Clinical outcomes associated with telemedicine/telehealth
ABSTRACT This paper is a comprehensive review and synthesis of the literature concerning clinical outcomes associated with various telemedicine applications. It starts out with a brief description of the findings reported by similar literature reviews already published. Subsequently, it proposes a conceptual model for assessing clinical outcomes based on Donabedian's formulation of the Medical Care Process. Accordingly, research findings are reported in terms of the relevant components of the medical care process, namely, diagnosis, clinical management, and clinical outcomes. Specific findings are organized according to the designated clinical and diagnostic application. This is followed by a general report of studies dealing with patient satisfaction.
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ABSTRACT: Information and communications technologies (ICT), such as telemedicine, can assist in the optimization of health and healthcare delivery systems as well as providing new business and economic opportunities. A number of challenges confront both the health and business sectors, however. These must be addressed by both sectors to realize the potential benefits. These challenges include: (i) the adoption, implementation and integration of ICT; (ii) understanding contexts and cultures; (iii) health system transformations and emerging technologies; (iv) business models and frameworks; (v) evaluation, evidence and best practices; and (vi) policy, standards, regulations and partnerships. This paper discusses these challenges and reviews what the landscape might look like if some of these obstacles were removed.Disease Management and Health Outcomes 12/2005; 14:9-13. DOI:10.2165/00115677-200614001-00004 · 0.35 Impact Factor
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ABSTRACT: Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. 159 caregivers (60.5 yrs +/- 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses.BMC Family Practice 02/2006; 7(1):46. DOI:10.1186/1471-2296-7-46 · 1.74 Impact Factor
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ABSTRACT: Individuals with Down syndrome (DS) who are at risk for dementia of the Alzheimer type (DAT) often live at sites remote from major medical centers. Telemedicine (TM) is a modality for providing medical care at remote locations but is underutilized for populations with Alzheimer disease (AD). We studied the feasibility of using TM to evaluate symptoms of DAT in 90 individuals with DS. Dementia was assessed by an informant questionnaire, a direct measure of praxis, pathological reflexes on the neurologic examination, and the presence of cortical atrophy on a neuroimaging procedure. The neurologist was blinded to the scores on neuropsychological measures. Differences in average cognitive scores between a TM and traditional academic medical center-based clinic site (TAC) were tested using 2-way analysis variance with site and premorbid IQ as factors. Logistic regression was used to explore the relationship, in addition to the cognitive scores, of influences such as age, premorbid IQ, and site to the prediction of the physician's diagnosis of dementia. Components of the neurologic, imaging, and neuropsychological examinations differentiated subjects with and without DAT (p<or=0.008) irrespective of whether a subject was evaluated at a TM or TAC site. It is feasible to make a diagnosis of DAT in DS by TM. This study supports the need for formal reliability and validity studies of TM preparatory to the consideration of this modality for use in clinical trials for AD.Alzheimer's & dementia: the journal of the Alzheimer's Association 07/2006; 2(3):179-84. DOI:10.1016/j.jalz.2006.04.001 · 17.47 Impact Factor