eHealth Use on Acute Inpatient Mental Health Units: Implementation Processes, Common Practices, and Barriers to Use

Adm Policy Ment Health  / https://doi.org/10.1007/s10488-023-01262-1

…Information technology to promote health (eHealth) is an important and growing area of mental healthcare, yet little is known about the use of patient-facing eHealth in psychiatric inpatient settings. This quality improvement project examined the current practices, barriers, implementation processes, and contextual factors affecting eHealth use across multiple Veteran Health Administration (VHA) acute mental health inpatient units. Staff from units serving both voluntary and involuntary patients (n = 49 from 37 unique sites) completed surveys regarding current, desired, and barriers to use of Veteran-facing eHealth technologies. Two subsets of respondents were then interviewed (high success sites in eHealth use, n = 6; low success sites, n = 4) to better understand the context of their eHealth use. Survey responses indicated that 20% or less of Veterans were using any type of eHealth technology while inpatient. Tablets and video chat were the most desired overall and most successfully used eHealth technologies. However, many sites noted difficulty implementing these technologies (e.g., limited Wi-Fi access). Qualitative analysis of interviews revealed differences in risk/benefit analysis and implementation support between high and low success eHealth sites. Despite desired use, patient-facing eHealth technology is not regularly implemented on inpatient units due to multiple barriers (e.g., limited staffing, infrastructure needs). Successful implementation of patient-facing eHealth may require an internal champion, guidance from external supports with experience in successful eHealth use, workload balance for staff, and an overall perspective shift in the benefits to eHealth technology versus the risks…

Full-text: eHealth Use on Acute Inpatient Mental Health Units: Implementation Processes, Common Practices, and Barriers to Use

Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

Parker S, Prince A, Thomas L On behalf of the IMPACT Study Group, et al. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open 2018;8:e019192. doi: 10.1136/bmjopen-2017-019192

The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.

Setting and participants: Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.

Results: Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.

Conclusions: Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

Bridging The Health Care Gap Through Telehealth

This case study looks at two telehealth models in Mexico and the U.S. targeting low- to middle-income parts of the population | Commonwealth Fund

Image source: Commonwealth Fund

In many developing nations, the public health system is unable to meet demand for services, driving people to seek costly services in the private sector. Telehealth can expand access to care while, in some cases, reducing unnecessary use of services, such as immediate acute care for non–health emergencies.

Using a call centre as the point of access, these models have reduced unnecessary use of services and supported patient navigation of local health services.

• Case study
• Commonwealth Fund publications

 

Telehealthcare for patients suffering from chronic obstructive pulmonary disease

Lilholt, P.H. et al. (2017) BMJ Open. 7:e014587.

Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objective: To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD).

Conclusions: The overall sample and all subgroups demonstrated no statistically significant differences in HRQoL between telehealthcare and usual practice.

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Telephone calls for post-discharge surveillance of surgical site infection

Nguhuni, B. et al. Antimicrobial Resistance & Infection Control | Published online: 8 May 2017

Background: Surgical site infection (SSI) is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved.

Conclusion: The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.

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The hospital of tomorrow in 10 points

Abstract

Technology has advanced rapidly in recent years and is continuing to do so, with associated changes in multiple areas, including hospital structure and function. Here we describe in 10 points our vision of some of the ways in which we see our hospitals, particularly those in developed countries, evolving in the future, including increased specialization, greater use of telemedicine and robots, the changing place of the intensive care unit, improved pre-hospital and post-hospital management, and improved end-of-life care.

New technology is going to increasingly impact how we practice medicine. We must learn how best to adapt to and encompass these changes if we are to achieve maximum benefit from them for ourselves and our patients. Importantly, while the future hospital will be more advanced technologically, it will also be more advanced on a personal, humane patient care level.

Full paper: Vincent, J.L. and Creteur, J.  The hospital of tomorrow in 10 points. Critical Care (2017) 21:93

Telecare is more than just technology – it has the power to create care networks for older people

Telecare is a range of remote care technologies and associated services that have been developed to accommodate an ageing population while helping people to stay in their homes | The Conversation

Image source: Moyan Brenn – Flickr // CC BY 2.0

Over the next 25 years, the percentage of people aged over 85 is set to more than double, with one in four in this age group already counting as “frail”. In the over 65s, this is estimated at one in ten. At the same time, the number of people, such as family, who might be caregivers is reducing due to different patterns of marriage and parenting, people living apart at greater distances and more women in paid employment.

Traditionally, elderly people who need care in their own homes rely on paid or unpaid carers. Telecare can be thought of as a form of care at a distance, which can allow older and frailer people to live independently. While some might see a risk of decreasing social contact, it can provide safety and security to those people who because of mobility problems and other health issues are housebound. Telecare should be considered as an aid, not a solution to growing demands for care.

Telecare can provide some care on a personal level through attachments that can develop between users and telephone operators, who regularly check in with the telephone operators for weekly test calls.

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Ethical Use of Telemedicine in Emergency Care

American College of Emergency Physicians(2016) Annals of Emergency Medicine. 68(6) p. 791

• The American College of Emergency Physicians (ACEP) believes that EDs using telemedicine should make this form of care accessible regardless of race, religion, sexual orientation, location, or ability to pay.

• ACEP believes that EDs and hospitals should ensure that their telemedicine systems and practices provide patients with at least the privacy and confidentiality required under HIPAA. This includes ensuring that their equipment and technology are up-to-date and secure.

• ACEP believes that telemedicine decisions relating to patient care, referrals, and transfers should be based on the patient’s health care needs.

• ACEP supports the establishment of standards for telemedicine practitioners and development of related quality assurance and educational programs to develop the discipline.

• ACEP supports legislative efforts that would allow single-state licensing to be sufficient for telemedical practice throughout the United States.

• ACEP believes that all aspects of the telemedical consultations between advance medical practitioners (ie, physicians, nurse practitioners, and physician assistants) are subject to the same informed consent and refusal standards as face-to-face medical encounters.

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Tele-Mental Health for Children: Using Videoconferencing for Cognitive Behavioral Therapy (CBT)

Goldschmidt, K. Journal of Pediatric Nursing. Published online: October 7, 2016

Mental health disorders occur in 4% of children and 10 to 20% of adolescents and are linked with “depression, anxiety, risky behaviors, poor physical health, obesity, substance abuse and suicide” (Garber, Frankel, & Herrington, 2016, p. 181). Adolescents diagnosed with a depressive disorder have high rates of recurrence: 25% within one year, 40% within two years, and 70% within five years (Mash & Wolfe, 2012). It is imperative for mental health specialist to reach children with mental health disorders early in their development in an effort to decrease morbidity and mortality; however, access to mental health care, especially for children, is limited (Lauckner & Whitten, 2015).

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Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

Dixon, P. et al. BMJ Open. 6:e012352

Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting: Patients recruited through primary care, and intervention delivered via telehealth service.

Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

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