Telecare Research Articles

Evaluación y seguimiento de tele - cuidados en pacientes pediátricos del servicio de oncología

Childhood cancer is mostly considered a chronic disease. Information about the disease and treatments is a necessitypresent in all family members, in the first moments it can be difficult to understand and remember why clear information andsimple it will allow a better understanding. The new information technologies make it possible to establish infinite connectionsand the field of Health, has not escaped this phenomenon, they have jumped into the health arena terms such as "Tele care"or "Tele-Nursing" , which refers to the use of information and communications technologies. Objective: to evaluate the benefitsof implementing Tics in the continuity of care in pediatric cancer patients and their family. Material and Method: descriptive -evaluative study, the population was of 9 patients who joined the Telecare Project. Interviews, records and checklist were used. The program has been implemented for 6 months in the institution, this evaluation corresponds to a first stage of its development. Results: these are analyzed according to the dimensions of Needs Assessment, Evaluation of conceptualization and logic of the program, Process evaluation and Evaluation of results. Conclusion: This study has allowed us to determine Tele Care as a tool that helps us improve nursing care, also increases communication processes and allows continuity of care.

Fast care – real-time sensor data analysis framework for intelligent assistance systems

Abstract Main target of fast care is the development of a real-time capable sensor data analysis framework for intelligent assistive systems in the field of Ambient Assisted Living, eHealth, Tele Rehabilitation, and Tele Care. The aim is to provide a medically valid integrated situation model based on a distributed, ad-hoc connected, energy-efficient sensor infrastructure suitable for daily use. The integrated situation model combining physiological, cognitive, and kinematic information about the patient is grounded on the intelligent fusion of heterogeneous sensor data on different levels. The model can serve as a tool for quickly identifying risk and hazards as well as enable medical assistance systems to autonomously intervene in real-time and actively give telemedical feedback.

Tele-Care (TC) For Comparative Individual Patient Effectiveness Research (CIPER) In Dentistry

Tele-Care (TC) For Comparative Individual Patient Effectiveness Research (CIPER) In Dentistry

Biomedical Monitoring Technologies and Future Healthcare Systems

Healthcare Systems (HCSs) throughout the world undergo important changes driven by aging populations and advances in biomedical technologies. At the same time, in the current economic climate, many Western countries are struggling to reduce public spending on all kinds of services, including healthcare. With this tension between tightening budgets and skyrocketing costs, many countries are seeking to identify ways of using Information Technology (IT) and Monitoring Technologies (MTs) to improve the efficiencies of HCSs while not reducing, or possibly even improving, the quality of healthcare and their delivery. Many experiments have been in progress since the 1990s. This paper has conducted a review evaluating such HCSs in terms of advantages and drawbacks. The objective of this review is to provide some illustrative publications and works and examples of Health Information Technology (HIT) systems to finally determine the place of biomedical MTs in the future HCS. We present the healthcare delivery system (HCDS) organization with roles of the different stakeholders, state initiatives in healthcare information delivery systems and the new relation between the hospital and the home though a new equilibrium. We mentioned the increasing role of telemedicine (TM), telecare (TLC) and telemonitoring (TLM) and expectations for monitoring the elderly. These expectations lead to preventive approaches based on monitoring technologies and pervasive healthcare (PH) which made healthcare improvements and cost reductions possible. Finally, we show the challenges and opportunities of the hospital versus home healthcare delivery.

How Can Health Information Technologies Contribute to Improve Health Care Services for High-Need Patients?

This paper discusses how health information technologies like tele-care, tele-health and tele-medicine can improve the condition for high-need patients, specifically in relation to access. The paper addresses specifically the values of timeliness and equity and how tele technological solutions can support and enhance these values. The paper introduces to the concept of scaffolding, which constitutes the framework for dynamic, appropriate, caring and embracing approaches for engaging and involving high-need patients that are vulnerable and exposed. A number of specific considerations for designing tele-technologies for high-need patients are derived, and the paper concludes that ethical and epistemological criterions for design are needed in order to meet the needs and requirements of the weak and exposed.

User satisfaction and experience with a telehealth system for the Danish TeleCare North Trial: a think-aloud study.

The aim was to evaluate a redesigned version of Telekit--a telehealth system developed for the Danish TeleCare North Trial. Telekit is used in the management of care in patients diagnosed with chronic obstructive pulmonary disease (COPD). This paper summarises the experience and the feedback received from six COPD-participants in terms of usability and satisfaction. Participants were asked to think-aloud while performing some system specific tasks. After each session, participants completed a post-test questionnaire. The think-aloud test was recorded, and notes from the tests were categorised and analysed. All tasks were completed by participants. Difficulties were observed concerning monitoring of measurements and use of the touchscreen. User feedback was mainly positive, and nearly all participants perceived Telekit as very easy to use. The study provides important insight regarding use of Telekit by patients suffering from a chronic illness and increased understanding about, how similar systems can more effectively be used in such home health initiatives.

Barriers and Facilitators to Uptake of Assistive Technologies: Summary of a Literature Exploration.

This paper aims to highlight some of the issues that arise with the uptake of assistive technology as found in the literature across four different domains: Telehealth; Telecare; Augmentative and Alternative Communication; and Education. The authors were not looking so much at service delivery models as user centred experiences and key words that were used to describe outcomes. The results showed remarkable similarities in the concerns of patients, families, users and other stakeholders. However, different terminologies across the fields highlighted the gulf between the fields, with professional 'silo-ing' of expertise occurring. There is a necessity for increased collaboration that could allow for knowledge sharing and enhanced assessment, uptake and continued use of assistive technologies for all potential users.

Home telemonitoring effectiveness in COPD: a systematic review

To provide a systematic review of the effectiveness of home telemonitoring to reduce healthcare utilisation and improve health-related outcomes of patients with chronic obstructive pulmonary disease (COPD). An electronic literature search in Medline, Embase, B-on and Web of Science was conducted from June to August 2012 and updated until July 2013, using the following keywords: [tele(-)monitoring or tele(-)health or tele(-)homecare or tele(-)care or tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. Randomised and non-randomised controlled trials evaluating home telemonitoring interventions in COPD were included. A meta-analysis using risk ratio (RR) and standardised mean difference (SMD) was conducted for healthcare utilisation (hospitalisations, length of stay, emergency department visits) and associated costs, and health-related outcomes [mortality, exacerbations and health-related quality of life (HRQOL)]. Nine articles were included. Significant differences were found for hospitalisation rates (RR=0.72; 95% CI=0.53-0.98; p=0.034); however, no differences in the other healthcare utilisation outcomes were observed. There was a trend to reduced healthcare costs in the telemonitoring group. In two studies, this intervention was associated with a reduced number of exacerbations (p<0.05) and a significant increase in HRQOL (SMD=-0.53; 95% CI=-0.97--0.09; p=0.019). Home telemonitoring appears to have a positive effect in reducing respiratory exacerbations and hospitalisations and improving quality of life. However, the evidence of its benefits is still limited and further research is needed to assess the effectiveness of home telemonitoring in COPD management, as there are still few studies in this area.

The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial

home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care. a study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities. General practice (GP) was the unit of randomisation and TC was compared with usual care (UC). participant-reported outcome measures were collected at baseline, short-term (4 months) and long-term (12 months) follow-up, assessing generic HRQoL, anxiety and depressive symptoms. Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed questionnaire measures at baseline assessment plus at least one other assessment (n = 873). analyses found significant differences between TC and UC on Short Form-12 mental component scores (P < 0.05), with parameter estimates indicating being a member of the TC trial-arm increases mental component scores (UC-adjusted mean = 40.52; TC-adjusted mean = 43.69). Additional significant analyses revealed, time effects on EQ5D (decreasing over time) and depressive symptoms (increasing over time). TC potentially contributes to the amelioration in the decline in users' mental HRQoL over a 12-month period. TC may not transform the lives of its users, but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC. International Standard Randomised Controlled Trial Number Register: ISRCTN 43002091.

Advances in telecare over the past 10 years

Advances in telecare over the past 10 years

Predictors for the use of remote telecare in older adults in the Netherlands

Predictors for the use of remote telecare in older adults in the Netherlands

Telecare for burns may reduce need for long patient transfers

Telecare for burns may reduce need for long patient transfers

Effectiveness of nurse-led disease management programs on health outcomes and health service utilization in adult patients with chronic obstructive pulmonary disease: A systematic review protocol

Review question/objective The overall objectives of this review are i) to determine the effects of nurse-led Chronic Obstructive Pulmonary Disease (COPD) management programs on patients’ health outcomes and health service utilization; and ii) identify the framework (i.e. structure/ process) of the nurse-led COPD management programs (DMP) which is most effective in improving patient outcomes and health service utilization. Inclusion criteria Types of participants The review will consider studies that include adults with a diagnosis of COPD, who are over 18 years old. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 31 and the American Thoracic/European Respiratory Society Guidelines (ATS/ERS) 32 , the description of the severity of disease is as follows: Airflow obstruction is measured as a reduced FEV 1 /FVC (FVC: Forced vital capacity) ratio (< 0.7) with stage I or mild disease as an FEV 1 of ≥ 80% predicted; stage II or moderate disease as an FEV 1 of 50-79% predicted; stage III or severe as an FEV 1 of 30-49% predicted and stage IV or very severe as an FEV 1 <30% predicted. COPD includes patients with chronic bronchitis and emphysema but not asthma. Types of intervention(s) The review will consider nurse-led COPD disease management programs, as defined according to the Care Continuum Alliance. 15 which implies that disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. 15 The nurse-led DMPs may be delivered by home visit, clinic visit, or tele care and can be delivered either in community-based settings or hospital/medical settings or combined settings. Nurse-led DMPs will be compared with usual care, with “usual care” referring to a wide range of general / routine care options offered in the study settings such as hospitals and out-patient clinics. The structure, process and outcome of the nurse-led COPD management programs will be presented in a narrative report to give an overview of the effectiveness the programs. Types of outcomes The outcomes to be considered in this review are: Self-reported measures of exercise-related dyspnoea Standardized lung function tests Exercise capacity as assessed TRUNCATED AT 350 WORDS

Minister describes telehealth and telecare partnership as “Win Win Win”

Minister describes telehealth and telecare partnership as “Win Win Win”

Trends in telemedicine assessment indicate neglect of key criteria for predicting success

This innovative analysis aims to quantify the use of evaluation criteria in telemedicine and to identify current trends in metric adoption. The focus is to determine the frequency of actual performance metric reporting in telemedicine evaluation, in contrast to systematic reviews where assessment of study quality is the goal. Automated literature search identified telemedicine studies reporting quantitative performance metrics. Studies were classified by telemedicine class; store-and-forward (SAF), real-time consultation (RTC) and telecare (TC), and study stage. Studies were scanned for evaluation metric reporting, i.e. clinical outcomes, satisfaction, patient quality and cost measures. Evaluation metric use was compared among telemedicine classes, and between pilot and routine use stages. Diagnostic accuracy was reported significantly more frequently in pilots for RTC and TC. Cost measures were more frequently reported in routine use for TC. Clinical effectiveness and hospital attendance were better reported in routine use for SAF. Comparison also revealed different evaluation strategies. In pilots, SAF favoured diagnostic accuracy, compared to RTC and TC. TC preferred clinical effectiveness evaluations and TC more frequently assessed patient satisfaction. Cost was only reported in less than 20 per cent of studies, but most frequently in RTC. Routine use led to increased reporting of all metrics, except diagnostic accuracy. Clinical effectiveness reporting increased significantly with routine use for RTC and SAF, but declined for TC. Clinical outcomes and patient satisfaction were reported frequently in telemedicine studies, but reporting of other performance metrics was rare. Understanding current trends in metric reporting will facilitate better design of future telemedicine evaluations.

Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

BackgroundTelehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.MethodsQualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.ResultsBarriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.ConclusionsThese findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.

Telecare is a valuable tool for hypertension management, a systematic review and meta-analysis

There is an increasing interest for using telecare(TC) in the management of hypertension. A systematic review to the use of blood pressure (BP) measurement in TC has been performed (Medline/PubMed, Embase, and Cochrane Library), selecting randomized clinical trials that compared TC with usual care (UC) for hypertension management (treatment and/or coaching). Nine randomized clinical trials were selected (n=2501, 61.4±0.6 years, 42±2.7% males). Overall there was a significant larger decrease in the TC group than in the UC group for systolic (5.2±1.5 mmHg; P<0.001) and diastolic BP (2.1±0.8 mmHg; P<0.01). When studies were separated for antihypertensive treatment modification during the study (yes or no), systolic BP decrease difference between the TC and UC groups (ΔTC-ΔUC) tended to be significantly lower (5.1±2.9 mmHg lower) with treatment modification compared with nontreatment modification in which the ΔTC-ΔUC was 8.6±2.4 mmHg, P=0.07. TC led to a greater decrease in systolic and diastolic BP than UC. The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied. TC seems a valuable tool for hypertension management.

Telecare and the quality of experience

Telecare and the quality of experience

Outcome of a Pilot Project on Case Management Service for Medical Aid Clients

Purpose: This study analyzed outcomes of a Telecare case management service pilot project for Korean Medicaid Program Clients in Seoul. Outcome data for provided services and medical aid cost data were analyzed. Methods: Case management services were delivered by 10 medical aid managers. The period of the project was from July to December 2007. Results: The total number of the objects was 9714, representing 43.4% of the total medical aid clients in the area. The average number of consults was 2.58. Consults were most frequently via letter and telephone, with in- person visits being least common. Of the total, 213 cases were referred to community services, 87.8% were transacted successfully. The medical expenditure was less than that from January-June, 2007. Conclusion: Telecare service via mail or telephone allows contact with many clients in a short time which can enable the discover and monitoring of high risk clients. This can be accomplished at a cost savings to the Korean Medicaid Program.

Comparison of Case Management between Tele Care Regions and General Care Regions in Korean Medicaid

Purpose: The purpose of the study was to compare recipients' health behavior, attitude to using medicaid, medication compliance, and the changes in hospital cost and visit-day of in-patient and out-patient care between tele-care regions (TCR) and general care regions (GCR) in Korean medicaid. Method: The design of the study was ex-post facto comparing recipients in TCR and GCR. The sample included 625 persons in TCR and 410 persons in GCR. To collect materials, the case manager interviewed recipients of medicaid and filled out questionnaires which were analyzed through SAS/PC 9.1. Results: In studying health behavior and medication, compliance was not significant. However, the attitude to using medicaid was significantly more positive in TCR than in GCR. In out-patients, the change of hospital visit-day was not significant between TCR and GCR, but TCR showed a reduction in hospital cost compared to GCR. For in-patient recipients, GCR showed a greater reduction in changes in hospital cost and visit-day compared to TCR. Conclusions: The results of the study show that attitudes to using medicaid via telephone are positive and results are more effective than hospital visit consultation, and the cost of out-patient care could be reduced.