Showing papers on "Telemedicine published in 2007"

European citizens' use of E-health services: A study of seven countries

Abstract: European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services. Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone. 44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important. The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.

What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings.

Abstract: Nearly half a century ago, telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Practitioners from a variety of medical specialties have claimed success in their telemedicine pursuits. Gradually, this new modality of healthcare delivery is finding its way into the mainstream medicine. As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. The meaning of telemedicine encapsulated in these definitions varies with the context in which the term was applied. An analysis of these definitions can play an important role in improving understanding about telemedicine. In this paper we present an extensive literature review that produced 104 peer-reviewed definitions of telemedicine. These definitions have been analyzed to highlight the context in which the term has been defined. The paper also suggests a definition of modern telemedicine. The authors suggest that telemedicine is a branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another. It is deployed to overcome issues like uneven distribution and shortage of infrastructural and human resources. We expect that this study will enhance the level of understanding and meaning of telemedicine among stakeholders, new entrants, and researchers, eventually enabling a better quality of life.

A randomized trial of telemedicine-based collaborative care for depression

Abstract: Background Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists.

A Mobile Care System With Alert Mechanism

Abstract: Hypertension and arrhythmia are chronic diseases, which can be effectively prevented and controlled only if the physiological parameters of the patient are constantly monitored, along with the full support of the health education and professional medical care. In this paper, a role-based intelligent mobile care system with alert mechanism in chronic care environment is proposed and implemented. The roles in our system include patients, physicians, nurses, and healthcare providers. Each of the roles represents a person that uses a mobile device such as a mobile phone to communicate with the server setup in the care center such that he or she can go around without restrictions. For commercial mobile phones with Bluetooth communication capability attached to chronic patients, we have developed physiological signal recognition algorithms that were implemented and built-in in the mobile phone without affecting its original communication functions. It is thus possible to integrate several front-end mobile care devices with Bluetooth communication capability to extract patients' various physiological parameters [such as blood pressure, pulse, saturation of haemoglobin (SpO2), and electrocardiogram (ECG)], to monitor multiple physiological signals without space limit, and to upload important or abnormal physiological information to healthcare center for storage and analysis or transmit the information to physicians and healthcare providers for further processing. Thus, the physiological signal extraction devices only have to deal with signal extraction and wireless transmission. Since they do not have to do signal processing, their form factor can be further reduced to reach the goal of microminiaturization and power saving. An alert management mechanism has been included in back-end healthcare center to initiate various strategies for automatic emergency alerts after receiving emergency messages or after automatically recognizing emergency messages. Within the time intervals in system setting, according to the medical history of a specific patient, our prototype system can inform various healthcare providers in sequence to provide healthcare service with their reply to ensure the accuracy of alert information and the completeness of early warning notification to further improve the healthcare quality. In the end, with the testing results and performance evaluation of our implemented system prototype, we conclude that it is possible to set up a complete intelligent health care chain with mobile monitoring and healthcare service via the assistance of our system.

The Contribution of Teleconsultation and Videoconferencing to Diabetes Care: A Systematic Literature Review

Abstract: Background: A systematic literature review was carried out to study the benefits of teleconsultation and videoconferencing on the multifaceted process of diabetes care. Previous reviews focused primarily on usability of technology and considered mainly one-sided interventions. - Objective: The objective was to determine the benefits and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care. - Methods: Electronic databases (Medline, PiCarta, PsycINFO, ScienceDirect, Telemedicine Information Exchange, ISI Web of Science, Google Scholar) were searched for relevant publications. The contribution to diabetes care was examined for clinical outcomes (eg, HbA1c, blood pressure, quality of life), behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials (RCTs) with HbA1c as an outcome were pooled using standard meta-analytical methods. - Results: Of 852 publications identified, 39 met the inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or videoconferencing not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (eg, HbA1c). There were 22 interventions related to teleconsultation, 13 to videoconferencing, and 4 to combined teleconsultation and videoconferencing. The heterogeneous nature of the identified videoconferencing studies did not permit a formal meta-analysis. Pooled results from the six RCTs of the identified teleconsultation studies did not show a significant reduction in HbA1c (0.03%, 95% CI = - 0.31% to 0.24%) compared to usual care. There was no significant statistical heterogeneity among the pooled RCTs (χ27= 7.99, P = .33). It can be concluded that in the period under review (1994-2006) 39 studies had a scope broader than clinical outcomes and involved interventions allowing patient-caregiver interaction. Most of the reported improvements concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions (16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were hardly observed. Teleconsultation programs involving daily monitoring of clinical data, education, and personal feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of videoconferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction, but also on monitoring disease. Additionally, videoconferencing seemed to maintain quality of care while producing cost savings. - Conclusions: The selected studies suggest that both teleconsultation and videoconferencing are practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the diversity in study design and reported findings makes a strong conclusion premature. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions.

Academic health center management of chronic diseases through knowledge networks: Project ECHO.

Abstract: The authors describe an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model. The program, based at the University of New Mexico School of Medicine, represents a paradigm shift in thinking and funding for the threefold mission of AHCs, moving from traditional fee-for-service models to public health funding of knowledge networks. This program, Project Extension for Community Health care Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners (nurse practitioners, primary care physicians, physician assistants, and pharmacists) present HCV-positive patients during weekly two-hour telemedicine clinics using a standardized, case-based format that includes discussion of history, physical examination, test results, treatment complications, and psychiatric, medical, and substance abuse issues. In these case-based learning clinics, partners rapidly gain deep domain expertise in HCV as they collaborate with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in comanaging their patients. Systematic monitoring of treatment outcomes is an integral aspect of the project. The authors believe this methodology will be generalizable to other complex and chronic conditions in a wide variety of underserved areas to improve disease outcomes, and it offers an opportunity for AHCs to enhance and expand their traditional mission of teaching, patient care, and research.

Physical rehabilitation using telemedicine.

Abstract: Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.

Project ECHO: Linking University Specialists with Rural and Prison-Based Clinicians to Improve Care for People with Chronic Hepatitis C in New Mexico:

Abstract: Project Extension for Community Healthcare Outcomes (Project ECHO) is a telemedicine and distance-learning program designed to improve access to quality health care for New Mexicans with hepatitis C. Project ECHO links health-care providers from rural clinics, the Indian Health Service, and prisons with specialists at the University of New Mexico. At weekly clinics, partners present and discuss patients with hepatitis C with specialists. Partners can receive continuing education credits for participating. Since June 2003, 173 hepatitis C clinics have been conducted with 1,843 case presentations. Partners have received 390 hours of training and 2,997 hours of continuing education credits. And in 2006, the State Legislature approved $1.5 million in annual funding for the project. Project ECHO has increased access to state-of-the art hepatitis C virus care for patients living in rural areas or prisons. Because of its success with hepatitis C, this project is being expanded to other chronic medical conditions.

Telemedicine in the upper amazon: interplay with local health care practices

Abstract: This article is based on the introduction of a telemedicine system in the jungles of northeastern Peru. The system was designed by a European consortium led by a Spanish polytechnic in cooperation with two universities in Lima and the Peruvian Ministry of Health. The purpose of the system was to improve health conditions by extending science-based medicine into a region with well-established traditional healing practices. The central analytical focus of this article is on the interplay between the public health care system, which used the telemedicine system, and local health care practices. The manner in which scientific medicine was delivered through information technology and public health care services is analyzed in terms of the health personnel's activity, the local population's conceptions of health, and the trajectories followed by patients seeking recovery. The author participated in the design of the second evaluation of the telemedicine system and acted as a participant observer in the regional hospital and peripheral clinics. In addition to interviewing health care staff from the study area, the author also met with traditional healers, and patients in the districts whether or not they were involved in the telemedicine project. New institutional theory provided the analytical framework for the interpretation of the observed behavior of the public health care staff, traditional healers, and potential patients. Empirically, this study describes the informal aspects of the functioning of the telemedicine system, and its partial mismatch with the definitions of health and illness employed by local communities and healers. An argument is made that people's construction of their health, which is embedded in their normal patterns of action, should be identified, and then considered in the design, implementation, and evaluation of future telemedicine projects. This article problematizes an approach to telemedicine-based health development that is weakly accountable to local social contexts and their diversity.

Improving healthcare accessibility through point-of-care technologies

Abstract: Background: The NIH is committed to improving healthcare quality in the US and has set up initiatives to address problems such as the fragmented nature of healthcare provision. A hypothesis has been developed that testing closer to the point at which care is delivered may reduce fragmentation of care and improve outcomes. Methods: The National Institute of Biomedical Imaging and Bioengineering (NIBIB), the NIH’s National Heart, Lung, and Blood Institute, and the National Science Foundation sponsored a workshop, “Improving Health Care Accessibility through Point-of-Care Technologies,” in April 2006. The workshop assessed the clinical needs and opportunities for point-of-care (POC) technologies in primary care, the home, and emergency medical services and reviewed minimally invasive and noninvasive testing, including imaging, and conventional testing based on sensor and lab-on-a-chip technologies. Emerging needs of informatics and telehealth and healthcare systems engineering were considered in the POC testing context. Additionally, implications of evidence-based decision-making were reviewed, particularly as it related to the challenges in producing reliable evidence, undertaking regulation, implementing evidence responsibly, and integrating evidence into health policy. Results: Many testing procedures were considered to be valuable in the clinical settings discussed. Technological solutions were proposed to meet these needs, as well as the practical requirements around clinical process change and regulation. From these considerations, a series of recommendations was formulated for development of POC technologies based on input from the symposium attendees. Conclusion: NIBIB has developed a funding initiative to establish a Point-of-Care Technologies Research Network that will work to bridge the technology/clinical gap and provide the partnerships necessary for the application of technologies to pressing clinical needs in POC testing.

Characteristics of successfully implemented telemedical applications.

Abstract: There has been an increased interest in the use of telemedical applications in clinical practice in recent years. Considerable effort has been invested in trials and experimental services. Yet, surprisingly few applications have continued beyond the research and development phase. The aim of this study is to explore characteristics of successfully implemented telemedical applications. An extensive search of telemedicine literature was conducted in order to identify relevant articles. Following a defined selection process, a small number of articles were identified that described characteristics of successfully implemented telemedical applications. These articles were analysed qualitatively, drawing on central procedures from Grounded Theory (GT), including condensation and categorisation. The analysis resulted in a description of features found to be of importance for a successful implementation of telemedicine. Subsequently, these features were discussed in light of Science and Technology studies (STS) and the concept of 'social negotiation'. Telemedical applications introduced into routine practice are typically characterised by the following six features: 1) local service delivery problems have been clearly stated, 2) telemedicine has been seen as a benefit, 3) telemedicine has been seen as a solution to political and medical issues, 4) there was collaboration between promoters and users, 5) issues regarding organizational and technological arrangements have been addressed, and 6) the future operation of the service has been considered. Our findings support research arguing that technologies are not fixed entities moving from invention through diffusion and into routine use. Rather, it is the interplay between technical and social factors that produces a particular outcome. The success of a technology depends on how this interplay is managed during the process of implementation.

Applying research evidence to optimize telehomecare.

Abstract: Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist with the care of the growing population of chronically ill adults. This article presents a summary and critique of the published empirical evidence about the effects of telehomecare on older adult patients with chronic illness. The knowledge gained will be applied in a discussion regarding telehomecare optimization and areas for future research. The referenced literature in PubMed, MEDLINE, CDSR, ACP Journal Club, DARE, CCTR, and CINAHL databases was searched for the years 1995-2005 using the keywords "telehomecare" and "telemedicine," and limited to primary research and studies in English. Approximately 40 articles were reviewed. Articles were selected if telehealth technology with peripheral medical devices was used to deliver home care for adult patients with chronic illness. Studies where the intervention consisted of only telephone calls or did not involve video or in-person nurse contact in the home were excluded. Nineteen studies described the effects of telehomecare on adult patients, chronic illness outcomes, providers, and costs of care. Patients and providers were accepting of the technology and it appears to have positive effects on chronic illness outcomes such as self-management, rehospitalizations, and length of stay. Overall, due to savings from healthcare utilization and travel, telehomecare appears to reduce healthcare costs. Generally, studies have small sample sizes with diverse types and doses of telehomecare intervention for a select few chronic illnesses; most commonly heart failure. Very few published studies have explored the cost or quality implications since the change in home care reimbursement to prospective payment. Further research is needed to clarify how telehomecare can be used to maximize its benefits among diverse adult chronic illness populations.

Telemedicine: its effects on health communication.

Abstract: This article analyzes telemedicine, the use of distant communication technologies within the context of clinical health care, and the effects it has on health communication. The main effect is that telemedicine has the capacity to substantially transform health care in both positive and negative ways and to radically modify personal face-to-face communication (Turner, 2003). This has tremendous implications for health communication scholars in that they can extend the telemedicine debate by integrating fresh insights into more acceptable approaches that will refine and humanize mediated channels of health communication. There are several key areas of telemedicine that need to be discussed (i.e., e-health services, clinical encounters, etc.), all of which are identified in this article. In addition to describing the past and current applications of telemedicine, this article provides a better understanding of unique needs, resources, problems, and opportunities germane to telemedicine services.

CAALYX: a new generation of location-based services in healthcare

Abstract: Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware tele-care applications. This paper introduces CAALYX – Complete Ambient Assisted Living Experiment, an EU-funded project that aims at increasing older people's autonomy and self-confidence by developing a wearable light device capable of measuring specific vital signs of the elderly, detecting falls and location, and communicating automatically in real-time with his/her care provider in case of an emergency, wherever the older person happens to be, at home or outside.

An Ontology-Based Context Model for Home Health Monitoring and Alerting in Chronic Patient Care Networks

Abstract: New care models have been defined in order to manage the increasing impact of chronic conditions. These models pose several technology-oriented challenges for home-based continuous care, requiring assistance services based on collaboration among different stakeholders: health operators, patient relatives, as well as social community members. This work describes an ontology-based context model and a related context management middleware providing a reusable and extensible application framework for monitoring and assisting patients at home. It provides flexible instruments for patient health status and social context representation, as well as reasoning mechanisms for alarm situation handling.

Teleradiology Part I. History and Clinical Applications

Abstract: Teleradiology—the ability to obtain images in one location, transmit them over a distance, and view them remotely for diagnostic or consultative purposes—has been explored for nearly 50 years and is part of the more encompassing concept of “telemedicine”—the delivery of health care services over a distance. Major advances in telecommunications and computer systems and advances in the ability to capture medical information in digital form have accelerated the ability to apply telemedicine methods in a practical and affordable manner. These enabling factors are especially relevant to radiology, which currently stands out as one of the most technologically and clinically advanced areas for telemedicine applications.

Development of a telemedicine protocol for the diagnosis of Alzheimer's disease.

Abstract: We developed a telemedicine protocol for diagnosis of Alzheimer's Disease (AD). Assessments by video-conferencing (remote) were compared with face to face (direct) assessments. Eight physicians performed direct assessments and two physicians conducted remote assessments. There was alternate allocation of direct or remote initial assessment. The participants were 20 subjects over 65 years living in a rural area and referred by general practitioners (GPs) because of cognitive impairment. Each assessment included a Standardised Mini Mental State Examination, Geriatric Depression Scale, Katz assessment of Activities of Daily Living, Instrumental ADL assessment, and the Informant Questionnaire for Cognitive Decline in the Elderly. Laboratory results and radiological imaging were available from referring GPs. There was good agreement for diagnosing Alzheimer's disease between telemedicine and direct assessment, kappa = 0.8 (P<0.0001). However, because of the small sample size, the presence of systematic bias could not be completely excluded. We conclude that it is possible to diagnose AD at a distance using telemedicine, but this requires validation with a larger study.

Home telecare for COPD/CHF patients: outcomes and perceptions.

Abstract: We evaluated the use of home telehealth for patients with chronic obstructive pulmonary disease (COPD) and/or congestive heart failure (CHF). Patients diagnosed with COPD and/or CHF who were prescribed home health-care services were randomly assigned to an experimental group where they received home health care through a combination of traditional face-to-face and telemedicine visits (n = 83), and a control group where only conventional home care was employed (n = 78). Data were collected via the Short Form 36 (SF-36), Outcome and Assessment Information Set (OASIS) and patient charts. In the experimental group, patient perceptions of the home telecare services were collected via telephone interviews. Overall, the addition of telehealth to COPD/CHF patient care was not a significant predictor of health and wellbeing, either positively or negatively. Although those receiving telehealth had worse ratings on the SF-36 general health subscale after the intervention, this measure was only significant when controlling for a number of key variables in the model. In regard to patient perceptions of home telecare, patients were satisfied with the technology and the way that care was delivered via this modality.

m-Health e-Emergency Systems: Current Status and Future Directions [Wireless corner]

Abstract: Rapid advances in wireless communications and networking technologies, linked with advances in computing and medical technologies, facilitate the development and offering of emerging mobile systems and services in the healthcare sector. The objective of this paper is to provide an overview of the current status and challenges of mobile health systems (m-health) in emergency healthcare systems and services (e-emergency). The paper covers a review of recent e-emergency systems, including the wireless technologies used, as well as the data transmitted (electronic patient record, bio-signals, medical images and video, subject video, and other). Furthermore, emerging wireless video systems for reliable communications in these applications are presented. We anticipate that m-health e-emergency systems will significantly affect the delivery of healthcare; however, their exploitation in daily practice still remains to be achieved

Telemedicine and telepresence for trauma and emergency care management

Abstract: The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application The university Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two pro...

Doctor-Patient Communication: A Comparison betweenTelemedicine Consultation and Face-to-Face Consultation

Abstract: Objective The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Method Five doctors who had been practicing internal med icine for 8t o 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures - video observation, medical record volume, and participants’ satisfaction - were used for the assessment. Results It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathyutterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. Conclusions This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

Teledermatology in the U.K.: Lessons in service innovation

Abstract: Background: teledermatology has the potential to revolutionize the delivery of dermatology services by facilitating access to specialist services at a distance. In the U.K. over the previous decade there have been numerous attempts at introducing and using teledermatology; however, the development of teledermatology as routine service provision remains limited. Objectives: to identify factors that promote successful use of teledermatology as a part of routine service provision. Methods: a longitudinal qualitative study of teledermatology, drawing on data from in-depth semistructured interviews; observations of systems in practice; and public meetings. Data were analysed collectively by the research team using established qualitative analytical techniques to identify key thematic categories. The sample consisted of teledermatology services within the U.K. (n = 12) studied over 8 years (1997–2005). Individual participants (n = 68 interviews) were consultant dermatologists, researchers, teledermatology nurses, administrators, patient advocates, general practitioners and technologists. Results: the analysis compared services that did or did not become part of routine healthcare practice to identify features that supported the normalization of teledermatology. Requirements for using and integrating teledermatology into practice included: political support; perceived benefit and relative commitment that outweighs effort; pragmatic approaches to proving efficacy and safety; perception of risk as being ‘manageable’ on the basis of professional judgement; high levels of flexibility in practice (in terms of individuals, technology and organization); and reconceptualizing professional roles. Conclusions: successful implementation of teledermatology as a routine service requires greater understanding of and attention to the interplay between social and technical aspects of teledermatology, and how this is accommodated both by healthcare professionals and the organizations in which they work

Continuous and integrated health care services in rural areas. A literature study.

Abstract: This article presents the result of a literature review examining possible ways to improve healthcare services in rural areas. While there is abundant literature on making healthcare programs integrated, interdisciplinary and managed in order to reduce fragmentation and improve continuity and coordination of care, only some part of this relates to rural issues. An added challenge is the lack of a generally accepted international definition of rurality, which makes it difficult to generalise from one region to another, and to develop an evidence-based understanding of rural health care. In evaluating the literature it was found that the development of new forms of interaction is particularly relevant in rural regions - such as interdisciplinary and team-based work with flexibility of roles and responsibilities, delegation of tasks and cultural adjustments. In addition, programs such as integrated and managed care pathways, outreach programs , shared care and telemedicine were relevant initiatives. These may be associated with greater equity in access to care, and more coherent services with greater continuity, but they are not necessarily linked to reduced costs; they may, in some cases, entail additional expenses. Such endeavours are, to a large degree, dependent on a well-functioning primary healthcare system as a base.