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Martin T, Veldeman S, Großmann H, Fuchs-Frohnhofen P, Czaplik M, Follmann A. Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study. JMIR Aging 2024; 7:e55471. [PMID: 38842915 PMCID: PMC11190630 DOI: 10.2196/55471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. OBJECTIVE This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. METHODS A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. RESULTS In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. CONCLUSIONS Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.
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Affiliation(s)
- Tobias Martin
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Sarah Veldeman
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | - Michael Czaplik
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Docs In Clouds Telecare GmbH, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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2
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Bhamra IB, Gallagher JE, Patel R. Telehealth technologies in care homes: a gap for dentistry? J Public Health (Oxf) 2024; 46:e106-e135. [PMID: 38102945 PMCID: PMC10901274 DOI: 10.1093/pubmed/fdad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Telehealth technologies are playing an increasing role in healthcare. This study aimed to review the literature relating to the use of telehealth technologies in care homes with a focus on teledentistry. METHODS Khangura et al.'s (Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012;1:10) rapid review method included an electronic database search on Embase, PubMed, Web of Science and OpenGrey. Out of 1525 papers, 1108 titles and abstracts were screened, and 75 full texts assessed for eligibility. Risk of bias was assessed using the Mixed Methods Assessment Tool 2018. RESULTS Forty-seven papers (40 studies) from 10 countries, published 1997-2021, were included in the review, four studies related to teledentistry. Whilst some preferred in-person consultations, perceived benefits by stakeholders included reduced hospitalization rates (n = 14), cost-savings (n = 8) and high diagnostic accuracy (n = 7). Studies investigating teledentistry using intra-oral cameras reported that teleconsultations were feasible with potentially high diagnostic accuracy (n = 2), cost-savings (n = 1) and patient acceptability (n = 1). CONCLUSION There is limited published research on teledentistry, but wider telehealth research is applicable to teledentistry, with findings suggesting that telehealth technologies play a role in care homes consultations that are acceptable, cost-saving and with potential diagnostic accuracy. Further research is needed on the mode, utility and acceptability of teledentistry in care homes.
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Affiliation(s)
- Ishmyne B Bhamra
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London SE5 9RS, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London SE5 9RS, UK
| | - Rakhee Patel
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London SE5 9RS, UK
- NHSE London Region, Wellington House, 133-135 Waterloo Road, London SE18UG, UK
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3
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Tan AJ, Rusli KD, McKenna L, Tan LL, Liaw SY. Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review. J Telemed Telecare 2024; 30:230-249. [PMID: 34666535 DOI: 10.1177/1357633x211049206] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. METHODS A scoping review was conducted. A systematic search for articles published in 2000-2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included 'telemedicine', 'telehealth' and 'nursing homes'. RESULTS Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. CONCLUSION AND IMPLICATIONS Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers' perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.
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Affiliation(s)
- Apphia Jq Tan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Khairul Db Rusli
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lc Tan
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Edna Mayela DLVC, Miriam LT, Ana Isabel GG, Oscar RC, Alejandra CA. Effectiveness of an online multicomponent physical exercise intervention on the physical performance of community-dwelling older adults: A randomized controlled trial. Geriatr Nurs 2023; 54:83-93. [PMID: 37716123 DOI: 10.1016/j.gerinurse.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/18/2023]
Abstract
This study aimed to assess the effectiveness of an online multicomponent physical exercise intervention (MPE) on the physical performance (PP) of older adults. A randomized controlled trial was conducted, with 110 participants assigned to either the MPE group or the control group. The MPE group engaged in endurance, strength, balance, and flexibility exercises for at least three days per week, while the control group received educational sessions. PP was evaluated using the Short Physical Performance Battery (SPPB) at baseline and after three months. The intervention group showed a mean increase over control group of 0.81 points on the SPPB scale (95% confidence interval [CI] 0.23-1.40; p=0.000) and in the tandem balance test with 1.26 more seconds (95% CI 0.21-2.31; p=0.019). These findings suggest that the online MPE intervention is effective in enhancing the PP of community-dwelling older adults, which may contribute to a reduction in functional dependence among this population.
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Affiliation(s)
| | - López-Teros Miriam
- Universidad Iberoamericana, Departamento de Salud. Ciudad de México, México.
| | - García-González Ana Isabel
- Universidad Iberoamericana, Departamento de Salud. Ciudad de México, México; Hospital General de México. "Dr. Eduardo Liceaga", Medicina Física Rehabilitación, Ciudad de México, México
| | - Rosas-Carrasco Oscar
- Universidad Iberoamericana, Departamento de Salud. Ciudad de México, México; Hospital General de México. "Dr. Eduardo Liceaga", Medicina Física Rehabilitación, Ciudad de México, México
| | - Castillo-Aragon Alejandra
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Ciudad de México, México
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Qi Tan AJ, Chua WL, McKenna L, Chin Tan LL, Lim YJ, Liaw SY. Enablers and barriers to nurse-facilitated geriatric teleconsultations in nursing homes: a qualitative descriptive multi-site study. Age Ageing 2022; 51:6936403. [PMID: 36580553 DOI: 10.1093/ageing/afac268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/25/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses' role in teleconsultations allows for more support in the provision of patient care through this modality. OBJECTIVE This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes. METHODS A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke's thematic analysis approach. RESULTS Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses' acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses' sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses' lack of confidence in physical assessment and communication competencies, role conflict due to nurses' perceived inability to meet physicians' expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges. CONCLUSION The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses' telemedicine competencies and optimising digital infrastructure are warranted.
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Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lean Chin Tan
- Division of Palliative and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore.,GeriCare@North, Yishun Health, Singapore
| | - Yu Jun Lim
- GeriCare@North, Yishun Health, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Valk-Draad MP, Bohnet-Joschko S. Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12944. [PMID: 36232255 PMCID: PMC9566431 DOI: 10.3390/ijerph191912944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.
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May S, Fehler G, Jonas K, Zahn T, Heinze M, Muehlensiepen F. [Opportunities and challenges for the use of video consultations in nursing homes from the caregiver perspective: a qualitative pre-post study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:48-58. [PMID: 35165047 DOI: 10.1016/j.zefq.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The implementation of medical video consultations in nursing homes can support primary care in rural areas and counteract the shortage of physicians. So far, video consultations have been limited to pilot projects and have not yet been comprehensively implemented. The present study addresses potentials of video consultations and challenges that may arise during the implementation of medical video consultations. METHODS Twenty-one guided interviews (pre-implementation: n = 13; post-implementation: n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). The data was analyzed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS Almost all of the interviewees' expectations regarding video consultations described prior to implementation have been met: time savings, improved communication, reduction of information breaks and increase in the quality of care. After implementation, other unexpected advantages of telemedical care became apparent, such as the possibility of regular monitoring or the improved ability to plan routine visits without interrupting the daily schedule. At the same time, the implementation of video consultations is associated with the following challenges: defining responsibilities, acquiring experience in handling video consultation tools, providing for sufficient qualification and training, dealing with new billing modalities as well as missing links between nursing documentation and medical information systems. DISCUSSION Video consultations can improve health care routines in nursing homes, lead to a wider availability of medical services, and contribute to improving patient safety and the quality of care. However, various aspects and contextual factors need to be addressed when implementing video consultations. These include: implementation of technical requirements, initial training with test consultations, continuous interactive development of potential fields of application, and the definition of the respective responsibilities of caregivers, physicians and medical assistants.
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Affiliation(s)
- Susann May
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland.
| | - Georgia Fehler
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland
| | - Kai Jonas
- bbw Hochschule Berlin, Berlin, Deutschland
| | | | - Martin Heinze
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Abteilung Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
| | - Felix Muehlensiepen
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus- Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam, Deutschland
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8
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Ho P, Lim Y, Tan LLC, Wang X, Magpantay G, Chia JWK, Loke JYC, Sim LK, Low JA. Does an Integrated Palliative Care Program Reduce Emergency Department Transfers for Nursing Home Palliative Residents? J Palliat Med 2021; 25:361-367. [PMID: 34495751 DOI: 10.1089/jpm.2021.0241] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Nursing homes (NHs) are faced with a myriad of challenges to provide quality palliative care to residents who are at their end of life. Objectives: To describe and examine the impact of the GeriCare Palliative Care Program, which comprises telemedicine, on-site clinical preceptorship, palliative care education program, and Advance Care Planning (ACP) advocacy in reducing emergency department (ED) transfers from NHs. Design: Retrospective cohort study. Setting/Subjects: A total of 217 telemedicine consults were conducted for 187 unique NH residents across 5 NHs in Singapore over a 27-month period from April 2018 to June 2020. Measurement: Records of all enrolled palliative care residents who were triaged by telemedicine consultations were examined. Results: Our findings revealed that 82% of our urgent telemedicine consultations have successfully averted ED transfers. Gender and completion of ACP were statistically significant between ED transfer group and non-ED transfer group. Among those who completed their ACP, 78.3% of the ED transfer group chose limited intervention as their main goals of care compared with 30% in the non-ED transfer group. Conclusions: The GeriCare Palliative Care Program is a novel program, which is developed to improve the quality of palliative care in NHs. The comprehensive GeriCare model comprises a systematic framework, an integration of clinical support, ACP advocacy, and education program. Our findings demonstrated that these interventions synergistically led to a reduction in ED transfers while optimizing the residents' quality of care. By carrying out the targeted initiatives to support NHs, the residents could age-in-place comfortably.
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Affiliation(s)
- Peiyan Ho
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yujun Lim
- GeriCare, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Laurence Lean Chin Tan
- GeriCare, Khoo Teck Puat Hospital, Singapore, Singapore.,Department of Geriatric Medicine and Palliative Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute (GERI), Singapore, Singapore
| | - Xingli Wang
- GeriCare, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | | | | | - Lai Kiow Sim
- Palliative Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - James Alvin Low
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,GeriCare, Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute (GERI), Singapore, Singapore
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9
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May S, Jonas K, Fehler GV, Zahn T, Heinze M, Muehlensiepen F. Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study. BMC Health Serv Res 2021; 21:925. [PMID: 34488746 PMCID: PMC8420146 DOI: 10.1186/s12913-021-06950-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions:
How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery?
Methods Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. Results Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. Conclusions Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06950-y.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Germany.
| | - Kai Jonas
- bbw Hochschule Berlin, Berlin, Germany
| | - Georgia V Fehler
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Germany
| | | | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Germany.,Faculty for Health Sciences Brandenburg, Potsdam, Germany
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10
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The Nuts and Bolts of Utilizing Telemedicine in Nursing Homes – The GeriCare@North Experience. J Am Med Dir Assoc 2020; 21:1073-1078. [DOI: 10.1016/j.jamda.2020.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/18/2022]
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11
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Cheong CY, Yap PLK. Letter to the editor: Staying True to the Calling of Geriatric Medicine Amid the Waves of COVID-19. J Nutr Health Aging 2020; 24:534-535. [PMID: 32346693 PMCID: PMC7170791 DOI: 10.1007/s12603-020-1370-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022]
Affiliation(s)
- C Y Cheong
- Chin Yee Cheong, Khoo Teck Puat Hospital, Yishun, Singapore,
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12
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Lillicrap L, Hunter C, Goldswain P. Improving geriatric care and reducing hospitalisations in regional and remote areas: The benefits of telehealth. J Telemed Telecare 2019; 27:397-408. [PMID: 31645171 DOI: 10.1177/1357633x19881588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of two geriatrician models of care, the telegeriatric service (TGS) and visiting geriatrician (VG), in regional and remote settings in terms of potential cost-savings to the health system and impact on health service use (HSU). Furthermore, to establish whether longer wait-times for clinic appointments led to increased HSU by study participants. METHODS Trends in patient emergency department presentations, hospitalisations and bed-days (HSU) were compared from 18 months before to 12 months after geriatrician appointment for the two services in the Western Australian Midwest region. The relationships between wait times, patient triage level and HSU were modelled. The costs of providing the services were offset against reductions in HSU after appointments. RESULTS The sample comprised consecutive patients using the TGS (n = 84) and VG service (n = 124). Patient characteristics were similar, although patients using the VG service had longer wait-times, were triaged as more urgent and demonstrated the highest levels of HSU. Both models were effective with similar rates of reduced HSU following appointments. Increased wait-times and higher patient triage urgency were associated with increased HSU. DISCUSSION Although TGS and VG showed similar reduced rates of HSU, TGS had the capacity to see a higher volume of patients, a broader geographical reach and improved waitlist management. Consequently, TGS was more effective at reducing avoidable hospitalisations and subsequent health deterioration due to shorter wait-times. Whilst face-to-face consultations are recognised as 'gold standard' a combination of the two models is most efficient.
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Affiliation(s)
- Louise Lillicrap
- Great Southern Population Health, Western Australia Country Health Service, Albany, Australia
| | - Christine Hunter
- Aged Care Directorate, Western Australia Country Health Service, Perth, Australia
| | - Peter Goldswain
- Aged Care Directorate, Western Australia Country Health Service, Perth, Australia
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