Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Non-invasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary healthcare utilization, and decrease healthcare costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim was to describe health care professionals’ (HCPs) (1) perception of and presumed experience with non-invasive TM in daily HF patient care, (2) perspectives of the relevance of and reasons for applying non- invasive TM and (3) barriers to the use of non-invasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and in Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43-items with closed- and open- ended questions. In Norway, the response rate was 69%, with 57 of 60 hospitals participating, whereas the response rate was 68% in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics and the open-ended questions were analyzed using summative content analysis. Results: This study showed that non-invasive TM is not part of current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with non-invasive TM in HF care in Norway (48 of 226, 21%) and in Lithuania (64 of 310, 20%). Around half of the HCPs in both countries perceived non-invasive TM to be relevant in follow-up of HF patients in Norway (58%) and Lithuania (49%). For physicians in both countries and nurses in Norway the three most mentioned reasons for introducing non-invasive TM were: to improve self-care, to reduce hospitalizations and to provide high quality care, while the Lithuanian nurses described: ability to treat more patients and reducing their workload. The main barriers to implement non-invasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive HF patients’ themselves could represent barriers due their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently non-users of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients’ condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be 'ready to be discharged'. We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

Background: Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. Methods: The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken. Results: Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory. Conclusions: The patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient’s pace in the decision-making process may lead to a more appropriate level of health care in line with the patient’s preferences and goals.