Showing papers on "Telehealth published in 2000"

Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care.

Abstract: Background Primary care treatment of depression needs improvement. Objective To evaluate the efficacy of 2 augmentations to antidepressant drug treatment. Design Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months. Setting Two managed care adult primary care clinics. Participants A total of 302 patients starting antidepressant drug therapy. Interventions For telehealth care: emotional support and focused behavioral interventions in ten 6-minute calls during 4 months by primary care nurses; and for peer support: telephone and in-person supportive contacts by trained health plan members recovered from depression. Main outcome measures For depression: the Hamilton Depression Rating Scale and the Beck Depression Inventory; and for mental and physical functioning: the SF-12 Mental and Physical Composite Scales and treatment satisfaction. Results Nurse-based telehealth patients with or without peer support more often experienced 50% improvement on the Hamilton Depression Rating Scale at 6 weeks (50% vs 37%; P =.01) and 6 months (57% vs 38%; P =.003) and on the Beck Depression Inventory at 6 months (48% vs 37%; P =. 05) and greater quantitative reduction in symptom scores on the Hamilton scale at 6 months (10.38 vs 8.12; P =.006). Telehealth care improved mental functioning at 6 weeks (47.07 vs 42.64; P =.004) and treatment satisfaction at 6 weeks (4.41 vs 4.17; P =.004) and 6 months (4.20 vs 3.94; P =.001). Adding peer support to telehealth care did not improve the primary outcomes. Conclusion Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.

Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls

Abstract: Telemedicine and telehealth are changing the face of health care delivery and becoming a multi-billion dollar industry. Dr. Darkins and Dr. Cary share their knowledge and provide practical insights and advice on making telemedicine programs into successful clinical services and a productive business. The book gives background knowledge and useful tips on starting up and managing programs in an array of settings. Most importantly, the book is based on the recognition that patients are customers of health care and telemedicine companies developing new products vital to delivering care to rural or inaccessible clients is vital to health care's future.

The coming of age of telecommunications in psychological research and practice.

Abstract: Rapid and far-reaching technological advances are revolutionizing the ways in which people relate, communicate, and live their daily lives. Technologies that were hardly used a few years ago, such as the Internet, e-mail, and video teleconferencing, are becoming familiar methods for modern communication. Telecommunications will continue to evolve quickly, spawning telehealth applications for research and the provision of clinical care in communities, university settings, clinics, and medical facilities. The impact on psychology will be significant. This article examines the application of developing technologies as they relate to psychology and discusses implications for professional research and practice.

Increasing the cost-effectiveness of telemedicine by embracing e-health.

Abstract: In 1999 a national study of telemedicine in Australia led to the promotion of the concept of 'e-health', the health sector's equivalent of 'e-commerce'. A new study explored the view that, with the convergence of technologies and the consequent increase in ability to perform multiple functions with those technologies, it is unwise to promote telemedicine in isolation from other uses of technologies in health-care. The major sources of information for the study were the presentations and discussions at five national workshops held to discuss the findings of the original report on telemedicine. Nineteen case studies were identified. The case studies showed that with the convergence of technologies telehealth is becoming part of e-health. The cost-effectiveness of both telehealth and telemedicine improves considerably when they are part of an integrated use of telecommunications and information technology in the health sector.

Telehealth in speech pathology: Applications to the treatment of stuttering:

Abstract: The potential value of telecommunications systems in treating communication disorders is being increasingly recognized. This mode of service delivery shows particular promise in giving patients access to specialist services for problems like stuttering, which are difficult to manage and often require long-term follow-up support. The Institute for Stuttering Treatment and Research at the University of Alberta has used videoconferencing to provide follow-up support to geographically remote adults who have undergone intensive treatment on site.

From Telehealth to E-Health: Internet and Distributed Virtual Reality in Health Care

Abstract: Since the development of methods of electronic communication, clinicians have been using information and communication technologies for the exchange of health-related information. However, the emer...

Reach Out and Heal Someone: Telemedicine and the Globalization of Health Care:

Abstract: This article considers how telemedicine emerged as an important new means of constructing new geographic and social relationships in health care. Telemedicine is considered in light of the telecommunications revolution of the 1990s and the potential for expanding health markets during this period. An argument is made that telemedicine is part of an actuarial mode of organizing peoples according to the interests of emerging health care corporations. The techniques of the field are central components of a spatial social ordering of subjects into populations within a newly converged global health network. This article argues that telemedicine is not simply a new approach to delivering health care better, it is a method of tailoring health-care communities to match the demands of a global health economy.

Telehealth acquires meanings: information and communication technologies within health policy

Abstract: . Over the last decade, British health policy has increasingly considered the role of information and information technologies in the provision of health care. Recently, there is a growing interest in new health applications, often referred to as telemedicine and telehealth, and incorporating a diverse range of services that can be provided in electronic form over various telecommunications networks. This paper discusses how such use of information and communication technologies (ICTs) in health acquires meanings through a policy process, and what implications it has for telehealth in particular. This is done through a hermeneutic exploration of four principal UK health policy papers published between 1989 and 1998.

Online sexual addiction and compulsivity: Integrating web resources and behavioral telehealth in treatment

Abstract: Technology is changing the nature of problems people are having as well as how we treat them. This article discusses how factors associated with use of the Internet may initiate and maintain sexually compulsive behavior online. Ways to make use of web resources in the treatment of online sexual addiction and compulsivity are suggested. Behavioral Telehealth, a possible avenue for conducting psychotherapy using communications technology, is introduced. Ethical, legal, and regulatory issues relevant to using communications technology to practice psychotherapy are reviewed.

Textbook Of Rural Medicine

Abstract: Overview of Rural Health Care The Health of rural People and the Communities and Environments in Which They Live The Rural Patient The Rural Physician The Rural Health Care Team Population-Based Medicine: Links to Public Health The Emergence of Federal Rural Health Policy Special Clinical Problems and Approaches in Rural Health Care Emergency Care Obstetric Care Special Medicinal Problems in Perinatel Care Surgery Home Care Rural Mental Health Dental Care Organization and Management of Rural Health Care Rural Hospitals, Consultation, and Referral Networks in Rural Practice Medicinal Informatics and Information Access Telemedicine and Telehealth Service Rural Health Networks: An Organizational Strategy The Economics of Rural Practice Quality of Care in Rural Settings: Brining the "New Quality" to Rural Practice Community-Oriented Primary Care and Rural Health Services Development Education for Rural Practice Predoctoral Education for Rural Practice Graduate Education for Rural Practice Continuing Medical Education for Rural Practice Lessons from Abroad Rural Practice in Canada Rural Practice in Australia Rural General Practice in the United Kingdom Rural Practice in South Africa Rural Practice in China

Telehealth: Passing Fad or Lasting Benefits?

Abstract: Advocates of telehealth argue that the delivery of health services by means of communications technologies is both feasible and desirable. Nevertheless, the benefits of telehealth, due to the variety of its applications and their uneven development, are not self-evident. The goal of this paper is to reflect on the processes by which telehealth applications do or do not contribute to the delivery of health services. We propose a framework structuring a preliminary analysis of the match between needs and the possibilities offered by telehealth. Four mechanisms of expected benefits are discussed: 1) decreasing patient transfers; 2) decreasing trips by providers and patients; 3) meeting the needs of underserved populations; and 4) building providers' and patients' knowledge and reducing rural isolation. We conclude by stressing that the participation of providers is crucial, both in the research on telehealth and in the steering of its evolution.

Evaluating psychosocial aspects of telemedicine and telehealth systems.

Abstract: Telemedicine and telehealth evaluations often address the technological aspects of health care while neglecting the psychosocial implications of the technology. Currently, little is known about the meaning of telehealth care in teims of access, quality of care, or financial impact. This article focuses on the human aspects of using technology to provide mental health care and the insight that psychology can bring to the evaluation process. It discusses telehealth's impact on and interface with health care facilities, specifically in relation to training, informatics, remote consultations, patient outcomes, provider health, and professional practice. It also presents guidelines and suggestions for the implementation of a telehealth evaluation, including evaluation design, examples of outcome-related questions that may be pertinent to telehealth evaluation, and suggestions for psychology's continuing role in telehealth.

An Overview of Telemedicine: The Virtual Gaze of Health Care in the Next Century

Abstract: This article considers the role of telemedicine in the production of biomedical health care using three specific theoretical constructs as lenses through which to examine this phenomenon: (J) Foucault's medical "gaze "; (2) the political economy of health; and (3) deterritorialization and multisite ethnography. This examination focuses first on the changing corporate structure of health care and changing political attitudes toward telemedicine. Second, it documents the current use of telemedicine in prisons, the military, and in cross-cultural settings. Third, it discusses responses to telemedicine of individual physicians, health care staff, and patients, finding that these responses are broadly conditioned by an individual's mode of articulation with biomedical institutions and that they are mediated by personal experience, [telemedicine, telehealth, Foucault, political economy]

Effectiveness of telehealth for teaching specialized hand-assessment techniques to physical therapists.

Abstract: Health care reform has changed the focus of patient care from primarily inpatient to an increased emphasis on outpatient services. The reductions in hospital beds, staff complements, and lengths of inpatient stays have led to an increased need for early referral of patients to health care professionals in the community. Unfortunately, a corresponding adjustment of outpatient resources has not occurred, resulting in an imbalance of resources and making accessibility to the appropriate services in the community extremely difficult. This is especially true for outlying communities, since metropolitan centers have disproportionately large numbers of health care specialists. In North America, with its vast geographic areas, travel between the metropolitan centers and the rural communities is often problematic, creating difficulties for patients needing care and for rural practitioners, who experience a feeling of professional isolation. Telehealth technology may provide an economically feasible solution to these concerns. Telehealth has been defined as the utilization of telecommunications technology to provide health care services and medical information over distance. Telehealth has the potential to improve services to rural communities by providing not only direct telemediated access to clinical specialists for patients, but also the opportunity for the efficient training of rural professionals in the necessary specialty care. A broad range of medical specialties has demonstrated the capabilities of telehealth to assess patients in remote areas. Much of this research, however, has focused on domains in which visual and/or auditory information is sufficient for accurate assessment. It is less clear, however, whether telehealth assessment is equally effective for specialties where tactile interaction between the patient and health care professional is considered critical. For these situations the health care professional at the distant site must be the ‘‘consultant’s hands.’’ There is a parallel in using telehealth for the purposes of clinical education. That is, telehealth may be effective for teaching knowledge-based topics, but many health profession domains, such as physical therapy assessment skills, have tactile components that require measurement and analysis. Training for these types of skills may challenge the application of telehealth beyond its current capabilities. The purpose of this research, therefore, was to determine the effectiveness of telehealth for teaching specialized assessment skills requiring ‘‘hands on’’ interaction with patients.

The Potential Effects of Telehealth on the Canadian Health Workforce: Where Is the Evidence?

Abstract: The literature reports that telehealth holds the potential to positively alter the health workforce, yet there is little evidence to support and substantiate this commonly held belief. This qualitative study examines the anticipated and realized effects of telehealth on health workforce concerns. The six themes examined include the distribution of expertise of health professionals, effect on skills base, recruitment and retention of health professionals, staffing of telehealth initiatives, appropriate use of health care resources, and other workforce outcomes. Twelve telehealth initiatives were selected for study - one from each of Canada's provinces and territories. Projects included eight consultation applications, two administrative information systems, and two community-based programs. A questionnaire guided the initial and 6-month follow-up interviews with project coordinators. The six themes were independently validated for accuracy, interpretation, consistency, and saturation. Positive effects from...

Telerehabilitation at the University of Alberta

Abstract: We established a telerehabilitation system to link staff at the University of Alberta with clinicians and students located in Two Hills, a rural community approximately 180 km east of Edmonton. From February 1996 to March 1999, the faculty of Rehabilitation Medicine conducted a total of 254 telehealth sessions, most of which involved participants in the rehabilitation discipline. Of these connections, only 11 were unsuccessful owing to technical or telecommunication problems (i.e. 96% were successful). The average duration of a session was 1 h 15 min. There were benefits to the Faculty in the areas of clinical supervision of students, clinical consultation, undergraduate and graduate education as well as professional development. The future benefits of such an initiative will depend on how well we address challenges pertaining to training, human resource and infrastructure.

Meeting the need for educational standards in the practice of telemedicine and telehealth.

Abstract: The first telemedicine standard to be developed, documented and adopted widely was the radiology standard, which includes technical and image transmission standards as well as requirements and qualifications needed for teleradiology practice. But many other health professionals engaged either full time or part time in telemedicine and telehealth—for example, telepsychiatry, telepathology, teletriage and tele-ophthalmology — also need and use special skills and knowledge. At present, they acquire these skills on the job and their skills may not be recognized. There should be performance standards and telepractice guidelines for professionals operating in the fields of telemedicine and telehealth. Furthermore, there is a case for the development and implementation of education and training standards, enabling professionals who practise in the field to obtain suitable skills, knowledge and recognition for telepractice.

Managing the 'fit' of information and communication technology in community health: a framework for decision making.

Abstract: The ‘fit‘ of information and communication technologies (ICT) in community health is important in meeting the needs of patients, carers, staff and organizations in the delivery of services. A good fit leads to greater efficiencies and effectiveness in ICT use. A multi-step research project was conducted to look not only at the role of ICT but at how to manage ICT and make a good ICT fit to enhance community health services. Telehealth was identified as the application of ICT to enhance population health, health promotion and health-service delivery. A participatory process was identified as critical to determining needs and potential uses as well as to the successful design and implementation of ICT in health. There was additional value in ensuring a diversity of desired outcomes which balance costs and benefits while fostering capacity and technical sustainability.

A telehealth project for supporting an isolated physiotherapist in a rural community of Hokkaido.

Abstract: Almost all towns and villages in the rural areas of Hokkaido suffer shortages of health-care professionals, particularly therapists (e.g. physiotherapists, occupational and speech therapists). A therapist in a rural community must work as a general rehabilitation therapist. This adds to the stress of both the responsibility and the isolation and it seems to be the major reason why therapists do not generally stay in rural communities. A telehealth project to overcome this vicious circle in Hokkaido was started at Sapporo Medical University in 1997, and the town of Betsukai joined the project. This outlines the support given to an isolated physiotherapist working in Betsukai, as part of a larger rehabilitation project. Regular videoconferences helped the physiotherapist gain confidence in her work in the rural community.

Distance education for health centre staff in rural Japan.

Abstract: We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for 'using a computer', 'using some computer software', 'using the Internet' and 'interest in telehealth' increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.

Improving user acceptance of health-care telematics.

Abstract: Telehealth represents a new approach to health-care with the potential for improving accessibility and reducing costs. Over the years, technology has become increasingly interactive, cheaper and standardized. Despite this, the uptake of technology has been low. One of the main reasons is that the introduction of telematics in health-care requires more than technology and software--organizational and cultural change is required as well. A suggested approach is based on the principles of service quality and quality management, to produce a partnership between the users and the developers of new technologies. This will in turn make it possible to bring user-validated requirements into the design of the system and create feelings of ownership and motivation on the part of users, in order to prepare their environment for the change. The methodology has been effectively used in various projects of the Telematics Application Programme of the European Commission.

Telenursing: Nursing Practice in Cyberspace

Abstract: Preface Definitions Telehealth: Past, Present, Future Nursing Informatics American Nurses Association Initiatives in Telenursing The National Council of State Boards of Nursing Licensure Issues in Telenursing Multistate Licensure Issues in Telenursing The National Council of State Boards of Nursing Mutual Recognition Model for Nursing Regulation and the Interstate Nurse Licensure Compact The American Nurses Association Position on Multistate Licensure and the Compact Telenursing and the Nursing Profession Educating Nurses About Telenursing and Tele-technology Telenursing and Nursing Practice Telephone Triage and Consultation as a Subset of Telenursing Advanced Practice Nurses in Telenursing Legal Issues in Telenursing Nursing Malpractice Liability in Telenursing Telehealth and the Health Care Consumer Privacy and Confidentiality Issues in Telehealth Privacy and Confidentiality of Computerized Medical Records Bibliography Index

Medical devices in the home: present and future applications.

Abstract: Putting together a comprehensive telehealth program is similar to putting together a puzzle. You have to fit all of the pieces together to see the big picture. An important piece of that puzzle is medical devices for telemonitoring. The equipment used in a telehealth program can span from low end, such as simply using a telephone; to high end, in which two-way audio-video systems are used with computer documentation, outcome software, and various medical device options.

Distance learning: Health education for ninth-grade students:

Abstract: A telehealth programme for schools was established by staff at the East Carolina University schools of nursing, health education, social work, nutrition, education and medicine, in conjunction with the Eastern Area Health Education Center. A health education curriculum was developed for rural high schools using the North Carolina Information Highway for delivery. A Web page provided additional resources for teachers, teenagers and health professionals. Four telehealth sessions were conducted over three years: two with the pilot school and two with a second school on-line simultaneously. A total of 76 ninth-grade students completed the courses. Evaluation indicated successful outcomes in student learning. Respondents to a follow-up survey of members of the first telehealth class had positive comments about the experience. Utilization of the Web page increased steadily from 1997.