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Rush KL, Singh S, Seaton CL, Burton L, Li E, Jones C, Davis JC, Hasan K, Kern B, Janke R. Telehealth Use for Enhancing the Health of Rural Older Adults: A Systematic Mixed Studies Review. THE GERONTOLOGIST 2022; 62:e564-e577. [PMID: 34661675 DOI: 10.1093/geront/gnab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. RESEARCH DESIGN AND METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. RESULTS Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance). DISCUSSION AND IMPLICATIONS Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Sarah Singh
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Cherisse L Seaton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric Li
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Charlotte Jones
- Faculty of Medicine, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Khalad Hasan
- Department of Computer Science, Mathematics, Physics and Statistics, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Brodie Kern
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Robert Janke
- Research and Administration, Library Administration, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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Alhuwail D, Abd-Alrazaq A, Al-Jafar E, Househ M. Telehealth for the geriatric population: uses, opportunities, and challenges. SMART HOME TECHNOLOGIES AND SERVICES FOR GERIATRIC REHABILITATION 2022:107-122. [DOI: 10.1016/b978-0-323-85173-2.00008-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Beks H, King O, Clapham R, Alston L, Glenister K, McKinstry C, Quilliam C, Wellwood I, Williams C, Wong Shee A. Community health programs delivered through information and communications technology in high-income countries: a scoping review (Preprint). J Med Internet Res 2020; 24:e26515. [PMID: 35262498 PMCID: PMC8943572 DOI: 10.2196/26515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/15/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Renee Clapham
- St Vincents Health Australia, Melbourne, Australia
- Ballarat Health Services, Ballarat, Australia
| | - Laura Alston
- School of Medicine, Deakin University, Geelong, Australia
- Colac Area Health, Colac, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Claire Quilliam
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
| | - Ian Wellwood
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | | | - Anna Wong Shee
- School of Medicine, Deakin University, Geelong, Australia
- Ballarat Health Services, Ballarat, Australia
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Ungerer MN, Busetto L, Begli NH, Riehle K, Regula J, Gumbinger C. Factors affecting prehospital delay in rural and urban patients with stroke: a prospective survey-based study in Southwest Germany. BMC Neurol 2020; 20:441. [PMID: 33276739 PMCID: PMC7718652 DOI: 10.1186/s12883-020-01999-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Reducing prehospital delay plays an important role in increasing the thrombolysis rate in patients with stroke. Several studies have identified predictors for presentation ≤4.5 h, but few compared these predictors in urban and rural communities. We aimed to identify predictors of timely presentation to the hospital and identify possible differences between the urban and rural populations. Methods From January to June 2017, we conducted a prospective survey of patients with stroke admitted to an urban comprehensive stroke centre (CSC) and a rural primary care centre (PCC). Predictors were identified using binary logistical regression. Predictors and patient characteristics were then compared between the CSC and PCC. Results Overall, 459 patients were included in our study. We identified hesitation before seeking help, awareness of the existence of a time-window, type of admission and having talked about stroke symptoms with friends/relatives who had previously had a stroke as the strongest predictors for presentation to the emergency room ≤4.5 h. Patients admitted to the rural PCC were more hesitant to seek help and less likely to contact emergency services, even though patients had comparable knowledge pertaining to stroke care concepts. Conclusions Patients from rural areas were more likely to be hesitant to seek help and contacted the EMS less frequently, despite similar self-awareness of having a stroke. Educational campaigns should focus on addressing these disparities in rural populations. Affected patients should also be encouraged to talk about their symptoms and take part in educational campaigns.
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Affiliation(s)
- Matthias N Ungerer
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Loraine Busetto
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nima H Begli
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katharina Riehle
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jens Regula
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in most countries. Lack of awareness of the impact CVD has on women is a continuing problem. Rural women are at a great risk for CVD and have specific barriers to early recognition and to access to treatment. OBJECTIVE The purpose of this systematic review was to identify how the state of the science for rural women and CVD has progressed over the last decade. METHODS Searches were conducted using the databases Cochrane, PubMed, and CINAHL with 5 major subject headings. The search resulted in the identification of 571 articles. Specific exclusion criteria resulted in an in-depth review of 15 articles. Two of the authors reviewed each article for scientific merit and interrater reliability. RESULTS Most studies were conducted in the United States (67%). Four studies focused on CVD knowledge; one, on physical activity; one, on diet plus other factors; one, on the effect of dried curry leaf powder and cucumber slices on hyperlipidemia; and one each, on waist circumference, exposure to smoke from wood stoves, and social support. Five of the 15 studies focused on more than 1 component, most on diet and physical activity. CONCLUSIONS Depth in a body of knowledge on any 1 topic, such as the most efficacious means to decrease CVD risk factors in rural women and increase health promotion activities in the population, is lacking. Another area of concern is the lack of research articles published in cardiovascular journals that include CVD in rural women.
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Ruiz-Pérez I, Bastos Á, Serrano-Ripoll MJ, Ricci-Cabello I. Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials. Prev Med 2019; 119:132-144. [PMID: 30597226 DOI: 10.1016/j.ypmed.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022]
Abstract
The objective of this systematic literature review is to examine the impact of interventions to improve cardiovascular disease healthcare provided to people living in rural areas. Systematic electronic searches were conducted in Medline, CINAHL, Embase, Scopus, and Web of Knowledge in July 2018. We included clinical trials assessing the effectiveness of interventions to improve cardiovascular disease healthcare in rural areas. Study eligibility assessment, data extraction, and critical appraisal were undertaken by two reviewers independently. We identified 18 trials (18 interventions). They targeted myocardial infarction (five interventions), stroke (eight), and heart failure (five). All the interventions for myocardial infarction were based on organizational changes (e.g. implementation of mobile coronary units). They consistently reduced time to treatment and decreased mortality. All the interventions for heart failure were based on the provision of patient education. They consistently improved patient knowledge and self-care behaviour, but mortality reductions were reported in only some of the trials. Among the interventions for stroke, those based on the implementation of telemedicine (tele-stroke systems or tele-consultations) improved monitoring of stroke survivors; those based on new or enhanced rehabilitation services did not consistently improve mortality or physical function; whereas educational interventions effectively improved patient knowledge and behavioural outcomes. In conclusion, a number of different strategies (based on enhancing structures and providing patient education) have been proposed to improve cardiovascular disease healthcare in rural areas. Although available evidence show that these interventions can improve healthcare processes, their impact on mortality and other important health outcomes still remains to be established.
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Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Ibs. Instituto de Investigación Biosanitaria de Granada, Spain.
| | - Ángel Bastos
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain
| | - Maria Jesús Serrano-Ripoll
- Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain; Universitat de les Illes Balears (UIB), Departament de Psicologia, Spain
| | - Ignacio Ricci-Cabello
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain
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Jaana M, Sherrard H. Rural-Urban Comparison of Telehome Monitoring for Patients with Chronic Heart Failure. Telemed J E Health 2018; 25:101-108. [PMID: 29847242 DOI: 10.1089/tmj.2017.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Rural geographic isolation may act as a promoting or restraining variable to the diffusion of technology and healthy aging in the community. Telehome monitoring (TM) leverages technology to support seniors living in the community with chronic conditions. To date, limited research has investigated the utilization of TM in rural settings. This study assesses the comparative utilization of TM for patients with heart failure in rural versus urban environments. MATERIALS AND METHODS We conducted a cross-sectional study involving chart reviews of all patients enrolled in the TM program at the University of Ottawa Heart Institute during 2014. Data were extracted on urban/rural status, demographic characteristics, and process and outcomes of care. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS More rural patients did not have a documented reason for emergency room visits compared to urban patients. There was no significant association between the urban/rural status and the process and outcome measures at the multivariate level. Being followed-up regularly by a family physician and a specialist, as opposed to a specialist or general practitioner only, was associated with significantly longer TM period and a higher number of diuretic adjustments and calls made by nurses. DISCUSSION Although more urban patients were older and living alone, their profile did not affect their utilization of TM. The difference in diagnosis between urban and rural patients also did not contribute to such differences. Hence, there is no variation in the process and outcome measures associated with the utilization of TM between urban and rural environments. CONCLUSIONS Rural patients may not be perceived as extensive users of resources nor patients who represent challenges in terms of feasibility of TM use.
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Affiliation(s)
- Mirou Jaana
- 1 Health Management Department, Telfer School of Management, University of Ottawa, Ottawa, Canada
| | - Heather Sherrard
- 2 Clinical Operations Department, University of Ottawa Heart Institute, Ottawa, Canada
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French BR, Boddepalli RS, Govindarajan R. Acute Ischemic Stroke: Current Status and Future Directions. MISSOURI MEDICINE 2016; 113:480-486. [PMID: 30228538 PMCID: PMC6139763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The evolving knowledge on stroke in conjunction with advances in the field of imaging, treatment approaches using recombinant tissue plasminogen activator (rtPA) or thrombectomy devices in recanalization, and efficient emergency stroke workflow processes have opened new frontiers in managing patients with an acute ischemic stroke. These frontiers have been reformed and overcome in overcoming the decades-long watch and wait approach towards patients with ischemic stroke. In this article, we focus on the current strategies for managing ischemic stroke and conclude by providing a brief overview of anticipating developments that can transform future stroke treatments.
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Affiliation(s)
- Brandi R French
- Brandi R. French, MD, Assistant Professor of Clinical Vascular Neurology, Medical Director of Inpatient Neurosciences Unit in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raja S Boddepalli
- Raja S. Boddepalli, MD, Research Assistant in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raghav Govindarajan
- Raghav Govindarajan MD, FISQua, FACSc, FCCP, MSMA member since 2013 and 2017 Boone County Medical society President, Assistant Professor in the Department of Neurology, University of Missouri - Columbia, Missouri
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An Interprofessional Virtual Healthcare Neighborhood for Caregivers of Elderly With Dementia. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
In response to rural health workforce shortages, universities and training providers offer rural and remote clinical placements. This has led to development of educational methods to counter the barriers of distance. In this emerging field, recent improvements in technology have provided solutions including the use of sophisticated videoconferencing systems such as the Cisco TelePresence model CTS-500. This paper evaluates the use of TelePresence in diverse medical education activities using a mixed methods design—questionnaires n=60, individual interviews n=33, and observed practice of activities n=22. TelePresence was found to be beneficial to learning and teaching and superior to other systems participants had used. In particular, the audiovisual quality, resulting intimacy, convenience, and ease of use facilitated teaching and learning, while the fixed camera and poorly arranged physical environment were found to be limitations. The system is best suited for small group activities. Clinical skills-based activities are viable. It is recommended that technical support be available during setup and use and a picture-in-picture mode be included and improved integration of office suite software to provide a joint workspace for display of presentations, images, editing or annotation of documents, and file sharing.
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Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. Systematic review of telestroke for post-stroke care and rehabilitation. Curr Atheroscler Rep 2014; 15:343. [PMID: 23761014 DOI: 10.1007/s11883-013-0343-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Telemedicine for acute stroke care is supported by a literature base. It remains unclear whether or not the use of telemedicine for other phases of stroke care is beneficial. The authors conducted a systematic review of the published literature on telemedicine for the purposes of providing post-stroke care. Studies were included if the title or abstract expressed use of two-way audio/video communication for post-stroke care. From an initial yield of 1,405 potentially eligible hits, two reviewers ultimately identified 24 unique manuscripts to undergo functionality, application, technology, and evaluative (F.A.T.E.) scoring. Each article was classified using a scoring rubric to assess the functionality, application, technology, and evaluative stage. It was found that most post-stroke telemedicine studies evaluated rehabilitation of adults. All primary data manuscripts were small and preliminary in scope and evaluative phase, and median F.A.T.E. score for primary data was 2. The use of telemedicine for post-stroke care is nascent and is primarily focused on post-stroke rehabilitation.
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Affiliation(s)
- Mark N Rubin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Rutledge CM, Haney T, Bordelon M, Renaud M, Fowler C. Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations. Int J Nurs Educ Scholarsh 2014; 11:/j/ijnes.2014.11.issue-1/ijnes-2013-0061/ijnes-2013-0061.xml. [PMID: 24423469 DOI: 10.1515/ijnes-2013-0061] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.
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