Homecare user needs from the perspective of the patient and carers: a review

There is a global shift towards a blending of care delivery within formal and informal environments in direct response to economic and demographic pressures. Homecare is at the hub of this activity, enabling people to age in place and keeping families intact. However, our understanding of patient and carer needs is fragmented; understandably so, given the complexity of these needs. This descriptive review offers a content analysis of papers focused on patients' and carers' needs and homecare published between January 2010 and October 2013. It is evident that homecare is an intensely researched area, yet it is disjointed. Emerging research emphasizes the need to take a holistic approach. Firstly, incorporating emotional psychosocial and cultural elements will help to draw together our current understanding within a more cohesive framework. Secondly, tensions that hinder communication and collaboration between stakeholders must be resolved. Thirdly, information and communications technology is rapidly becoming synonymous with homecare, and offers solutions for facilitating care delivery, collaboration, and training of future professionals. The rate of international activity promises much for future research collaborations to compare, contrast, and identify best practices for the future of homecare as we endeavor to meet the ever-increasing pressures on health and social care systems

If telecare is the answer, what was the question? Storyline, tensions and the unintended consequences of technology-supported care

This document is the Accepted Manuscript version. The final, definitive version of this paper has been published in Critical Social Policy, March 2018, published by SAGE Publishing. Content in the UH Research Archive is made available for personal research, educational, and non-commercial purposes only. Unless otherwise stated, all content is protected by copyright, and in the absence of an open license, permissions for further re-use should be sought from the publisher, the author, or other copyright holder.Telecare—services employing technology to monitor people’s movement, medication and home environment at a distance—has emerged as a key component of global social care and health policies. The relationship between policies about telecare and the experiences and aspirations of service users has been under-interrogated. This paper draws on findings from an organisational case study involving people living with complex conditions using various telecare devices and employs Hajer’s (1995) concept of argumentative discourse analysis to identify two key storylines arguing that telecare improves people’s quality of life and promotes independence. While these storylines point to seemingly logical and incontestable objectives, uncritical policy and practice fails to recognise and prioritise the aspirations of service users, leading to unintended consequences that can deepen people’s isolation and minimise organisational benefits.Peer reviewedFinal Accepted Versio

SCALS : a fourth-generation study of assisted living technologies in their organisational, social, political and policy context

Introduction: Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe a fourth generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context. Methods and analysis: SCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people’s experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory. Ethics and dissemination: Research ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies’ credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users

Assistive Technology for Independent Living with Dementia: Stylized Facts and Research Gaps

Background: Demographic change and continuously increasing spending on public health have intensified the public debate as well as deliberations on the development and deployment of new assistive technologies; particularly for dementia patients as it affects a large and increasing number of people, not only causing massive social distress, but also great economic losses. Recent advancement in assistive technologies (AT) have therefore fueled the debate on new, IT-reliant ways of providing cure and care of dementia. Still the impact on practice has been little. With this paper, we want to find out to which extent current studies have discussed the impacts of AT for dementia. Methods: We conduct a scoping review of the literature. We identified n=539 unique articles, out of which n=36 reported on impacts of AT use in the context of dementia. Based on this subset, we extracted a list of original statements, which was then further aggregated to 6 stylized facts. Results: The identified stylized facts describe common findings that can be observed in most studies reporting on IT-reliant assistive tools for dementia patients although applying different methods, focusing on different technologies, or working in different contexts. Conclusions: While the identified stylized facts indicate how much evidence behind certain common assumptions is, we additionally found that studies in the area of AT for dementia often neglect the socio-economic and ethical dimension. These are important research gaps for future work

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Telephone support and adherence in patients with chronic disease:A qualitative review of reviews

Divya Balasubramanian,1 Joanne Yoong,1&ndash;3 Hubertus JM Vrijhoef1,3&ndash;6 1Saw Swee Hock School of Public Health, National University Singapore, Singapore; 2Center for Economic and Social Research, University of Southern California, California, USA; 3Center for Health Services and Policy Research, National University Health System, Singapore; 4Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands; 5Department of Patients &amp; Care, Maastricht University Medical Center, Maastricht, The Netherlands; 6Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium Abstract: Among patients with a chronic disease, low adherence to prescribed treatments is very common, leading to substantial morbidity, mortality, and increase in health care costs. Telephone or mobile phone support is a common form of intervention that can be used to improve their adherence. We reviewed existing systematic and nonsystematic reviews to analyze the effectiveness of telephone interventions to improve treatment adherence in patients with chronic disease. Secondary aims were to evaluate the selected reviews in terms of cost-effectiveness of the intervention and frequency of messages affecting the adherence outcomes. A search for reviews was conducted in three databases, including PubMed, the Cochrane Library, and CINAHL, and three reviews that met the inclusion criteria were selected for final analysis. A qualitative review of the selected reviews was conducted, and reviews were evaluated to extract and summarize the characteristics and outcomes. Two of the selected reviews studied mobile phone text messaging, and one review studied telephone or mobile phone consultation. All three reviews reported an overall improvement in adherence, but the reviews varied in the types of research and the outcome measures. However, none of the reviews reported costs as an outcome. The evidence from reviews to characterize the effectiveness or cost-effectiveness of telephone support as an intervention to improve adherence among people with chronic diseases is fairly small and weak. Telephone support interventions have to be evaluated more systematically in routine practice against a comprehensive set of criteria, including their relative costs and outcomes. Keywords: literature review, compliance, telemedicine, communicable diseases, cost-effectivenes

Project Home - there is no place like home: using telehealth technology to support a proposed restorative care program in the community

A major challenge in today’s current healthcare system is the risk of readmissions by older adults recently discharged from an acute care facility. Current evidence-based literature does not have a single contributor for the reason for the readmission following discharge, but evidence does suggest some strong indicators for risk for readmission back into hospital. The risk for readmission into the hospital following a discharge from acute care increases due to older age, multiple diseases, co-morbidities, and functional limitations (Tinetti et al., 2012; Garcia-Perez et al., 2011). One of the key risks is the fact that an older adult is physically deconditioned while staying in hospital and inadequate transition planning takes place. The older adult is quickly returned to their pre-hospital living environment and expected to resume 100% of daily living activities. Tinetti et al. (2012), suggest that enhancing functional recovery during a period of home care following an acute hospitalization may reduce the risk of readmission to hospital. Telehealth is a service delivery method that is increasingly being used by occupational therapy to reach more clients and to provide greater access and flexibility vii (AOTA, 2013). Telehealth technologies could be utilized by the OTs to help facilitate ongoing communication between the client, caregiver and the OT, as well as other health care providers to provide a cost effective model of care. The creation of a six-week program designed for older adults (over the age of 65) recently discharged from an acute care hospitalization uses telehealth to deliver the OT services but will utilize the support of an in home support worker to help deliver the restorative care program. Project Home is built upon the philosophy of targeting daily living skills that are of importance to the older adult while gradually decreasing the level of support provided to the older adult to maximize their independence

The Evolution of Elderly Telehealth and Health Informatics

Many elderly individuals experience memory loss and often dementia as they age. This causes problems for the elderly due to diminished skills and increase in medical problems and natural decline. The Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Such programs are cost-effective. Long-term care insurance companies are likely to cover these services. Home care and nursing home corporations are following the VHA’s lead. We have recently witnessed significant advances in technology. Internet and mobile applications have opened a new world, providing information and opportunities for individuals to learn more information about illness and at a much faster rate. Smart home technology has evolved. Elderly patients often encounter difficulties using these technologies. Despite the advances in telehealth and telemedicine and the evolution of the technology, many individuals cannot afford the treatment or the technology. These same individuals and families are part of the digital divide, and they have not embraced the new technology. Federal programs have been developed and implemented to help this portion of the population

Effective implementation and monitoring of telehealth and telecare in Ireland: learning from international best practice.

This document synthesises the information provided in a number of papers relating to Telecare/Telehealth commissioned by and developed for the National Disability Authority between 2014 and 2017. The papers in question were developed by researchers in Work Research Centre (WRC), the National Disability Authority and the University of Ulster, and this report has taken key learning and information from each of them to create this composite briefing paper