Telephone support and adherence in patients with chronic disease – a qualitative review of reviews Divya Balasubramanian,1 Joanne Yoong,1–3 Hubertus JM Vrijhoef1,3–6 1Saw Swee Hock School of Public Health, National University Singapore, Singapore; 2Center for Economic and Social Research, University of Southern California, California, USA; 3Center for Health Services and Policy Research, National University Health System, Singapore; 4Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands; 5Department of Patients & Care, Maastricht University Medical Center, Maastricht, The Netherlands; 6Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium Abstract: Among patients with a chronic disease, low adherence to prescribed treatments is very common, leading to substantial morbidity, mortality, and increase in health care costs. Telephone or mobile phone support is a common form of intervention that can be used to improve their adherence. We reviewed existing systematic and nonsystematic reviews to analyze the effectiveness of telephone interventions to improve treatment adherence in patients with chronic disease. Secondary aims were to evaluate the selected reviews in terms of cost-effectiveness of the intervention and frequency of messages affecting the adherence outcomes. A search for reviews was conducted in three databases, including PubMed, the Cochrane Library, and CINAHL, and three reviews that met the inclusion criteria were selected for final analysis. A qualitative review of the selected reviews was conducted, and reviews were evaluated to extract and summarize the characteristics and outcomes. Two of the selected reviews studied mobile phone text messaging, and one review studied telephone or mobile phone consultation. All three reviews reported an overall improvement in adherence, but the reviews varied in the types of research and the outcome measures. However, none of the reviews reported costs as an outcome. The evidence from reviews to characterize the effectiveness or cost-effectiveness of telephone support as an intervention to improve adherence among people with chronic diseases is fairly small and weak. Telephone support interventions have to be evaluated more systematically in routine practice against a comprehensive set of criteria, including their relative costs and outcomes. Keywords: literature review, compliance, telemedicine, communicable diseases, cost-effectiveness

Telemedicine-based care provides remote health and social care to maintain people's autonomy and increase their quality of life. The rapidly aging population has come with a sig- nificant increase in the prevalence of chronic diseases and their effects, and thus the need for increased care and welfare. The elderly have become one of the main target groups for telecare technologies. Smart home systems allow older adults to live in the environment of their choice and protect them against institutionalization or placement in a nursing home. It gives the elderly person a feeling of reassurance and safety, and appears to be one of the most promising approaches to facilitate independent living in a community-dwelling situation. Telecare solu- tions give a new opportunity for diagnosis, treatment, education, and rehabilitation, and make it possible to monitor patients with a number of chronic diseases. It also reduces socioeconomic disparity with regard to access to care and gives equal chances to patients from urban and rural areas. However, although telecare has undisputed benefits, it also has some limitations. Older people are often resistant to use of new technology, in particular acquiring the knowledge and skills necessary for use of electronic devices and computer systems. Further, privacy and security are important elements when building confidence in telemedicine systems. Leaking of sensitive information, such as health or test results, may have a negative and far-reaching impact on the personal and professional life of the patient. Telemedicine-based care should now be personalized for the needs, capabilities, and preferences of the elderly, with adapta tion over time as care needs evolve. If technologies are introduced that are familiar, usable, desir- able, and cost-effective, and able to be adapted to seniors' lives and plans, then telecare would become an integral part of the lives of the elderly in the near future, allowing them to function independently in a friendly home environment.

Information and communication technology-based cardiac rehabilitation homecare programs Marlien Varnfield, Mohanraj KarunanithiAustralian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organization, Royal Brisbane and Women's Hospital, Brisbane, AustraliaAbstract: Cardiac rehabilitation (CR) has, for many years, been a highly recommended approach to secondary prevention for patients recovering after a heart attack or heart surgery. These programs are traditionally delivered from a hospital outpatient center. Despite demonstrated benefits and guideline recommendations, CR utilization has been poor, particularly in women, older patients, and ethnic minority groups. To overcome some of the barriers to the traditional delivery of CR, different delivery platforms and approaches have been developed in recent years. In general, Telehealth solutions which have been used to address the delivery of CR services remotely include: 1) patient–provider contact delivered by telephone systems; 2) the Internet, with the majority of patient–provider contact for risk factor management taking place online; and 3) interventions using Smartphones as tools to deliver CR through (independently or in combination with) short message service messaging, journaling applications, connected measurement devices, and remote coaching. These solutions have been shown to overcome some of the barriers in CR participation and show potential as alternative or complementary options for individuals that find traditional center-based CR programs difficult to commit to. The major benefits of remote platforms for CR delivery are the ability to deliver these interventions without ongoing face-to-face contact, which provides an opportunity to reach large numbers of people, and the convenience of selecting the timing of cardiovascular disease management sessions. Furthermore, technologies have the potential to deliver long-term follow-up, which programs delivered by health professionals cannot afford to do due to staff shortages and budget restrictions. However, change in the existing CR services is not without challenges. There is a need to identify development issues that can hamper the implementation of the interventions outside controlled trial settings systems, which may require new computing infrastructures, specific clinical responsibilities, time for training, and development and openness to new ways of doing things.Keywords: cardiovascular disease, Telehealth, telephone, Internet, mobile phones

Asynchronous telemedicine applications in rehabilitation of acquired speech-language disorders in neurologic patients Lilian Beijer,1 Toni Rietveld2 1Sint Maartenskliniek, 2Centre of Language Studies, Radboud University of Nijmegen, Nijmegen, The Netherlands Abstract: In this time of an aging population in the Western world and a concomitant need for cost reduction, there is an obvious need for innovative health care delivery. One of the consequences is that a growing number of telemedicine applications are emerging in different health care domains. Also in the area of speech-language (SL) disorders, particularly neurogenic disorders, telemedicine is rapidly gaining interest. In this paper, we place applications for neurogenic SL disorders in a telemedicine taxonomy in order to establish common features along the dimensions of functionality, application, and technology, and their components. Thus, we aim at identifying common features in a wide variety of telemedicine applications and to establish common interests of stakeholders in health care for classified groups of telemedicine applications. This may facilitate decision-making with regard to expansion of innovative products, and give directions to measures needed for upscaling and structural embedding of feasible and effective SL telemedicine applications in health care. Common interests of stakeholders in health care, established using telemedicine taxonomy, is a key factor in decision-making with regard to which telemedicine applications should be given priority for genuine utilization. Priorities of health care institutions, patients, and reimbursement companies are also leading for researchers aiming at solid scientific evidence for the beneficial effects of target applications. That is, although research results tend to indicate the potential of telemedicine in the area of SL pathology, the alleged benefits of most applications have not been confirmed according to the accepted standards for clinical outcome testing as yet. Methodologic obstacles and the lack of adequate speech materials and suitable outcome measures for efficacy and effectiveness testing partially account for this. From the perspective of scientific evidence, the benefits of asynchronous SL telemedicine applications concern data storage and data analyses. To facilitate implementation of telemedicine, there is a call for development of information and communication technology infrastructures that allow feasible applications which meet requirements with regard to licensure and medical privacy laws. For applications with evidence for beneficial effects, we are challenged to develop new business models that apply to a new health care environment. Keywords: telemedicine, speech, language, disorders, rehabilitation&nbsp

Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one’s progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored.

Telemedicine has been used successfully in monitoring patients with a variety of chronic illnesses. Studies in the field of gastroenterology have shown that telemedicine is a feasible and well accepted method of patient monitoring. Several inflammatory bowel disease (IBD) centers have developed telemedicine systems to improve the management of these com- plex diseases. Implementation of these systems is feasible, and telemedicine is well received by patients. Telemedicine has been shown to improve disease activity, quality of life, adherence with short-term treatment, and to shorten relapses. Telemedicine has also been shown to decrease health care utilization; however, use of telemedicine systems is also associated with increased non-billable encounters (phone calls and electronic messages). Telemedicine has also been shown to be an effective mechanism to provide remote care in areas without access to IBD spe- cialty care. It is likely that telemedicine will be increasingly utilized in the future as an adjunct to traditional monitoring, especially for patients at high risk for nonadherence, and for those with limited access to IBD centers of excellence, to improve patient self-management, and as a mechanism to provide education, health maintenance, and medication reminders to patients.

Using portable negative pressure wound therapy devices in the home care setting Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT) is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

Examining perspectives on telecare: factors influencing adoption, implementation, and usage David Barrett,1 Jonathan Thorpe,2 Nick Goodwin3 1Faculty of Health and Social Care, 2Knowledge Exchange, University of Hull, Hull, 3International Foundation for Integrated Care, Oxford, UK Abstract: Telecare, or the use of remote care technologies to support safe and independent living, offers great potential to mitigate the challenges faced in a time of changing demographics. By supporting people to live for longer in their own home, telecare can enhance quality of life, reduce reliance on institutional care settings, and reduce costs. Despite these potential opportunities, the adoption of telecare has not been as fast or widespread as it might have been. This article discusses some of the factors acting as drivers or barriers, which have influenced adoption and impacted on implementation. The implications of the availability of such a wide range of telecare applications is explored; this diversity of choice allows for services to be tailored to the specific needs of users, but also causes a tangled web of terminology that can lead to confusion and lack of clarity. In terms of the evidence base, although evaluations of telecare services often demonstrate a high level of cost benefit and user satisfaction, primary research findings are not as positive. This paper focuses particularly on the Whole System Demonstrator, a large-scale, randomized controlled trial that raised questions about the value and cost-effectiveness of telecare. The paper also discusses the ethical, governance, and resource issues associated with telecare implementation and the organizational complexities inherent in such exciting but challenging changes to services. The policy perspective is also summarized, highlighting how much of the adoption of telecare to date has been influenced by top-down initiatives. Telecare will continue to evolve as our understanding and the technology continue to develop. This paper provides information and advice for commissioners, providers, and practitioners regarding the factors that will shape the future of telecare. Keywords: telecare, barriers and facilitators, perspectives, assisted living, independent living