Clinical Outcomes Associated with Telemedicine/Telehealth
Partners Telemedicine, Boston, MA 02114, USA. Telemedicine and e-Health
(Impact Factor: 1.67).
07/2005; 11(3):329-47. DOI: 10.1089/tmj.2005.11.329
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.
Available from: Nabil Natafgi
- "Interestingly, all three were on telemedicine in intensive care units (ICU). A systematic review on a broad range of applications  found generally positive results with the strongest evidence among hospital-based applications in pediatric cardiology, intensive care, and emergency care/trauma. Surprisingly, no meta-analyses or systematic reviews of telemedicine in specific hospital-based applications other than those covering tele-ICU  were found. "
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ABSTRACT: Despite the frequency of use of telemedicine in emergency care, limited evidence exists on its impacts at the patient, provider, organization, and system level. Hospital-based applications of telemedicine present a potentially important solution, particularly for small and rural hospitals where access to local specialists is rarely available.
We conducted a systematic review of telemedicine applications for hospital-based emergency care, which aims to synthesize the existing evidence on the impact of tele-emergency applications that could inform future efforts and research in this area.
A search of four databases (PubMed, CINAHL, EMBASE, Cochrane) using a combination of telemedicine and emergency room (ER) keywords for publications yielded 340 citations. Four coders independently determined eligibility based on initial criteria and then extracted information on the 38 resulting articles based on four main categories: study setting, type of technology, research methods, and results.
Of the 38 articles, 11 studies focused on telemedicine for diffuse patient populations that typically present in ERs, 8 studies considered telemedicine in the context of minor treatment clinics for patients presenting with minor injuries or illnesses, and 19 studies focused on the use of telemedicine to connect providers in ERs to medical specialists for consultations on patients with specific conditions. Overwhelmingly, tele-emergency studies reported positive findings especially in terms of technical quality and user satisfaction. There were also positive findings reported for clinical processes and outcomes, throughput, and disposition, but the rigor of studies using these measures was limited. Studies of economic outcomes are particularly sparse.
Despite limitations in their research methodology, the studies on tele-emergency indicate an application with promise to meet the needs of small and rural hospitals to address infrequent but emergency situations requiring specialist care. Similarly, studies indicate that tele-emergency has considerable potential to expand use of minor treatment clinics to address access issues in remote areas and overcrowding of urban ERs.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Available from: Kathrin Cresswell
- "Another review of different types of telehealthcare in mixed chronic diseases found that, although clinical outcomes did not improve significantly, patients were overwhelmingly satisfied with the technology. In one study they rated telehealthcare an average of 4 out of 5 on a Likert scale . "
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ABSTRACT: Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare.
Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature.
Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.
Available from: Maida J Sewitch
- "Often aware of when their elderly patients seek health care in the ED, primary care physicians could suggest that the spouse come in for a check up or to discuss how s/he is handling things at home, and/or point out resources that are available in the community. With the advent of telehealth, additional opportunities for interventions designed to support vulnerable caregivers will become available. "
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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.
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