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Table 2 Cross-site comparison – contexts and implementation

From: Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework

  Site A: large city, South East England Site B: major city, Northern Ireland Site C: major city, East Midlands Site D: rural, South West England Site E: major city, North West England Site F: urban area, South East England Site G: major town, South England
Existing service prior to SUPPORT-HF2 trial Consultant-led clinics and inpatient management
Standard primary care diagnosis and ongoing management
Hospital HFSN team, community HFSN teams serving HFrEF only Hospital and community HFSN teams Hospital and community HFSN teams Hospital and community HFSN teams Community HFSN team in one part of CCG only Hospital and community HFSN teams No community HFSN team
Staff involved in SUPPORT-HF2 trial Chief investigator, secondary care HF nurses, SUPPORT HF trial team Local PI, 2 research nurses Local PI, secondary care-based lead HFSN and 2 communities Local PI, secondary care HFSNs, 2 research practitioners Local PI, research administrator Local PI, secondary care-based HFSN Local PI
Setting for recruitment Study lead nurse recruited from wards or clinics, community HF nurses in the early phase only Research nurse recruited from CCU and other wards or by letters sent out post-discharge Recruited by lead HFSN then later by research nurse and community HFSNs from the clinic 2 research practitioners, secondary care HFSNs and local PI recruited from wards and hospital clinics By local PI in hospital clinic By secondary care nurse in hospital clinic By local PI in hospital clinic
Clinical profile of participants in this site As per protocol, no specific distinction described. As per protocol, no specific distinction described. Patients were recruited only when ready for discharge from the hospital clinic or HFSN service. As per protocol, no specific distinction described. Patients were targeted if they were particularly unwell and deemed in need of monitoring between 6 monthly clinic visits. In time, with appreciation of RCT design, staff avoided recruitment of any patients deemed too unstable for the control arm. As per protocol, no specific distinction described.
How technology use by patients was supported during the trial By CCM team By local research nurse, supported by the CCM team By local research nurse, supported by the CCM team By local research nurse, supported by the CCM team By CCM team By CCM team By CCM team
Extent to which the model was integrated into clinical pathways Initially integrated, later separated due to role overlap Limited: resistance from both hospital and community HFSNs and GPs Partial: intention was for participants to be looked after by the CCM team, but sometimes, the hospital HFSN accessed patient data. Partial: integrated with secondary care only as community HFSN service was resistant Not integrated: following recruitment, participants were looked after by the CCM team. Not integrated: following recruitment, participants were looked after by the CCM team. Not integrated: following recruitment, participants were looked after by the CCM team.