Addressing telehealth's foremost barrier: provider as initial gatekeeper.
ABSTRACT During the past decade, telehealth has enjoyed a plethora of public funding and publication outlets around the world. Yet, rhetoric appears to be outpacing the actual diffusion and utilization of telehealth technologies for patient care. Several barriers, such as reimbursement and legal/regulatory issues, are commonly cited as impeding the successful deployment of this innovation. However, two separate studies carried out in Michigan that controlled for these barriers point out a more significant initial gatekeeper to the deployment of telehealth, namely providers.
Multiple data collection strategies were used in both the telehospice and telepsychiatry projects, including utilization logs, surveys, telehospice nursing notes, cost frame data collection, patient interviews, caregiver interviews and focus groups, and videotaped visits.
This study summarizes data from the two studies to support the hypothesis that the provider is the most important initial gatekeeper for telemedicine.
The implications from this conclusion have important consequences for health system deployment strategies. Specifically, telemedicine project managers must keep providers' needs (ease of use and incentives) in mind when designing a telemedicine system.
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ABSTRACT: Telemental health (TMH) is one approach to rectifying geographic disparity in access to evidence-based mental health treatment for ADHD. We describe a brief (6-session) intervention for the TMH delivery of medication treatment with psychoeducation and Caregiver Behavioral Training to families of children with ADHD from underserved communities. Information on family engagement, satisfaction, and fidelity to intervention protocols are presented. Overall, both parts of the intervention were well-received by families who engaged with the treatment, who learned information and skills, and who indicated very high levels of satisfaction with treatment, even though it was relatively brief in nature. Mean ratings of satisfaction for the combined ADHD treatment was 38 (range = 27–40) out of a possible total score of 40 on the Client Satisfaction Questionnaire. Both telepsychiatrists and therapists were highly faithful to the intervention protocols, as demonstrated by their independently-rated fidelity. Telepsychiatrists adhered to the intervention protocol with 91.6 ± 9.5 % reliability, and therapists adhered to their intervention protocol with 94.3 % (SD: 9.7 %) reliability This brief stabilization model of intervention is particularly relevant to working with a remote population where treatment resources are scarce. This study demonstrates that it is possible to provide direct psychiatric and behavioral services through telepsychiatry and to train and supervise therapists remotely.Journal of Child and Family Studies 01/2014; DOI:10.1007/s10826-014-9977-5 · 1.42 Impact Factor
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ABSTRACT: The aim of this study is to evaluate consultant general paediatricians' opinions of a UK paediatric telecardiology service. A structured questionnaire was developed and sent to all consultant paediatricians working in a district general hospital in Northern Ireland. Paediatricians (n = 35) regarded the regional paediatric telecardiology service as very useful and of good value for money. Paediatricans in hospitals without access to telecardiology expressed a desire to join the network (86%, 12/14). More frequent use of the paediatric telecardiology service was associated with increased confidence in performing echocardiography and using the telemedicine equipment and a special interest in neonatology. The vast majority of paediatricians (32/35, 91%) believed that there should be a shared clinical responsibility for the patient following a teleconsultation. A total of 33/35 (94%) stated that the telephone costs of the consultation should be paid by the paediatrician but that the professional time of the cardiologist should be paid by the tertiary centre (29/35, 83%). Paediatricians have consistently positive experiences of a regional paediatric telecardiology service. They believe that clinical responsibility is shared, and there should not be any professional fee for telemedicine activities.Journal of Paediatrics and Child Health 02/2014; 50(6). DOI:10.1111/jpc.12501 · 1.19 Impact Factor
Dataset: 2013 Ped Pall Care systematic review