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Remote activity monitoring for family caregivers of persons living with dementia: a mixed methods, randomized controlled evaluation. BMC Geriatr 2021; 21:715. [PMID: 34922475 PMCID: PMC8684277 DOI: 10.1186/s12877-021-02634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The goal of the present study was to determine whether a remote activity monitoring (RAM) system benefited caregivers who aided relatives with Alzheimer’s disease or related dementias (ADRD) living at home. We hypothesized that over 18 months, families randomly assigned to receive RAM technology in the home of the person with ADRD would experience statistically significant (p < .05): 1) improvements in caregiver self-efficacy and sense of competence when managing their relative’s dementia; and 2) reductions in caregiver distress (e.g., burden, role captivity, and depression). Methods An embedded mixed methods design was utilized, where 179 dementia caregivers were randomly assigned to receive RAM or not. Caregivers were surveyed bi-annually over an 18-month period to collect quantitative and qualitative data on RAM’s effects. Semi-structured interviews with 30 caregivers were completed following the 18-month data collection period to explore more in-depth how and why RAM was perceived as helpful or not. Results Growth curve models showed no direct or moderation effect of RAM on dementia caregiver outcomes. The qualitative data revealed a complex utilization process of RAM influenced by the care environment/context as well as the temporal progression of ADRD and the caregiving trajectory. Conclusions The findings suggest the need for developing more effective mechanisms to match appropriate technologies with the heterogeneous needs and care contexts of people living with ADRD and their caregivers. A triadic approach that incorporates professional care management alongside passive monitoring systems such as RAM may also enhance potential benefits. Trial registration ClinicalTrials.govNCT03665909, retrospectively registered on 11 Sept 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02634-8.
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Zhang XY, Zhang PY. Hospital information technology in home care. Exp Ther Med 2016; 12:2408-2410. [PMID: 27698741 PMCID: PMC5038446 DOI: 10.3892/etm.2016.3664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/26/2016] [Indexed: 11/11/2022] Open
Abstract
The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.
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Affiliation(s)
- Xiao-Ying Zhang
- Nanjing University of Chinese Medicine, Information Institute, Nanjing, Jiangsu 210029, P.R. China
| | - Pei-Ying Zhang
- Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu 221009, P.R. China
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Levy CE, Silverman E, Jia H, Geiss M, Omura D. Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes. ACTA ACUST UNITED AC 2016; 52:361-70. [PMID: 26230650 DOI: 10.1682/jrrd.2014.10.0239] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/12/2015] [Indexed: 11/05/2022]
Abstract
This study examined functional outcomes, health-related quality of life (HRQoL), and satisfaction in a group of Veterans who received physical therapy via an in-home video telerehabilitation program, the Rural Veterans TeleRehabilitation Initiative (RVTRI). A retrospective, pre-post study design was used. Measures obtained from 26 Veterans who received physical therapy in the RVTRI program between February 22, 2010, and April 1, 2011, were analyzed. Outcomes were the Functional Independence Measure (FIM); Quick Disabilities of the Arm, Shoulder, and Hand measure; Montreal Cognitive Assessment (MoCA); and the 2-minute walk test (2MWT). HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), and program satisfaction was evaluated using a telehealth satisfaction scale. Average length of participation was 99.2 +/- 43.3 d and Veterans, on average, received 15.2 +/- 6.0 therapeutic sessions. Significant improvement was shown in the participants' FIM (p < 0.001, r = 0.63), MoCA (p = 0.01, r = 0.44), 2MWT (p = 0.006, r = 0.73), and VR-12 (p = 0.02, r = 0.42). All Veterans reported satisfaction with their telerehabilitation experiences. Those enrolled in the RVTRI program avoided an average of 2,774.7 +/- 3,197.4 travel miles, 46.3 +/- 53.3 hr of driving time, and $1,151.50 +/- $1,326.90 in travel reimbursement. RVTRI provided an effective real-time, home-based, physical therapy.
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Stern A, Valaitis R, Weir R, Jadad AR. Use of home telehealth in palliative cancer care: a case study. J Telemed Telecare 2012; 18:297-300. [DOI: 10.1258/jtt.2012.111201] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We conducted a mixed-methods case study to explore the perceptions of family caregivers and palliative cancer patients of home telehealth, and their experience with it. The intervention in the randomized controlled trial from which study participants were selected consisted of specialist nurses available 24 hours per day who communicated with patients and families using videophones, with optional remote monitoring. Qualitative data were collected from interviews with five patient/caregiver dyads and seven bereaved family caregivers, direct observation and nursing documentation. Quantitative data were collected from computerized nursing documentation and analyzed for patterns of use. During the study there were 255 contacts, including videophone, telephone or face-to-face visits, between tele-nurses and families. Overall the patients, family caregivers and tele-nurses felt that home telehealth enabled family caregiving, citing increased access to care, and patient and family caregiver reassurance. Pain management was the most common reason for initiating contact with the nurse, followed by emotional support. Concerns included lack of integration of services, inappropriate timing of the intervention and technical problems. The case study confirmed the importance of timely and accessible care for a group of clinically vulnerable, dying cancer patients and their family caregivers.
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Affiliation(s)
- Anita Stern
- University of Toronto,
Toronto, Ontario, Canada
| | - Ruta Valaitis
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario,
Canada
| | - Robin Weir
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario,
Canada
- System Linked Research Unit,
Hamilton, Ontario, Canada
| | - Alejandro R Jadad
- University of Toronto,
Toronto, Ontario, Canada
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario,
Canada
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Hudson P, Remedios C, Zordan R, Thomas K, Clifton D, Crewdson M, Hall C, Trauer T, Bolleter A, Clarke DM, Bauld C. Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. J Palliat Med 2012; 15:696-702. [PMID: 22385026 PMCID: PMC3362953 DOI: 10.1089/jpm.2011.0466] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Support for family caregivers, including bereavement follow-up, is a core function of palliative care. Many caregivers acknowledge positive aspects associated with the role; however a considerable proportion will experience poor psychological, social, financial, spiritual, and physical well-being and some will suffer from complicated grief. Many family caregivers have unmet needs and would like more information, preparation, and support to assist them in the caregiving role. There is a shortage of evidence-based strategies to guide health professionals in providing optimal support while the caregiver is providing care and after the patient's death. PURPOSE To develop clinical practice guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. METHODS (1) Literature review; (2) focus groups and structured interviews with key stakeholders within Australia; (3) national and international expert opinion to further develop and refine the guidelines using a modified Delphi process; and (4) endorsement of the guidelines from key palliative care, caregiver, and bereavement organizations (national and international). RESULTS The guidelines were developed for multidisciplinary health care professionals and clinical services commonly involved in caring for adult patients receiving palliative care in a variety of care sites throughout Australia. These consensus-based guidelines have been endorsed key Australian and international organizations. CONCLUSIONS The guidelines may prove valuable for the international palliative care community and for generalist health care providers who occasionally care for palliative care patients. Research is recommended to explore the uptake, implementation, and effectiveness of the guidelines.
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Affiliation(s)
- Peter Hudson
- Centre for Palliative Care at St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
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Abstract
OBJECTIVES To describe the current level of utilization of informatics systems in hospice and palliative care and to discuss two projects that highlight the role of informatics applications for hospice informal caregivers. DATA SOURCES Published articles, Web resources, clinical practice, and ongoing research initiatives. CONCLUSION There are currently few informatics interventions designed specifically for palliative and hospice care. Challenges such as interoperability, user acceptance, privacy, the digital divide, and allocation of resources all affect the diffusion of informatics tools in hospice. IMPLICATIONS FOR NURSING PRACTICE Caregiver support through use of information technology is feasible and may enhance hospice care.
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Abstract
This review paper explores the use of telehealth in relation to palliative care in the UK. Information technology (IT) developments are being harnessed throughout society, and there is growing interest in the ways in which they can be used to meet and support patients' health needs in the community. The aim of the literature review was to scope the information available from published and unpublished research, with particular reference to older people. The evidence suggests that, despite the challenges, there are numerous examples of good practice in relation to telehealth, palliative and end-of-life care, and older people. Developments in technology that have increased the capacity to improve care, through reaching greater numbers of people of all age groups, mean that telehealth has much to offer people living with and dying from advanced illness. However, some of the evaluative evidence is limited and further rigour is needed when evaluating future telehealth innovations.
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Affiliation(s)
- Bridget Johnston
- University of Dundee, School of Nursing and Midwifery, 11 Airlie Place, Dundee, UK.
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Hudson P, Payne S. Family Caregivers and Palliative Care: Current Status and Agenda for the Future. J Palliat Med 2011; 14:864-9. [DOI: 10.1089/jpm.2010.0413] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital & Collaborative Centre of The University of Melbourne, Australia, and Queens University, Belfast, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, School of Health and Medicine, Lancaster University, Lancashire, United Kingdom, and Monash University, Melbourne, Australia
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A conceptual framework of outcomes for caregivers of assistive technology users. Am J Phys Med Rehabil 2009; 88:645-55; quiz 656-8, 691. [PMID: 19620830 DOI: 10.1097/phm.0b013e3181ae0e70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users. DESIGN The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework. RESULTS An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable). CONCLUSIONS Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.
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Hopp FP, Hogan M. Community-based tele-health systems for persons with diabetes: development of an outcomes model. SOCIAL WORK IN HEALTH CARE 2009; 48:134-153. [PMID: 19197771 DOI: 10.1080/00981380802533389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to obtain information on the perceptions of persons with diabetes regarding participation in a tele-health program. We conducted three focus groups among diabetics who had used a monitoring and messaging device (MMD), a commonly used tele-health care system. Analysis involved open and axial coding to identify major themes and relationships. Results suggest that these systems enhance communication, care-manager relationships, self-discipline, and clinical follow-up. The results suggest mechanisms by which tele-health systems influence the health care system and point to areas for further tele-health development.
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Affiliation(s)
- Faith P Hopp
- School of Social Work, Wayne State University, Detroit, Michigan 48202, USA.
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Fetter MS. Improving information technology competencies: implications for psychiatric mental health nursing. Issues Ment Health Nurs 2009; 30:3-13. [PMID: 19148816 DOI: 10.1080/01612840802555208] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While substantial evidence links information technology (IT) with improved patient safety, care quality, access, and efficiency, nurses must demonstrate competencies in computers, informatics, and information literacy in order to use IT for practice, education, and research. The nursing profession has established IT competencies for all nurses at beginning and experienced levels. Newly revised standards also articulate role-specific expectations for advanced practice nurses. Unfortunately, there is a concern that many nurses may not possess these capabilities and that nurse educators are not prepared to teach them. IT competency evaluations, which have focused predominately on nursing education, indicate novice skill levels for most faculty and students. In numerous studies, again conducted largely in nursing education, significant improvement in IT competencies has been achieved only with intensive interventions. Deficits in IT competencies are a significant concern, because the federal government has mandated full implementation of Electronic Health Records (EHR) by 2014. EHR will require all nurses to use IT to deliver, document, and obtain reimbursement for patient care. In response to these concerns, two recent initiatives, the "Health Information Technology Scholars (HITS)" and "Technology Informatics Guiding Education Reform (TIGER)" projects, have been launched. By enhancing IT competencies, these projects will enable nurses to use evidence-based practice and other innovations to transform clinical care, education, and research. This report updates psychiatric-mental health nurses on the IT competencies literature, recent enhancement initiatives and innovations, and their implications for the specialty.
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Affiliation(s)
- Marilyn S Fetter
- College of Nursing, Villanova University, Villanova, Pennsylvania 19085, USA.
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Demiris G, Oliver DP, Wittenberg-Lyles E. Assessing caregivers for team interventions (ACT): a new paradigm for comprehensive hospice quality care. Am J Hosp Palliat Care 2008; 26:128-34. [PMID: 19116302 DOI: 10.1177/1049909108328697] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article provides a framework labeled ACT that aims to successfully integrate family caregivers and patients into one unit of care, as dictated by the hospice philosophy. ACT (assessing caregivers for team interventions) is based on the ongoing assessment of the caregiver background context, primary, secondary, and intrapsychic stressors as well as outcomes of the caregiving experience and subsequently, the design and delivery of appropriate interventions to be delivered by the hospice interdisciplinary team. Interventions have to be tailored to a caregiver's individual needs; such a comprehensive needs assessment allows teams to customize interventions recognizing that most needs and challenges cannot be met by only one health care professional or only one discipline. The proposed model ensures a holistic approach to address the multifaceted challenges of the caregiving experience.
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Affiliation(s)
- George Demiris
- School of Nursing, University of Washington, Seattle, WA 98195, USA.
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