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Buist BD, Kramer BE, Wright KE, Edwards PK, Petrofes AM, Furzer BJ. "It's a Very Good Second Option": Older Adults' Experience of Telehealth. J Phys Act Health 2024; 21:668-674. [PMID: 38684218 DOI: 10.1123/jpah.2023-0176] [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: 04/20/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The growing ability to provide online services has enabled the proliferation of exercise-based telehealth interventions; however, adoption in older adults may be impacted by low digital literacy and "technophobia." OBJECTIVES The aim of this study was to explore the experience of community and aged-care dwelling older adults following exercise-based telehealth services to provide insights that could guide future telehealth exercise delivery. DESIGN Semi-structured interviews for qualitative analysis. METHODS Participants (age ≥60) who had completed at least one online exercise session from a registered health professional were recruited through a combination of purposeful and snowball sampling methods via their exercise facility or provider. A semi-structured interview guide was used by 2 interviewers to investigate participants' experiences and a "critical friends" approach used to identify common themes. RESULTS Thirteen interviews with 21 participants were conducted from 2 different facilities. Analysis identified meaning units within 3 themes and subthemes. Technology subthemes related to digital confidence prior to telehealth and changes during interventions, as well as the usability of technology for telehealth. Clinical practice subthemes described the different motivations to exercise, perceived benefits of telehealth, important implications for practitioners, and perceptions of safety. The social connection theme related to the social benefits of telehealth. CONCLUSIONS Older adults in our sample were technologically confident and capable of performing exercise sessions delivered via telehealth. They notice benefits from this form of exercise delivery however, prefer face-to-face exercise delivery.
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Affiliation(s)
- Brett D Buist
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Ben E Kramer
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Kemi E Wright
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Peter K Edwards
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Alyssa M Petrofes
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Bonnie J Furzer
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
- Fremantle Hospital Mental Health Service, South Metropolitan Health Service, Perth, WA, Australia
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de Siqueira Silva Í, de Araújo AJ, Lopes RH, Silva CRDV, Xavier PB, de Figueirêdo RC, Brito EWG, Lapão LV, Martiniano CS, de Araújo Nunes VM, da Costa Uchôa SA. Digital home care interventions and quality of primary care for older adults: a scoping review. BMC Geriatr 2024; 24:507. [PMID: 38858634 PMCID: PMC11163791 DOI: 10.1186/s12877-024-05120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.
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Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande Do Norte, Natal, Brazil.
| | | | | | | | - Pedro Bezerra Xavier
- Postgraduate in Health Sciences, Federal University of Rio Grande Do Norte, Natal, Brazil
| | | | | | - Luís Velez Lapão
- WHO Collaborating Center on Health Workforce Policy and Planning, IHMT, Universidade Nova de Lisboa, Lisbon, Portugal
- UNIDEMI, Department of Mechanical and Industrial Engineering, Nova School of Science and Technology, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, Escola de Engenharia Universidade do Minho, Campus Azurém, 4800-058, Guimarães, Portugal
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Chen X, Wu M, Wang D, Zhang J, Qu B, Zhu Y. Association of smart elderly care and quality of life among older adults: the mediating role of social support. BMC Geriatr 2024; 24:471. [PMID: 38811904 PMCID: PMC11138067 DOI: 10.1186/s12877-024-05073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In the current context of ageing, the field of smart elderly care has gradually developed, contributing to the promotion of health among older adults. While the positive impact on health has been established, there is a scarcity of research examining its impact on the quality of life (QoL). This study aims to investigate the mediating role of social support in the relationship between smart elderly care and QoL among older adults. METHODS A total of 1313 older adults from Zhejiang Province, China, participated in the study. Questionnaires were used to collect data on participants' basic demographic information, smart elderly care, social support, and QoL. The descriptive analyses of the demographic characteristics and correlation analyses of the three variables were calculated. Indirect effects were tested using bootstrapped confidence intervals (CI). RESULTS The analysis revealed a positive association between smart elderly care and social support (β = 0.42, p < 0.01), as well as a positive correlation between social support and QoL (β = 0.65, p < 0.01). Notably, social support emerged as an important independent mediator (effect size = 0.28, 95% bootstrap CI 0.24 to 0.32) in the relationship between smart elderly care and QoL. CONCLUSIONS The results of this study underscore the importance of promoting the utilization of smart elderly care and improving multi-faceted social support for older adults, as these factors positively contribute to the overall QoL.
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Affiliation(s)
- Xi Chen
- College of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, P.R. China
| | - Miaoling Wu
- College of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, P.R. China
| | - Dongbo Wang
- Beijing Tongren Hospital Capital Medical University, No. 1 Dongjiaominxiang Dongcheng District, Beijing, 100730, China
| | - Jian Zhang
- College of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, P.R. China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, P.R. China.
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, P.R. China.
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Kirkland DA, Lindley LC. Discussion of federal policies affecting broadband expansion and telehealth in Appalachia. Contemp Nurse 2024; 60:318-326. [PMID: 38735048 DOI: 10.1080/10376178.2024.2351902] [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: 03/10/2023] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. OBJECTIVES The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. METHODS A search of PubMed was conducted in January 2023, using the search words, "policy", "telehealth", "broadband", and "Appalachia". FINDINGS New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. CONCLUSION This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth.
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Affiliation(s)
- Deborah A Kirkland
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd. #147, Knoxville, TN 37996-4180, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd. #147, Knoxville, TN 37996-4180, USA
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Miranda R, Oliveira MD, Nicola P, Baptista FM, Albuquerque I. Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review. Int J Health Policy Manag 2023; 12:7299. [PMID: 37579426 PMCID: PMC10461888 DOI: 10.34172/ijhpm.2023.7299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. METHODS To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and reallife initiatives; (2) RPM; and (3) care integration. RESULTS 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. CONCLUSION RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.
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Affiliation(s)
- Rafael Miranda
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Enterprise Services, Siemens Healthineers Portugal, Lisboa, Portuga
| | - Mónica Duarte Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- iBB - Institute for Bioengineering and Biosciences and i4HB - Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Nicola
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portuga
| | | | - Isabel Albuquerque
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
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Jesus AG, de Lima MP, Vilar M, Pachana NA. Feasibility, Acceptability, and Preliminary Efficacy of A Cognitive-Emotional Intervention Program in Homebound Older Adults: A Pilot Randomized Controlled Trial. Clin Gerontol 2022; 46:359-375. [PMID: 35916398 DOI: 10.1080/07317115.2022.2105670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To conduct a pilot randomized controlled trial to assess the feasibility, acceptability, and preliminary efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI) among homebound older adults with mild cognitive impairment and depressive or anxious symptomatology. METHODS Fifty-one participants were randomly assigned to the intervention group or to the wait-list control group and completed baseline and post-intervention assessments. Feasibility and acceptability were the primary outcomes. Secondary outcomes included changes in cognitive function, depressive and anxiety symptoms, subjective memory complaints, functional status, and quality of life. Intervention effects were assessed both at a group level (two-way mixed ANOVA) and at an individual level (Reliable Change Index). RESULTS The HEPPI was a feasible and acceptable non-pharmacological intervention. Compared to the wait-list control group, the intervention group showed significant improvement in cognitive, emotional, and functional domains at post-intervention. Differences between groups in the distributions by clinical change categories were observed. CONCLUSIONS Results provide evidence of the HEPPI's feasibility, acceptability, and preliminary efficacy in increasing the cognitive and functional performance of homebound older adults and reducing their psychological symptomatology. CLINICAL IMPLICATIONS Home-delivered cognitive-emotional interventions may be a promising and acceptable mental health approach for homebound older adults, improving their cognitive and emotional functioning.
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Affiliation(s)
- Andreia G Jesus
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Manuela Vilar
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Australia
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Fjellså HMH, Husebø AML, Storm M. eHealth in Care Coordination for Older Adults Living at Home: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e39584. [DOI: 10.2196/39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
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Chen Z, Qi H, Wang L. Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption. Healthcare (Basel) 2021; 9:healthcare9111494. [PMID: 34828539 PMCID: PMC8619684 DOI: 10.3390/healthcare9111494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
[Background]: In recent years, aging has become a global social problem. Intelligent health management technology (IHMT) provides solutions for the elderly to deal with various health risks. However, the elderly are facing many difficulties in using IHMT. Studying the application types of IHMT and the influencing factors of the elderly’s acceptance of it will help to improve the use behavior of the elderly. [Methods]: This paper summarizes the application types of IHMT, identifies the influencing factors of the elderly’s adaption of IHMT, and makes a systematic comment on the influencing factors. [Results]: We divide the different functions of IHMT for the elderly into four types: self-monitoring, medical care, remote monitoring, and health education. The influencing factors are divided into three types: individual, social, and technology. [Conclusions]: This study finds that IHMT’s application covers all aspects of the health services of the elderly. Among these applications, self-monitoring is the most used. We divided the influencing factors of the elderly’s acceptance of IHMT into three categories and nine subcategories, having 25 variables.
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Affiliation(s)
- Zhu Chen
- School of Nursing, Peking University, Beijing 100191, China;
| | - Huiying Qi
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
- Correspondence: ; Tel.: +86-10-82805574
| | - Luman Wang
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
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Araújo R, Matos N, Mariano T, Medved I, Santos S, Pinheiro H. Functional capacity, risk of falling and chronic pain in older adults during the COVID-19 pandemic: a telemonitoring study. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To compare active and sedentary older adults regarding functional capacity, risk of falling, and chronic pain in a population assisted by telemonitoring during the pandemic lockdown. METHODS: This analytical, cross-sectional study included 104 older adults who were telemonitored during the COVID-19 lockdown by a team from a Brazilian Unified Health System outpatient clinic specializing in geriatrics and gerontology. A structured interview was used to collect data. Following normality testing with the Shapiro-Wilk test, Student’s t-test was used for group comparisons. Associations were analyzed using the χ2 test, and the odds ratio was calculated in a 2x2 table of sedentarism and falls in the last six months. The data were analyzed using SPSS version 26.0, with p ≤ 0.05 considered significant. RESULTS: The 57 active older adults had a lower rate of continuous medication use (24.84 vs 27.62%), fewer falls (50 vs 32.11%), less pain (12.31 vs 3.83%), and greater independence in basic activities of daily living (44.39 vs 26.46%). CONCLUSIONS: Older adults who were physically active in the midst of social distancing had better functional capacity in basic activities of daily living, fewer falls, and less pain than their sedentary peers. Independence in instrumental activities of daily living did not differ significantly between the groups.
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Affiliation(s)
- Rute Araújo
- Health Sciences Education and Research Foundation, Brazil
| | - Neuza Matos
- Health Sciences Education and Research Foundation, Brazil
| | | | - Isabely Medved
- Health Sciences Education and Research Foundation, Brazil
| | - Silvana Santos
- Health Sciences Education and Research Foundation, Brazil
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Zhao X, Bhattacharjee S, Innes KK, LeMasters TJ, Dwibedi N, Sambamoorthi U. The impact of telemental health use on healthcare costs among commercially insured adults with mental health conditions. Curr Med Res Opin 2020; 36:1541-1548. [PMID: 32609549 PMCID: PMC7535072 DOI: 10.1080/03007995.2020.1790345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the impact of telemental health (TMH) use on total healthcare costs and mental health (MH)-related costs paid by a third party among adults with mental health conditions (MHC). METHOD This study employed a pre-post design with a non-equivalent control group. The cohort comprised adults with MHCs identified using diagnosis codes from de-identified claims data of the Optum Clinformatics DataMart (2010 January 01 to 2017 June 30). We identified mental health (MH) service users and TMH users (N = 348) based on procedure codes. Non-users (N = 238,595) were defined as those who only used in-person MH services. A Difference-in-Differences (DID) analysis was performed within a multivariable two-part model (TPM) framework to examine the impact of TMH use on adjusted standardized costs (2018 US $) of all healthcare services and MH services. Patient-level and state-level factors were adjusted in TPM. RESULTS TMH use was associated with significantly higher MH-related costs [Marginal effect = $461.3, 95% confidence interval: $142.4-$780.2] and an excess of $370 increase in MH-related costs at follow-up as compared to baseline. However, TMH use was not associated with an increase in total third-party healthcare costs nor with changes in total costs from baseline to follow-up. CONCLUSIONS Despite having a higher likelihood of MH services use and MH-related costs, TMH users did not have higher total costs as compared to adults using only in-person MH services. Our findings suggest that TMH can increase access to MH care without increasing total healthcare costs among adults with MHC. Future studies exploring whether TMH use can lead to cost-savings over a longer period are warranted.
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Affiliation(s)
- Xiaohui Zhao
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Kim K. Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Traci J. LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Parker S, Prince A, Thomas L, Song H, Milosevic D, Harris MF. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open 2018; 8:e019192. [PMID: 30158214 PMCID: PMC6119429 DOI: 10.1136/bmjopen-2017-019192] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management. DESIGN We searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description ('thick') were synthesised using a realist matrix. SETTING AND PARTICIPANTS Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics. RESULTS Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed. CONCLUSIONS Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.
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Affiliation(s)
- Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Prince
- South Western Sydney Primary Health Network, Campbelltown, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Hyun Song
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Diana Milosevic
- Planning Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW This article systematically reviews studies examining remote measurement-based care (RMBC), defined as using technology to measure patients' psychiatric symptoms outside the context of a clinical encounter. RECENT FINDINGS Thirty-six studies were identified that measured patients' psychiatric symptoms remotely and provided feedback to treatment providers. The majority were single group designs. There was evidence supporting the short-term feasibility and acceptability of RMBC, although long-term sustainability was less clear. Thirteen randomized controlled trials were identified. RMBC was typically implemented as part of a multicomponent intervention (e.g., internet-based cognitive behavioral therapy with feedback to provider). Three studies experimentally isolated the clinical effects of RMBC, with two reporting no statistically significant differences between the RMBC and control conditions and one reporting greater symptom improvement associated with RMBC. RMBC appears feasible and acceptable and may be a promising intervention for improving mental health care, but additional experimental studies are needed.
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Wu S, Ell K, Jin H, Vidyanti I, Chou CP, Lee PJ, Gross-Schulman S, Sklaroff LM, Belson D, Nezu AM, Hay J, Wang CJ, Scheib G, Di Capua P, Hawkins C, Liu P, Ramirez M, Wu BW, Richman M, Myers C, Agustines D, Dasher R, Kopelowicz A, Allevato J, Roybal M, Ipp E, Haider U, Graham S, Mahabadi V, Guterman J. Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial. J Med Internet Res 2018; 20:e147. [PMID: 29685872 PMCID: PMC5938593 DOI: 10.2196/jmir.7692] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/10/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.
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Affiliation(s)
- Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Haomiao Jin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Policy Analysis Unit, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chih-Ping Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | | | - Laura Myerchin Sklaroff
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,College of Social and Behavioral Sciences, California State University, Northridge, Los Angeles, CA, United States
| | - David Belson
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Joel Hay
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Chien-Ju Wang
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Geoffrey Scheib
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Paul Di Capua
- Caremore Medical Group, East Haven, CT, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Caitlin Hawkins
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Pai Liu
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Magaly Ramirez
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Brian W Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark Richman
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, United States
| | - Caitlin Myers
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Davin Agustines
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Robert Dasher
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Alex Kopelowicz
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Joseph Allevato
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Mike Roybal
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Eli Ipp
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States.,Los Angeles Biomedical Research Institute, Los Angeles, CA, United States
| | - Uzma Haider
- Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Sharon Graham
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Vahid Mahabadi
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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14
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Xiang X, Danilovich MK, Tomasino KN, Jordan N. Depression prevalence and treatment among older home health services users in the United States. Arch Gerontol Geriatr 2018; 75:151-157. [DOI: 10.1016/j.archger.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/19/2017] [Accepted: 12/10/2017] [Indexed: 01/20/2023]
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15
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Moving towards novel multidisciplinary approaches for improving elderly quality of life: The emerging role of telemedicine in Sicily. J Telemed Telecare 2018; 25:318-324. [DOI: 10.1177/1357633x17753057] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Elderly care is a worldwide social and economic challenge for the public health system, and it requires the development of new management strategies. Telemedicine provides an innovative approach towards elderly care, especially for those with chronic diseases. In this study, we aimed to evaluate the potential role of a multidisciplinary telemedicine approach for improving elderly quality of life. Methods Twenty-two participants received weekly vital parameter monitoring and nutritional counselling, biweekly psychological counselling and a monthly consultation with a neurologist. The neuropsychological assessment included the Mini Mental State Examination, the Activities of Daily Living, the Instrumental Activities of Daily Living, the Geriatric Depression Scale and the Short-Form Health Survey, and was administered at enrolment (T0) and at the end of the study (T3). The nutritional evaluation included haematochemical examinations of glycaemia, total cholesterol, and triglycerides at baseline (T0) and every four months (T1, T2, T3). Results Significant differences in Activities of Daily Living, Geriatric Depression Scale and all domains of the Short-Form Health Survey were observed between baseline and the end of the study. The haematochemical parameters showed obvious changes over time, especially in cholesterol values, and the patients with hypercholesterolaemia and hypertriglyceridaemia showed a reduction in body mass index. Moreover, we found that the haematochemical values were moderately correlated with the Activities of Daily Living, Geriatric Depression Scale and Short-Form Health Survey scores. Conclusion Telemedicine can be a suitable tool for caring for elderly people more efficiently by promoting the remission of depressive symptoms and improving social functioning, cognitive levels and nutritional habits to prevent vascular diseases and exacerbations of pre-existing chronic illness.
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16
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Braga PP, de Sena RR, Seixas CT, de Castro EAB, Andrade AM, Silva YC. [Supply and demand in home health care]. CIENCIA & SAUDE COLETIVA 2017; 21:903-12. [PMID: 26960102 DOI: 10.1590/1413-81232015213.11382015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 07/10/2015] [Indexed: 11/22/2022] Open
Abstract
The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing.
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17
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Death by Suicide Within 1 Week of Hospital Discharge: A Retrospective Study of Root Cause Analysis Reports. J Nerv Ment Dis 2017; 205:436-442. [PMID: 28511191 DOI: 10.1097/nmd.0000000000000687] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a high risk for death by suicide after discharge from an inpatient mental health unit. To better understand system and organizational factors associated with postdischarge suicide, we reviewed root cause analysis reports of suicide within 7 days of discharge from across all Veterans Health Administration inpatient mental health units between 2002 and 2015. There were 141 reports of suicide within 7 days of discharge, and a large proportion (43.3%, n = 61) followed an unplanned discharge. Root causes fell into three major themes including challenges for clinicians and patients after the established process of care, awareness and communication of suicide risk, and flaws in the established process of care. Flaws in the design and execution of processes of care as well as deficits in communication may contribute to postdischarge suicide. Inpatient teams should be aware of the potentially heightened risk for suicide among patients with unplanned discharges.
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18
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Mermelstein H, Guzman E, Rabinowitz T, Krupinski E, Hilty D. The Application of Technology to Health: The Evolution of Telephone to Telemedicine and Telepsychiatry: A Historical Review and Look at Human Factors. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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Huang KTL, Lu TJ, Alizadeh F, Mostaghimi A. Homebound patients’ perspectives on technology and telemedicine: A qualitative analysis. Home Health Care Serv Q 2016; 35:172-181. [DOI: 10.1080/01621424.2016.1264341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristin T. L. Huang
- Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Tracy J. Lu
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Arash Mostaghimi
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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20
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Musich S, Wang SS, Hawkins K, Yeh CS. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care. Geriatr Nurs 2015; 36:445-50. [DOI: 10.1016/j.gerinurse.2015.06.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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21
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Hilty D, Yellowlees PM, Parrish MB, Chan S. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? Psychiatr Clin North Am 2015; 38:559-92. [PMID: 26300039 DOI: 10.1016/j.psc.2015.05.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.
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Affiliation(s)
- Donald Hilty
- Psychiatry & Behavioral Sciences, Telehealth, USC Care Health System, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC Suite 2200, Los Angeles, CA 90033, USA.
| | - Peter M Yellowlees
- Psychiatry & Behavioral Sciences, Health Informatics Graduate Program, University of California, Davis School of Medicine and Health System, 2450 48th Street, Suite 2800, Sacramento, CA 95817, USA
| | - Michelle B Parrish
- Telepsychiatry and Health Informatics, University of California, Davis School of Medicine & Health System, 2450 48th Street Suite 2800, Sacramento, CA 95817, USA
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, University of California, Davis School of Medicine & Health System, 2150 Stockton Boulevard, Sacramento, CA 95817, USA
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22
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Bolle S, van Weert JCM, Daams JG, Loos EF, de Haes HCJM, Smets EMA. Online Health Information Tool Effectiveness for Older Patients: A Systematic Review of the Literature. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1067-1083. [PMID: 26165846 DOI: 10.1080/10810730.2015.1018637] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Online health information tools (OHITs) have been found to be effective in improving health outcomes. However, the effectiveness of these tools for older patients has been far from clear. This systematic literature review therefore provides an overview of online health information tool effectiveness for older patients using a two-dimensional framework of OHIT functions (i.e., providing information, enhancing information exchange, and promoting self-management) and outcomes (i.e., immediate, intermediate, and long-term outcomes). Comprehensive searches of the PubMed, EMBASE, and PsycINFO databases are conducted to identify eligible studies. Articles describing outcomes of patient-directed OHITs in which a mean sample or subgroup of age ≥65 years was used are included in the literature review. A best evidence synthesis analysis provides evidence that OHITs improve self-efficacy, blood pressure, hemoglobin levels, and cholesterol levels. Limited evidence is found in support of OHIT effects on knowledge, perceived social support, health service utilization, glycemic control, self-care adherence, exercise performance, endurance, and quality of life. OHITs seem promising tools to facilitate immediate, intermediate, and long-term outcomes in older patients by providing information, enhancing information exchange, and promoting self-management. However, future studies should evaluate the effectiveness of OHITs for older patients to achieve stronger levels of evidence.
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Affiliation(s)
- Sifra Bolle
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , The Netherlands
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23
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Pratt SI, Bartels SJ, Naslund JA, Wolfe R, Pixley HS, Mueser KT, Josephson L. Feasibility and Effectiveness of an Automated Telehealth Intervention to Improve Illness Self-Management in People With Serious Psychiatric and Medical Disorders. Psychiatr Rehabil J 2013; 36:297-305. [PMID: 24320837 PMCID: PMC5472060 DOI: 10.1037/prj0000022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. METHODS We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. RESULTS Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as "much better" or "somewhat better" postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.
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Affiliation(s)
| | | | | | | | | | | | - Louis Josephson
- Riverbend Community Mental Health Center, Concord, New Hampshire
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24
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Choi NG, Sirey JA, Bruce ML. Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions. CURRENT TRANSLATIONAL GERIATRICS AND EXPERIMENTAL GERONTOLOGY REPORTS 2013; 2:16-23. [PMID: 23459163 PMCID: PMC3582679 DOI: 10.1007/s13670-012-0032-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Homebound older adults are more likely than their ambulatory peers to suffer from depression. Unfortunately, the effectiveness of antidepressant medications alone in such cases is limited. Greater benefits might be realized if patients received both pharmacotherapy and psychotherapy to enhance their skills to cope with their multiple chronic medical conditions, isolation, and mobility impairment; however, referrals to specialty mental health services seldom succeed due to inaccessibility, shortage of geriatric mental health providers, and cost. Since a large proportion of homebound older adults receive case management and other services from aging services network agencies, the integration of mental health services into these agencies is likely to be cost-efficient and effective. This review summarizes recent advances in home-based assessment and psychosocial treatment of depression in homebound recipients of aging services.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712; ; 512-232-9590; 512-471-9600 (fax)
| | - Jo Anne Sirey
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-4333; 914-682-6979 (fax)
| | - Martha L. Bruce
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-5977
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