The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.
[Show abstract][Hide abstract] ABSTRACT: Objective
Numerous telecare interventions and technologies are used in the management of type 2 diabetes mellitus. This systematic review examines the different telecare interventions implemented, the technologies used, as well as the outcomes. Such a synthesis serves to optimize telecare use for diabetic patients and inform decision makers on technology selection and the impacts that can be expected with telecare use.
Materials and Methods
Following a systematic, comprehensive search of databases, 2,139 qualitative and quantitative studies were initially selected; after careful review and screening, 50 studies were coded and analyzed.
A typology is proposed that identifies the nature of telecare interventions and technologies used as well as the outcomes associated with their use. Overall, telecare produces positive results with a variety of outcomes, such as improved health status, increased quality of care, decreased health service use or cost, increased satisfaction and increased patient knowledge.
While telecare is seen to have overall positive outcomes, some caveats have been identified. There is no “one size fits all” solution. Inexperience with technology combined with a mediocre user interface can create many problems that inhibit appropriate adoption of the technology. There is a growing presence of mobile technologies, which provide immediate feedback and can be integrated with social media.
The results of this review can be used by healthcare professionals, organizations and patient support groups to tailor their policies with regards to the choice, planning, diffusion and monitoring of telecare interventions and the technologies implemented to care for patients with diabetes.
Health Policy and Technology 06/2014; 3(2). DOI:10.1016/j.hlpt.2014.01.004
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