51 research outputs found

    Using Teach Back to Evaluate the Efficacy of a Pediatric Headache Program: A DNP Project

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    abstract: Background: Only 40%-80% of health information is retained during an office visit due to ineffective communication. Caregivers, and patients, are unable to remember how to manage their health care needs. Teach back is an effective tool that encourages a conversation between the caregiver/patient and provider. The purpose of this project is to increase knowledge retention and self-management behaviors using a headache teach back tool. Methods: The quality department at a large children’s hospital in the southwestern United States approved the project as a practice change and parent consent was not required. The project design was a randomized controlled group: pretest-posttest design, quality improvement method. Participants were chosen by convenience sample. Required diagnoses were headache or migraine. Each group had 18 participants, for a total of 36 participants. Ages ranged from four to 18 years of age, with legal guardians present for the intervention group only. New and follow-up patients were included in the project. Demographics for each group were statistically similar. Questionnaires were used to assess knowledge pre and post implementation of teach back tool. Self-management was measured by a follow-up phone call after their appointment to inquire regarding implementation of the headache diary. Charts were reviewed for both groups regarding the number and type of phone calls received by the office. Outcomes: Paired sample t-test was used to evaluate mean differences in knowledge from pre and post questions of teach back tool. Data analysis concluded a statistical increase in knowledge of triggers and prevention techniques. Cohen’s d for triggers was 2.21 and 1.87 for prevention. Self-management of behavior was measured by use of headache diary and determined by a percentage. Sixty-seven individuals started to use the headache diary. Independent t-test was used to compare number of phone calls from each group. Data concluded a decrease in phone calls. However, due to a small sample size, statistical significance could not be established. Conclusion: Teach back encourages caregiver/patient and provider interaction, which increases health literacy retention and increases self-management behaviors. Future research should focus on patients with headaches with unknown triggers for their headaches

    A telehealth programme for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial

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    The objective of this pilot study was to investigate the use of and satisfaction with a chronic obstructive pulmonary disease (COPD) telehealth program applied in both primary and secondary care. The program consisted of four modules: 1) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior, 2) web-based exercise program for home exercising, 3) self-management of COPD exacerbations via a triage diary on the web portal, including self-treatment of exacerbations, and 4) teleconsultation. Twenty-nine COPD patients were randomly assigned to either the intervention group (telehealth program for 9 months) or the control group (usual care). Page hits on the web portal showed the use of the program, and the Client Satisfaction Questionnaire showed satisfaction with received care. The telehealth program with decision support showed good satisfaction (mean 26.4, maximum score 32). The program was accessed on 86% of the treatment days, especially the diary. Patient adherence with the exercise scheme was low (21%). Health care providers seem to play an important role in patients’ adherence to telehealth in usual care. Future research should focus on full-scale implementation in daily care and investigating technological advances, like gaming, to increase adherence

    Digital diffusion in the clinical trenches : findings from a Telemedicine Needs Assessment

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    Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Architecture, 2002.Includes bibliographical references (leaves 105-110).Broadly stated, this dissertation focuses on how practitioners and provider organizations integrate the computer and web into healthcare delivery. The opportunity that afforded this research was a Telemedicine Needs Assessment commissioned by a Massachusetts-based provider organization, consisting of two hospitals and 29 community group practices (CGP). The Telemedicine Needs Assessment incorporated qualitative and quantitative research programs to include: 1. cross-sectional, institution-wide, in-depth interviews; 2. participant observation at administrative and clinical day-to-day operations, and lastly, 3. a 68 item, closed-ended survey distributed to all 586 clinical practitioners to assess the access, use, and perceived needs of current computer, web, and telemedicine technologies. Data from the survey, (72% response rate), established a computer and web enablement baseline against which the success, failure, or potential usefulness of any future medical informatics implementation would be evaluated. Findings included: 1. Computer and web enablement within the organization is not ubiquitous. Access is high, use is low; 2. Practitioner status, practice location, and gender affect enablement. Non-MDs, CGP-based practitioners, and female practitioners report lowest access and use. 3. No differences were reported specific to home access to computers and use of e-mail. 4. Hospital-based practitioners report greater access and use. CGP-based practitioners report greater perceived needs for teletechnologies.(cont.) 5. Hospital-based and CGP-based male MDs emerge as the most polarized subgroups due to differences in computer and web use and perceived needs. 6. Female practitioners are more successful than male practitioners securing tech support at home and at work. 7. With regard to technology uptake, female MDs constitute a more homogeneous group than male MDs. Also, four products emerged from the Telemedicine Needs Assessment: 1. a needs assessment theory and methodology derived from Process Architecture which promulgates that discussions specific to the end users' work must always be inextricably linked with their work practice; 2. a typology of barriers to the integration of computer and web-based technologies into healthcare delivery stratified by practitioner, administration, organization, and industry; 3. a framework which defines and integrates real and virtual healthcare delivery services, products, and technologies, and finally; 4. a systems-based model of clinical and telecommunications integrated delivery networks providing IS, IT, and administrative infrastructure support for the framework.by Verlé Margaret Harrop.Ph.D

    Palliative home-based technology from a practitioner's perspective: benefits and disadvantages

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    This critical review paper explores the concept of palliative home-based technology from a practitioner's perspective. The aim of the critical review was to scope information available from published and unpublished research on the current state of palliative home-based technology, practitioner-focused perspectives, patient-focused perspectives, quality of life, and the implications for clinical practice. Published and unpublished studies were included. An example of one UK patient-centered home-based technology is explored as an exemplar. The evidence suggests that despite the challenges, there are numerous examples of good practice in relation to palliative home-based technology. Improvements in technology mean that telehealth has much to offer people being cared for at home with palliative needs. However, some of the evaluative evidence is limited, and further rigor is needed when evaluating future technology-based solutions innovations

    Patient-Related Characteristics Associated with Rehospitalization in Medicare Recipients with Heart Failure Receiving Telehomecare

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    Heart failure (HF) is the leading cause of rehospitalization in the United State. One potential way to reduce HF rehospitalizations is through the use of telehomecare, which is a remote monitoring intervention in home care settings. However, studies on telehomecare use conducted in the United States have demonstrated mixed results in reducing HF rehospitalizations. Little is known about risk factors for rehospitalization during a telehomecare episode. The aims of the study were to identify patient characteristics associated with all-cause rehospitalizations and patient characteristics associated with time-to-first rehospitalization within 60 days of the home health care episode. This is a non-experimental, cross-sectional secondary analysis of the Outcome Assessment Information Set dataset from Medicare recipients with HF provided with telehomecare. This study used multiple logistic regression, decision tree techniques and survival analysis methods. The main findings of this study were that results of a formal pain assessment and the ability to dress one\u27s lower body safely were associated with rehospitalizations. In particular, subjects who were independent in dressing their lower body had a consistently higher risk of rehospitalization than functionally dependent groups. While the logistic regression model and survival analysis presented the associations between rehospitalization and single risk factors, the decision tree techniques presented the relative contributions of and interactions between risk factors for rehospitalization as a global picture, which may provide clinicians with a visual guide to targeting those patients most likely to benefit from telehomecare, or who may need additional interventions

    Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

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    Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth

    Assessing the implementability of telehealth interventions for self-management support: a realist review.

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    BACKGROUND: There is a substantial and continually growing literature on the effectiveness and implementation of discrete telehealth interventions for health condition management. However, it is difficult to predict which technologies are likely to work and be used in practice. In this context, identifying the core mechanisms associated with successful telehealth implementation is relevant to consolidating the likely elements for ensuring a priori optimal design and deployment of telehealth interventions for supporting patients with long-term conditions (LTCs). METHODS: We adopted a two-stage realist synthesis approach to identify the core mechanisms underpinning telehealth interventions. In the second stage of the review, we tested inductively and refined our understanding of the mechanisms. We reviewed qualitative papers focused on COPD, heart failure, diabetes, and behaviours and complications associated with these conditions. The review included 15 papers published 2009 to 2014. RESULTS: Three concepts were identified, which suggested how telehealth worked to engage and support health-related work. Whether or not and how a telehealth intervention enables or limits the possibility for relationships with professionals and/or peers. Telehealth has the potential to reshape and extend existing relationships, acting as a partial substitute for the role of health professionals. The second concept is fit: successful telehealth interventions are those that can be well integrated into everyday life and health care routines and the need to be easy to use, compatible with patients' existing environment, skills, and capacity, and that do not significantly disrupt patients' lives and routines. The third concept is visibility: visualisation of symptoms and feedback has the capacity to improve knowledge, motivation, and a sense of empowerment; engage network members; and reinforce positive behaviour change, prompts for action and surveillance. CONCLUSIONS: Upfront consideration should be given to the mechanisms that are most likely to ensure the successful development and implementation of telehealth interventions. These include considerations about whether and how the telehealth intervention enables or limits the possibility for relationships with professionals and peers, how it fits with existing environment and capacities to self-manage, and visibility-enabling-enhanced awareness to self and others
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