Is There a Business Case for Telehealth in Home Health Agencies?

How technology in care at home affects patient self-care and self-management: a scoping review

The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.

Factors influencing the adoption of home telecare by elderly or chronically ill people: a national survey

AIMS AND OBJECTIVES

The primary aim is to provide insight into client characteristics and characteristics of home telecare contacts, which may influence the adoption of home telecare. Secondary aim is to examine the applicability of four perceived attributes in Rogers' diffusion of innovations theory, which may influence the adoption: relative advantage, compatibility, complexity and observability.

BACKGROUND

Western countries face strongly increasing healthcare demands. At the same time, a growing nursing shortage exists. The use of home telecare may be instrumental in improving independence and safety and can provide support to older and chronically ill people, but a precondition for its uptake is that clients consider it as a useful and helpful technological tool.

DESIGN

A survey conducted among clients of seven home care organisations in the Netherlands connected to a home telecare system.

METHODS

In 2007, a postal questionnaire was distributed to 468 older or chronically ill clients: 254 responded (54%). The data were analysed by regression techniques, employing a theoretical model.

RESULTS

This study showed that clients' perceived attributes - relative advantage, compatibility, complexity and observability - have a significant effect on adoption of home telecare explaining 61% of the variance. The chance of adoption is higher when a client already receives long-term personal and/or nursing care, he/she lives alone and when there are fixed daily contacts via the home telecare system. The perception of possible benefits can still be enhanced.

CONCLUSIONS

  The concept of perceived attributes, derived from Rogers' diffusion of innovation theory, has been useful to explain clients' adoption of home telecare.

RELEVANCE TO CLINICAL PRACTICE

Home care organisations can best focus on clients already in care and people living alone, in offering home telecare. Nurses, who aim to enhance the client's adoption of home telecare, have to take into account clients' perceived attributes of such new technology.

Telehomecare communication and self-care in chronic conditions: moving toward a shared understanding

BACKGROUND

Remote telemonitoring of patients' vital signs is a rapidly increasing practice. Although methods of communication in remote electronic monitoring differ from those in traditional home health care, the understanding shared by the nurse, patient, and family members remains the same: patients' self-care behaviors affect exacerbations of chronic health conditions. The purpose of this paper is to examine the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses (THN).

METHODS

The original study used the Social Relations Model to examine relationships within 43 triads composed of patients with chronic conditions, home helpers, and their nurse involved in telehomecare at three Veterans Health Administration sites. This secondary descriptive and correlational analysis compared 43 patients' and nine THNs' ratings of themselves and each other on communication (frequency, timeliness, and understanding) and the use of patients' daily telemonitored information.

RESULTS

There was almost no correlation between patients' perception of THNs' communication (frequency [r=0.05], timeliness [r=0.09], and understandability [r=0.03]) and patients' integration of information into daily health practices. However, significant correlations were found between the THNs' perception of patients' communication frequency and timeliness, and integration, (p=0.02; p<0.001) respectively.

CONCLUSIONS

This study suggests that frequent phone communication may lead the remote THN to believe patients are integrating blood pressure, weight, and other information into daily self-care behaviors, when in fact the patient reports that they are not. The influence of a halo effect on the THN may cloud an accurate perception of what is actually occurring. Remote communication may require more attention to THNs educating patients about shared understandings when using telemonitoring. Best practices for THN should include explicit goals and intentions for telemonitored home care with individualized instructions about how to use the information for self-care.

Costs and financial benefits of video communication compared to usual care at home: a systematic review

We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home (up to December 2009). Studies were only included when data about the costs of video communication as well as the financial benefits were presented. The methodological quality of the included studies was assessed. Nine studies, mainly conducted in the US, met the inclusion criteria. The methodological quality was poor, except for one study. Most studies (8 of the 9) did not demonstrate that the financial benefits were significantly greater than the costs of video communication. One study - the only one with a high methodological quality - found that costs for patients who received video communication were higher than for patients who received traditional care. The review found no evidence that the cost of implementing video communication in home care was lower than the resulting financial benefits. More methodologically well conducted research is needed.

Telerehabilitation: policy issues and research tools

The importance of public policy as a complementary framework for telehealth, telemedicine, and by association telerehabilitation, has been recognized by a number of experts. The purpose of this paper is to review literature on telerehabilitation (TR) policy and research methodology issues in order to report on the current state of the science and make recommendations about future research needs. An extensive literature search was implemented using search terms grouped into main topics of telerehabilitation, policy, population of users, and policy specific issues such as cost and reimbursement. The availability of rigorous and valid evidence-based cost studies emerged as a major challenge to the field. Existing cost studies provided evidence that telehomecare may be a promising application area for TR. Cost studies also indicated that telepsychiatry is a promising telepractice area. The literature did not reference the International Classification on Functioning, Disability and Health (ICF). Rigorous and comprehensive TR assessment and evaluation tools for outcome studies are tantamount to generating confidence among providers, payers, clinicians and end users. In order to evaluate consumer satisfaction and participation, assessment criteria must include medical, functional and quality of life items such as assistive technology and environmental factors.

The impact of curriculum on a national telehealth program

Pakistan developed a curriculum for training in telemedicine based upon international experience and regional needs. The curriculum was offered to selected specialists across the spectrum of medicine, policymakers, and engineer experts. The curriculum was experience based and hands-on. Each participant at the end was asked to develop a telemedicine application based upon their area of practice or expertise. Most of the first 30 graduates are currently involved in telemedicine applications in varied and unanticipated areas of contribution. The first graduates also were instrumental in the national and regional response to the earthquake disaster of 2005 in the Rawalpindi region. The curriculum is being expanded under government sponsorship to become a national telemedicine initiative.