Chang) ； 林克峯(Ke-Feng Lin)

《醫務管理期刊》 14卷4期 (2013/12) Pp. 310-337

https://doi.org/10.6174/JHM2013.14(4).310

摘要

目的：隨著人口高齡化及慢性疾病的患病率增加，醫療照護產業產生了沉重的財政和人員需求。這將導致在護理之家提供的醫療照護，需要更適當的工具。研究顯示應用雲端運算技術可進行醫療知識共享並減少護理人員作業負擔，但是目前應用在護理之家的藥事照護上顯有不足。為了達到這個目的，我們提出了一個以雲端運算為基礎的藥事照護系統，並探索護理人員在臨床實務中採用這種技術的意願。方法：考量社會影響層面及認知程序層面對於使用意願的影響，我們採用以TAM進行擴展（TAM2）來測量他們的使用意願。研究資料蒐集期間自2011年7月至10月，於南台灣51家護理之家獲得有效問卷共168份進行分析。分析方法採用不受小樣本影響的PLS結構方程式。結果：護理之家的護理人員對於雲端藥事照護系統極有使用意願。進一步了解其使用意願僅受到系統知覺有用性影響，而知覺有用性亦受到與其工作內容相關的因素所影響。結論：為鼓勵護理人員採用雲端藥事照護系統，醫療照護服務提供者必須強調的該項雲端科技的有用性，有關系統方便性則無需強調。本研究亦提供給醫療照護行業提供不同的差異策略重要的考慮因素。

關鍵字

雲端運算 ； 長期照護 ； 遠距照護 ； 藥事照護 ； 科技接受模式

並列摘要

Objective: An increasing prevalence of chronic illnesses, in addition to an aging population, is generating a heavy demand on finances and personnel in the health care industry. For nursing homes in particular, this will result in a need for improved administration tools for the provision of medical care. Current nursing-home pharmaceutical care systems are inadequate, however, studies show that cloud computing allows for the sharing of information and applications and reduces nurse workloads. Thus, we propose a cloud-based mobile pharmaceutical care system (CM-Pharm) and explore nurse intentions for adopting this technology into their clinical practice.Methods: Considering social influence processes and cognitive instrumental processes, we use an extended version of TAM (TAM2) to examine nurse adoption intentions. Data collection was conducted from June to October 2011, comprising 168 nurses in 51 nursing homes in southern Taiwan. We used partial least squares (PLS) to mitigate minimal restrictions on sample size and residual distributions to test our hypotheses.Results: Our results showed that the nurses have strong intentions to adopt the proposed system. However, except for perceived ease of use and subjective norms, only the factor of perceived usefulness has a significant effect on user adoption and that nurses formed perceived usefulness judgments in part by cognitively comparing what the system is capable of doing with what they need to get their job done.Conclusions: To encourage nurses to adopt a cloud-based mobile pharmaceutical care system, healthcare service providers must emphasize the usefulness of cloud-based technology that is tailored to nurse functions and deemphasize ease of use of the system. We believe these findings provide important insights into the factors that healthcare service providers can consider when developing implementation strategies for cloud-based mobile pharmaceutical care systems.

並列關鍵字

telecare ； cloud computing ； pharmaceutical care ； nursing homes ； TAM2

參考文獻

Armbrust, M., Fox, A., Griffi th, R., Joseph, A. D., Katz, R., Konwinski, A., Lee G., Patterson D.A., Rabkin A., & Stoica, I. (2009). A view of cloud computing. Communications of the ACM, 53(4), 50-58.

Bakken, S., Grullon-Figueroa, L., Izquierdo, R., Lee, N. J., Morin, P., Palmas, W., & Starren, J. (2006). Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. Journal of the American Medical Informatics Association, 13(6), 660-667.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.

Barlow, J., Bayer, S., Curry, R., & Hendy, J. (2007). The costs of telecare: from pilots to mainstream implementation. Units costs of health and social care, University of Kent, Canterbury UK.

Barlow, J., Singh, D., Bayer, S., & Curry, R. (2007). A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. Journal of Telemedicine and Telecare, 13(4), 172-179.