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.

Advertisements

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

health gap
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.

 

Telehealthcare for patients suffering from chronic obstructive pulmonary disease

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

https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=4&_IXSR_=2p3MuvUMEsU&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26%252asform%3dwellcome%252dimages%26_IXACTION_%3dquery%26wi_credit_line%253atext%3d%2522Neil%2bWebb%2522%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26%2524%2bwith%2bimage_sort%3d%252e%26_IXMAXHITS_%3d15%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
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.

Read the full article here

Telephone calls for post-discharge surveillance of surgical site infection

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

phone-1662579_960_720.jpg

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.

Read the full article here

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

5238549826_6670487358_z
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.

Read the full blog post here

Ethical Use of Telemedicine in Emergency Care

American College of Emergency Physicians(2016) Annals of Emergency Medicine68(6) p. 791

ehr-1476525_960_720.png

  • 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.

Read the full abstract here