Showing papers in "Telemedicine Journal and E-health in 2004"
TL;DR: In this paper, a study was conducted to determine whether home telehealth, when integrated with the health facility's electronic medical record system, reduces healthcare costs and improves quality-of-life outcomes relative to usual home healthcare services for elderly high resource users with complex co-morbidities.
Abstract: The aim of this study was to determine whether home telehealth, when integrated with the health facility's electronic medical record system, reduces healthcare costs and improves quality-of-life outcomes relative to usual home healthcare services for elderly high resource users with complex co-morbidities. Study patients were identified through the medical center's database. Intervention patients received home telehealth units that used standard phone lines to communicate with the hospital. FDA-approved peripheral devices monitored vital signs and valid questionnaires were used to evaluate quality-of-life outcomes. Out-of-range data triggered electronic alerts to nurse case managers. (No live video or audio was incorporated in either direction.) Templated progress notes facilitated seamless data entry into the patient's electronic medical record. Participants (n = 104) with complex heart failure, chronic lung disease, and/or diabetes mellitus were randomly assigned to an intervention or control group for 6-12 months. Parametric and nonparametric analyses were performed to compare outcomes for (1) subjective and objective quality-of-life measures, (2) health resource use, and (3) costs. In contrast to the control group, scores for home telehealth subjects showed a statistically significant decrease at 6 months for bed-days-of-care (p < 0.0001), urgent clinic/emergency room visits (p = 0.023), and A1C levels (p < 0.0001); at 12 months for cognitive status (p < 0.028); and at 3 months for patient satisfaction (p < 0.001). Functional levels and patient-rated health status did not show a significant difference for either group. Integrating home telehealth with the healthcare institution's electronic database significantly reduces resource use and improves cognitive status, treatment compliance, and stability of chronic disease for homebound elderly with common complex co-morbidities.
249 citations
TL;DR: CBT delivered by videoconference was as effective as CBT delivered face-to-face and Hypotheses are proposed to explain the rapid creation of strong therapeutic alliances in videoconferencing.
Abstract: Delivering psychotherapy by videoconference could significantly increase the accessibility of empirically validated treatments. The aim of this study was to compare the effectiveness of cognitive-b...
225 citations
TL;DR: Results of this study confirm the potential for SLP treatment using videoconferencing and indicate a need for continued research in the field.
Abstract: This paper presents results from a study conducted at the Rehabilitation Engineering Research Center (RERC) on Telerehabilitation at the National Rehabilitation Hospital. The study was designed to measure performance by brain-injured subjects, with medical diagnoses of stroke or traumatic brain injury, on a standardized Speech-Language Pathology evaluation conducted in both face-to-face and videoconference-based telerehabilitation settings. The Story Retelling Procedure (SRP), which measures connected language production and comprehension of spoken narratives, was administered to each subject in both settings. The primary objectives of this study were to: (1) compare communication as measured by the SRP between experimental settings, and (2) determine if subject variables (such as age, education, technology experience or gender) had an effect on performance differences between settings. The rationale was that any difference in this aspect of performance must be identified and characterized before this mode of intervention can be used clinically. Across all subjects (n = 40), no significant difference (p > 0.05) was found between SRP performance measured in the two settings. Additionally, variables including age, education, technology experience, and gender did not significantly affect the difference between performance in the two settings. Overall, subjects reported a high level of acceptance of videoconferencing with 34 subjects responding "yes," 4 responding "no," and 2 responding "maybe" when asked if they would use videoconferencing again to talk to a clinician. Results of this study confirm the potential for SLP treatment using videoconferencing and indicate a need for continued research in the field.
133 citations
TL;DR: The development and implementation of Alzheimer's Caregiver Support Online (also known as AlzOnline), an Internet- and telephone-based education and support network for caregivers of individuals with progressive dementia, is described.
Abstract: Family caregivers of older adults with progressive dementia (e.g., Alzheimer's disease) are confronted with a variety of challenges in providing assistance to their loved ones, such as dealing with persistent, repetitive questions, managing episodes of agitation and aggressive responding, as well as monitoring hygiene and self-care activities. Although professional and governmental organizations have called for the creation of community-based education and support programs, a significant proportion of dementia caregivers in the United States continue to receive little or no formal instruction in responding effectively to these anxiety-provoking situations. This paper describes the development and implementation of Alzheimer's Caregiver Support Online (also known as AlzOnline), an Internet- and telephone-based education and support network for caregivers of individuals with progressive dementia. An outcome analysis of a Robert Wood Johnson Foundation-funded strategic marketing initiative to promote the use of AlzOnline is reviewed, followed by a presentation of the findings of an initial program evaluation. Finally, future directions for online caregiver evaluation research are proposed.
117 citations
TL;DR: It is demonstrated that telehomecare linking homebound patients with their home health-care nurses over the plain old telephone system (POTS) provides high-quality, clinically useful, and patient satisfactory interactions.
Abstract: The aim of this study was to demonstrate that telehomecare linking homebound patients with their home health-care nurses over the plain old telephone system (POTS) provides high-quality, clinically useful, and patient satisfactory interactions. Congestive heart failure, chronic obstructive pulmonary disease, and chronic wound-care patients receiving skilled home nursing care were randomized into control (standard home health care, HHC) and two intervention (standard care plus video conferencing/Internet access; the above plus physiological monitoring) groups. Virtual visits (VVs), consisting of two-way audio and video interactions between the central site HHC nurse and the subject at home, were compared for technical quality and clinical usefulness by the HHC nurses who performed the VVs. Subject perception of telehomecare and satisfaction with their HHC were assessed over the course of the project. There were a total of 567 virtual and 1,057 actual visits conducted for the 53 subjects completing the study. The technical quality of VVs were rated at 94.7%. They were considered to be as useful as actual visits in 90.7% of cases. Subject telehomecare perception increased after experiencing the process. All subjects were satisfied with their HHC; satisfaction increased with an increasing level of telehomecare intervention. Subjects receiving physiological monitoring and video conferencing/Internet access in addition to standard care were most satisfied with their care. VVs can be conducted over POTS. Patients can use telehomecare with moderate levels of training. These programs can provide timely and quality home health nursing care with VVs augmenting traditional home visits.
114 citations
TL;DR: The study showed a high level of satisfaction among all users of a store-and-forward teledermatology consult system, and, in some cases, the survey results could be validated with observed clinical outcomes.
Abstract: The aim of this study was to assess satisfaction with and acceptance of a store and forward teledermatology consult system among patients, referring primary-care clinicians, and consultant dermatologists. As part of a randomized clinical trial that compared the clinical and economic outcomes of store and forward teledermatology to a conventional referral process, we conducted satisfaction assessments among participating patients, referring primary-care clinicians, and consultant dermatologists. Survey questions included issues related to the timeliness of each consult process, the confidence participants displayed in each consult modality, and assessments of overall satisfaction and preferences. A majority of referring clinicians (92%) and dermatologist consultants (75%) reported overall satisfaction with the teledermatology consult process. Ninety-five percent of referring clinicians reported that teledermatology resulted in more timely referrals for their patients. This finding was validated by the observation that teledermatology patients reached a point of initial intervention significantly sooner than did patients in usual care (41 days versus 127 days, p = 0.0001). Teledermatology patients reported satisfaction with the outcome of their teledermatology consultation 82% of the time. However, patients did not express a clear preference for a consult method. A total of 41.5% of patients preferred teledermatology, 36.5% preferred usual care, and 22% were neutral. Our study showed a high level of satisfaction among all users of a store-and-forward teledermatology consult system, and, in some cases, our survey results could be validated with observed clinical outcomes.
104 citations
TL;DR: This document addresses current diabetic retinopathy telehealth clinical and administrative issues and provides recommendations for designing and implementing a diabetic Retinopathy ocular telehealth care program.
Abstract: Telehealth holds the promise of increased adherence to evidenced-based medicine and improved consistency of care Goals for an ocular telehealth program include preserving vision, reducing vision loss, and providing better access to medicine Establishing recommendations for an ocular telehealth program may improve clinical outcomes and promote informed and reasonable patient expectations This document addresses current diabetic retinopathy telehealth clinical and administrative issues and provides recommendations for designing and implementing a diabetic retinopathy ocular telehealth care program The recommendations also form the basis for evaluating diabetic retinopathy telehealth techniques and technologies Recommendations in this document are based on careful reviews of current evidence, medical literature and clinical practice They do not, however, replace sound medical judgment or traditional clinical decision-making "Telehealth Practice Recommendations for Diabetic Retinopathy" will be annually reviewed and updated to reflect evolving technologies and clinical guidelines
98 citations
TL;DR: Three fictional case vignettes are presented that illustrate the ways that VR telerehabilitation might be implemented with varying degrees of success in the future and a system that is currently being used to deliver virtual worlds over the Internet for training safety skills to children with learning disabilities is described.
Abstract: Continuing advances in virtual reality (VR) technology along with concomitant system cost reductions have supported the development of more useful and accessible VR systems that can uniquely target a wide range of physical, psychological, and cognitive rehabilitation concerns and research questions. VR offers the potential to deliver systematic human testing, training, and treatment environments that allow for the precise control of complex dynamic three-dimensional stimulus presentations, within which sophisticated interaction, behavioral tracking, and performance recording is possible. The next step in this evolution will allow for Internet accessibility to libraries of VR scenarios as a likely form of distribution and use. VR applications that are Internet deliverable could open up new possibilities for home-based therapy and rehabilitation. If executed thoughtfully, they could increase client involvement, enhance outcomes and reduce costs. However, before this vision can be achieved, a number of signi...
93 citations
TL;DR: The experimental results show that VTS may be suitable for a practical telemedicine system in home healthcare and verified no data loss during Bluetooth and Internet communication.
Abstract: The VitalPoll Telemedicine System (VTS) was designed and developed for wireless home healthcare. The aims of this study were: to design the architecture and communication methods for a telemedicine system; to implement a physiologic routing hub to collect data from different medical devices and sensors; and to evaluate the feasibility of this system for applications in wireless home healthcare. The VTS was built using Bluetooth wireless and Internet technologies with client/server architecture. Several medical devices, which acquire vital signs, such as real-time electrocardiogram signals, heart rate, body temperature, and activity (physical motion), were integrated into the VTS. Medical information and data were transmitted over short-range interface (USB, RS232), wireless communication, and the Internet. The medical results were stored in a database and presented using a web browser. The patient's vital signals can be collected, transmitted, and displayed in real time by the VTS. The experiments verified no data loss during Bluetooth and Internet communication. Bluetooth and the Internet provide enough bandwidth channels to tranmit these vital signs. The experimental results show that VTS may be suitable for a practical telemedicine system in home healthcare.
70 citations
TL;DR: Evidence supports the use of a specific home-telehealth strategy for care coordination to improve functional independence in non-institutionalized veterans with chronic disease.
Abstract: This study compared health-related outcomes, during a 1-year period, for two groups of frail elders-one that received care coordination via distance monitoring (home-telehealth) and one that received no intervention. A case-control design was employed. The home telehealth intervention group was made up of 111 male veterans who were enrolled in a Veterans Health Administration project. The control group consisted of 115 men who were referred from either senior service agencies or hospital rehabilitation programs, but did not receive home-telehealth. Subjects in both groups had primary diagnoses of hypertension, diabetes, respiratory disease, or heart disease. The two groups were similar in terms of age, race, marital status, and independence in instrumental activities of daily living (IADL) at baseline. A paired t-test was used to study the before-after (baseline to 12-month follow-up) improvements in the outcome measures within each group. Regression models were used to compare the outcome improvements between the two groups. Over 1 year, the intervention group improved 2.2 points more in IADL, 14.4 points more in FIM motor scores, and 2.7 points more in FIM cognitive scores than the control group (p < 0.0001). This evidence supports the use of a specific home-telehealth strategy for care coordination to improve functional independence in non-institutionalized veterans with chronic disease. A randomized controlled trial should be employed to confirm these findings.
69 citations
TL;DR: This research was undertaken to inform future telehealth policy directions regarding the socioeconomic impact of telehealth, and revealed a focus on certain socioeconomic indicators such as cost, access, and satisfaction.
Abstract: This research was undertaken to inform future telehealth policy directions regarding the socioeconomic impact of telehealth. Fifty-seven sources were identified and analyzed through a comprehensive literature search of electronic databases, the Internet, journals, conference proceedings, as well as personal communication with consultants in the field. The review revealed a focus on certain socioeconomic indicators such as cost, access, and satisfaction. It also identified areas of opportunity for further research and policy analysis and development (e.g., social isolation, life stress, poverty), along with various barriers and challenges to the advancement of telehealth. These included confidentiality, reimbursement, and legal and ethical considerations. To become fully integrated into the health care system, telehealth must be viewed as more than an add-on service. This paper offers 19 general and 20 subject-specific telehealth recommendations, as well as seven policy strategies.
TL;DR: Results indicated that youth evaluated through the TPC were broadly comparable to youth evaluated in the CAPOC, and telepsychiatry appears to serve youth that are representative of those seeking psychiatric care, and it is not restricted to youth with no medical insurance or with selected diagnoses.
Abstract: Several studies have described successful applications of telepsychiatry with children and adolescents. However, there has been little examination of the populations served by telepsychiatry and the ability to evaluate youth accurately through this medium. In this article, we examined whether telepsychiatry patients are representative of those in usual outpatient care. Participants included 369 patients 3-19 years old evaluated at two clinics. A new telepsychiatry clinic (TPC) developed to provide services to under-served communities, and a child and adolescent psychiatric outpatient clinic (CAPOC) that served youth from predominantly metropolitan areas were included in the study. The telepsychiatry sites were linked using ISDN lines at 384 KB/sec. We examined these two samples regarding demographics, payor status, and diagnostic profiles. Results indicated that youth evaluated through the TPC were broadly comparable to youth evaluated in the CAPOC. Therefore, telepsychiatry appears to serve youth that are representative of those seeking psychiatric care, and it is not restricted to youth with no medical insurance or with selected diagnoses. The similarity of diagnoses further suggests that telepsychiatry provides adequate technical resolution and doctor-patient rapport to detect psychopathology of youths. These findings suggest the need for further systematic investigation of telepsychiatry as a tool for providing psychiatric care to young people.
TL;DR: Given the substantial financial savings, support for underserved rural programs, and significant funds kept in the rural community, this may serve as a viable model for providing care to acutely ill and injured infants and children.
Abstract: The objective of this research was to examine the fiscal impact of telemedicine consultations for acutely ill and injured children in a rural setting using pediatric intensive care unit (ICU) telemedicine. One hundred seventy-nine acutely ill and injured infants and children were cared for in the Mercy Redding ICU from April 2000 to April 2002. Data were gathered from these patients, including 47 patients who received 70 pediatric ICU telemedicine consultations during the same time period. Transport and hospital costs avoided were calculated for patients who received telemedicine consultations (Group 1) and for those not transferred due to the availability telemedicine consultations (Group 2), estimated to be one-half of the 179 patients (Group 2). The revenue generated in the rural ICU based on the ability to keep these patients was also determined. An estimated annual cost savings of $172,000 and $300,000 for transport and inpatient care was demonstrated for Group 1 and Group 2, respectively. Additionally, this program resulted in generating $186,000 and $279,000 of inpatient revenue annually for the two groups at the rural hospital. The cost of this program was approximately $120,000 per year. Given the substantial financial savings, support for underserved rural programs, and significant funds kept in the rural community, this may serve as a viable model for providing care to acutely ill and injured infants and children.
TL;DR: This 12-month study was designed to assess the readiness of clients, health care professionals, and organizations to adopt telehomecare services for adult diabetic clients within the Calgary Health Region and identified differences in stakeholder conceptions of the technology.
Abstract: Numerous pilot studies have demonstrated that telehomecare technology may improve client outcomes through timely intervention and health crises prevention, thereby reducing return visits to hospitals and physician offices. Although the potential of telehomecare to increase access to services and improve quality of care and health outcomes is recognized, expectations for its widespread adoption have not been realized. Factors affecting diffusion of innovations include, among other things, perceptions of the technology, organizational characteristics, and communication. These require further exploration for telehealth applications because evidence alone will not automatically produce large-scale conversions in practice. This 12-month study was designed to assess the readiness of clients, health care professionals, and organizations to adopt telehomecare services for adult diabetic clients within the Calgary Health Region. A qualitative approach was used to collect data through focus groups with clients and home care nurses along with interviews with family physicians and key informants responsible for planning and resource allocation in diabetic homecare and telehealth programs. The transcripts of these interviews were analyzed for themes, which were categorized with respect to their effect on quality of care (including structure, process or outcome of care), including those related to the individual client, the health care provider, and the organization as a whole. The study findings identified differences in stakeholder conceptions of the technology, including common themes among clients, providers, and organizations. Implications of study results for developing a strategy to incorporate telehomecare into routine community care are discussed.
TL;DR: The authors conclude that the proposed framework can be used to conceptualize, understand, and optimize the key components of a telerehabilitative process and to analyze alternative approaches for optimizing outcomes.
Abstract: For telehealth to become an accepted component of rehabilitation, a scientific base verifying that telehealth improves outcomes must be developed. A conceptual framework based on theory and empirical findings is necessary for this area of inquiry to flourish. Most academic curricula possess such an educational pillar, which serves to help prepare professionals to practice in the new arena, and scholars to perform quality research. Currently, the authors are involved in developing areas of the biomedical engineering and nursing curricula at Marquette University to address key areas of telerehabilitation. This paper outlines the conceptual framework for these curricular areas. The conceptual framework is derived from three areas that modulate each other, and ultimately impact the outcomes of telerehabilitation. These areas are rehabilitative biosystems, human-technology interfaces, and behavioral compliance. Each can be viewed from the context of an optimization process, and the model can be applied to help identify the weak link for a given telerehabilitative approach under study. Examples of how the model can be used to frame telerehabilitation research are presented, with a special focus on designing home-based solutions for two societal challenges of large scope and great need-stroke and cardiac rehabilitation. The authors conclude that the proposed framework can be used to conceptualize, understand, and optimize the key components of a telerehabilitative process and to analyze alternative approaches for optimizing outcomes.
TL;DR: Higher than expected proportions of patients did not meet chosen eligibility criteria or refused to participate and these results should be helpful in designing home-care telemedicine programs and clinical trials.
Abstract: This study reports challenges in recruiting patients for a randomized controlled trial of homecare telemedicine. Descriptive statistics on patient eligibility for home-care telemedicine services and patient refusals for participation are provided. Frequency counts of reasons for study exclusion and participant refusal and Chi-square tests to compare race and age-related differences are given. Of 302 home-care patients reviewed, 197 (65.2%) did not meet inclusion criteria. The most common reasons for study exclusion were patients either needing 3 skilled nurse visits per week (n = 46, 23.4%). Of the eligible patients (n = 105), 79 persons (75.2%) refused participation. The most common reasons for refusals were lack of perceived addition benefit of telemedicine (n = 27, 34.2%), and that routine health care was sufficient (n = 23, 29.1%). Higher than expected proportions of patients did not meet chosen eligibility criteria or refused to participate. These results should be helpful in designing home-care telemedicine programs and clinical trials.
TL;DR: This clinic represents a viable model for the delivery of telepsychiatric services and future research is needed regarding the process and outcomes of delivering psychiatric care by this means for rural, isolated, American Indians, as well as of the treatment of PTSD via real-time, interactive videoconferencing.
Abstract: This paper describes a weekly telepsychiatry clinic treating post-traumatic stress disorder (PTSD) among Northern Plains American Indian Veterans. The clinic represents a unique partnership of five different organizations, including two agencies within the Veterans Affairs Administration, a tribal veterans program, the Indian Health Service, and a university medical center. It is the first report of a telepsychiatry clinic targeting American Indians, as well as the first account of a telepsychiatry clinic focusing on PTSD treatment. A total of 50 telehealth clinic interactions occurred during the first 7 months, consisting of ongoing group psychotherapy, individual therapy, and medication management. Quality control measures exhibited a high degree of patient satisfaction and comfort with the clinic. Although the findings presented here are preliminary, this clinic represents a viable model for the delivery of telepsychiatric services. Future research is needed regarding the process and outcomes of delivering psychiatric care by this means for rural, isolated, American Indians, as well as of the treatment of PTSD via real-time, interactive videoconferencing.
TL;DR: An automatic remote system for use in monitoring the health of independent elderly people living in conventional homes and it was found that total counts from all sensor outputs matched the concurrently acquired data on physical activity obtained from a pedometer.
Abstract: We have developed an automatic remote system for use in monitoring the health of independent elderly people living in conventional homes. In this study, a monitoring system was installed and evaluated in the house of one subject to test the feasibility of determining activities from sensor outputs. Over a period of 6 months, it was found that total counts from all sensor outputs matched the concurrently acquired data on physical activity obtained from a pedometer. Performance of each basic activity of daily living could be confirmed from the sensor output records.
TL;DR: Phone and e-mail consultation appears satisfactory to PCPs and specialty providers as a way to enhance specialty input to rural patients and its multispecialty panel.
Abstract: The University of California (UC), Davis Health System, and California Department of Developmental Services (CDDS) developed the Physician Assistance, Consultation and Training Network (PACT Net) to assist primary-care providers (PCPs) care for patients with developmental disabilities in rural California. This manuscript describes PACT Net, a warm line using phone and e-mail, and its multispecialty panel. A pilot study evaluated whether or not PCPs needed such a consultation service, whether or not it assisted them in providing care, and their overall satisfaction with the service. PCPs were informed on how to request a consultation. Data were collected from patients (demographics), PCPs (satisfaction with preexisting consultation availability and quality, PACT Net consultation reason, preferred mode of contact, duration, and, satisfaction), and specialists (ease, quality of request, and satisfaction). Satisfaction was measured prospectively using a 7-point Likert scale. Data were collected on 30 consulta...
Journal Article•
TL;DR: The purpose of the present study was to fill this void by reporting the utilization patterns in telemedicine programs in state and federal correctional facilities throughout the United States.
Abstract: Although national justice and technology associations have endorsed the utilization of telemedicine and telehealth, little is known about the current utilization of this technology across our nation's correctional facilities. Several voluntary registries and state Web sites exist, but only limited information on telemedicine utilization may be gleaned from these. The purpose of the present study was to fill this void by reporting the utilization patterns in telemedicine programs in state and federal correctional facilities throughout the United States. Using telephone-administered interviews, data were collected from all 50 states. Respondents were asked about utilization, benefits, and barriers to the use of technology in healthcare in state and federal correctional facilities. Slightly over half of state correctional institutions and 39% of federal institutions are using some sort of telehealth or telemedicine applications. The most common benefits cited were improved security, personnel safety, costs savings, and access to specialists. The most common barriers cited were costs of technology, resistance from medical personnel, lack of staff technical expertise, and difficulties coordinating services.
TL;DR: Through experiences, successes, failures, and lessons learned, approaches to overcoming barriers to adoption and sustainment of telehealth applications are developed, including the establishment of partnerships with economic development projects in the state.
Abstract: Access to appropriate healthcare services continues to be a major challenge in rural America. Telehealth technologies offer an opportunity to bridge gaps in health services in rural and remote areas and possibly support rural economic development. Lack of access to healthcare services to a growing population may create barriers to recruitment of businesses and economic growth. Several rural-oriented programs have attempted to leverage these emerging distance technologies, but success has varied despite the application of considerable federal, state governmental, and private resources. Barriers to adoption and sustainability of rural telehealth embody several factors that must be considered when planning, developing, implementing, and evaluating a rural telehealth program. New Mexico, the fifth largest state in the United States, represents many of the issues related to the potential benefits and challenges in developing a telehealth system to serve its rural communities. The Center for Telehealth at the U...
TL;DR: There is a strong business case for the application of telerehabilitation, onsite, in large corporations and therefore is profitable to medical device manufacturers.
Abstract: This paper is an analysis of the economics of physical telerehabilitation, at home, in the clinic, and at work. This study was a precursor to generating a business case for manufacturing telerehabi...
TL;DR: Willingness to use telepsychiatry was relatively high and was affected by the participants' attitudes toward telemedicine, the patient-physician relationship, and by the level of anxiety toward technology.
Abstract: The aim of this study was to assess potential users' willingness to use telepsychiatry and its correlates within a theoretical framework guided by the principles of social-cognitive models. The conceptual model proposed willingness to use telepsychiatry to be associated directly to attitudes toward telemedicine, attitudes toward the patient-physician relationship, and satisfaction with current medical care, and indirectly to anxiety to technology. Phone interviews were conducted with a representative sample of 1,204 Jewish, noninstitutionalized adults in Israel (mean age = 58; 51% female). Structural equation modeling was used to examine hypothesized relationships. Willingness to use telepsychiatry was relatively high and was affected by the participants' attitudes toward telemedicine, the patient–physician relationship, and by the level of anxiety toward technology. Efforts aimed at encouraging the use of telemedicine for psychiatric care should target potential users' attitudes, as well as feelings of u...
TL;DR: There was a significant, high correlation between telepsychiatrist evaluation on the CGI and inmate report of overall symptoms on the SCL-90-R and the findings support the effectiveness of telepsychiatric evaluation for the jail population.
Abstract: The effectiveness of a jail telepsychiatry service was evaluated by comparing psychiatrist and inmate report of psychopathology. Sixty-two inmates completed a total of 107 consultations at a rural county jail via interactive televideo. The inmates completed the Symptom Rating Checklist-90-Revised (SCL-90-R), and the psychiatrist completed a Psychiatrist Evaluation Form including the Clinical Global Impression Scale--Severity Index (CGI) after each teleconsultation. Most inmates were rated mild to moderately ill on the CGI. There was a significant, high correlation between telepsychiatrist evaluation on the CGI and inmate report of overall symptoms on the SCL-90-R [r(101) = 0.35, p < 0.05]. The findings support the effectiveness of telepsychiatric evaluation for the jail population. The patterns of telepsychiatric use in the county jail as well as future directions in this setting are described.
TL;DR: The use of videoconferencing technology to provide mental health services (telepsychiatry) offers hope for addressing longstanding problems regarding work force shortages and access to care, especially in remote or rural areas but data on treatment outcomes are virtually nonexistent, representing an important gap in the literature.
Abstract: The use of videoconferencing technology to provide mental health services (telepsychiatry) offers hope for addressing longstanding problems regarding work force shortages and access to care, especially in remote or rural areas. However, data on treatment outcomes (i.e., based on randomized clinical trials) from telepsychiatry applications are virtually nonexistent, representing an important gap in the literature. An important methodological decision point in developing treatment outcome research is whether to take an efficacy or effectiveness approach. Efficacy approaches offer enhanced internal validity; however, they may have limited generalizability to real-world settings. Effectiveness approaches offer enhanced external validity. But, they are typically less controlled than efficacy studies, thereby limiting the assumptions that can be made about causality. The current state of telepsychiatry research necessitates efficacy studies, the outcomes from which can be used to inform future effectiveness stu...
TL;DR: Parents of children being treated for cancer are receptive to applications of technology in health care, particularly in facilitating non-medical services (e.g., supportive care, education), and potential barriers to use of telemedicine may reflect personal communication preferences rather than perceptions of relevance or technology access.
Abstract: Use of telemedicine in childhood cancer may offer the means to enhance quality and continuity of care for families, especially to reduce travel-related stress (i.e., more treatment closer to home). Little is known, however, about the attitudes and perceptions of parents toward telemedicine, especially potential barriers to implementation. One hundred parents from two regional groups (rural, city) and two childhood cancer groups (leukemia, solid tumor) were surveyed on their understanding and attitudes toward interactive videoconferencing in specific oncology applications. Parents also rated the impact of time and distance factors in complying with cancer treatment, as well as general communication preferences. Parents gave higher ratings for the usefulness of videoconferencing for enhancing psychosocial care or educational opportunities, rather than for clinical uses or treatment planning. Parents' least favored potential application was "diagnostic services," while the most favored was "contact between s...
TL;DR: In this paper, the effects of compression on melanocytic lesion images acquired by means of a digital videomicroscope on the identification of morphological details of the image and on diagnostic accuracy were investigated.
Abstract: Early melanoma diagnosis is an important goal for dermatologists. Polarized light systems are increasingly employed for dermatoscopic diagnosis of melanocytic lesions. For the purpose of teledermoscopy, whose importance is increasingly growing for consultation and teaching purposes, it is of utmost importance to establish whether, after compression, polarized light images maintain their informativeness. The aim of our study was to check the effects of compression on melanocytic lesion images acquired by means of a digital videomicroscope on the identification of morphological details of the image and on diagnostic accuracy. A total of 170 50-fold-magnified pigmented skin lesion images, acquired in Tagged Image File Format (TIFF) by a digital videomicroscope, were compressed using Joint Photographic Experts Group (JPEG) algorithms (compression factor 30). Two experts in videomicroscopy evaluated both original and compressed images twice by describing single lesion features and expressing a diagnosis. Reproducibility in the assessment of dermoscopic parameters and observer performance were studied by kappa statistics and Receiver Operating Characteristic (ROC) analysis. Both intra- and interobserver reproducibility in the assessment of morphological details were higher when TIFF images were considered, indicating a better image quality. Nonetheless, there was no significant difference in the diagnostic accuracy between uncompressed images and compressed ones, although the intraobserver reproducibility in the diagnostic judgement was higher for uncompressed images. Despite loss in image details, factor 30 compressed videomicroscopic images enable a good diagnostic accuracy.
TL;DR: Promoting the use of tele health in the general population and dissipating concerns related to its applications will require global educational strategy that will inform the public about the benefits of telehealth as well as addressing ethical and legal issues.
Abstract: Telehealth is widely considered to be a promising tool that addresses many of the challenges currently facing the health care system in Canada. However, diffusion of telehealth will ultimately depend on its acceptance among health care professionals and the general population. This study explores public understanding and perceptions of telehealth in the Province of Quebec (Canada). A telephone survey involving interviews with a random sample of 1242 individuals was conducted in various Quebec regions. Only 8.9% of respondents were familiar with the term "telehealth," whereas telehealth applications, especially teletriage, appeared to be more commonly known. A large majority of respondents believed telehealth could facilitate access to health care services, improve quality of care, and reduce health care expenditures. Legal responsibility in cases of medical error was reported as the leading public concern related to telehealth. Furthermore, nearly 50% of Quebec's population would use telehealth services when offered to them. The principal factors weighing in favor of willingness to use telehealth services were: knowledge of telehealth applications perception of telehealth benefits, reduced barriers to telehealth, and the fact of being female. Promoting the use of telehealth in the general population and dissipating concerns related to its applications will require global educational strategy that will inform the public about the benefits of telehealth as well as addressing ethical and legal issues.
TL;DR: Its initial effectiveness and more consistent use suggest that remote monitoring may be successfully used in short-term interventions and in settings where staffing for case management is weak.
Abstract: Asthma prevalence is increasing among poor and minority children. We examined the effectiveness of a novel interactive device programmed for self-management of pediatric asthma in reducing asthma control problems and hospitalizations. A randomized controlled trial (66 children in the intervention group and 68 in the control group) was conducted at home and in an outpatient hospital clinic with 8-16-year-old inner-city children with physician-diagnosed asthma. During a 12-week period, children in the experimental group received an asthma self-management and education program, the Health Buddy (Health Hero Network), designed to enable them to monitor their symptoms and transmit this information to a case manager through a secure website. Control group participants used an asthma diary. After adjusting for baseline asthma control problems, asthma severity, and seasonality, children randomized to automated self-management had a significantly lower mean number of asthma control problems at 6 weeks (2.0, SD = 1.6) as compared to children assigned to the asthma diary (2.7, SD = 1.6) (p = 0.03). By 12 weeks, after adjusting for time and the other covariates, asthma control problems dropped markedly in both groups, and did not differ by intervention modality (p = .07). The intervention modality was not a significant predictor of hospitalization. Educational interventions that encourage children's active involvement in their own care and symptom monitoring would help children increase their control of asthma problems. Compared to the asthma diary, the automated self-management had a significant short-term impact on asthma control problems. Its initial effectiveness and more consistent use suggest that remote monitoring may be successfully used in short-term interventions and in settings where staffing for case management is weak.