EVALUATING TELEMEDICINE IN RURAL SETTINGS: ISSUES AND APPLICATIONS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distances separates the participantsis one technology that has impacted the efficiency of delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, evaluation efforts to date for these technologies, and issues that need to be addressed in designing an economic-based framework to evaluate the net benefits of telemedicine technologies to rural communities and consumers. An evaluation framework needs to be capable of quantifying the tradeoffs among access to health care services, the costs of delivery of a given level of services, and changes in the quality of the service that is being delivered via electronic communications; and how these tradeoffs shift as the level of telemedicine and the technology changes. The framework that is proposed is based on models of consumer behavior that incorporate discrete choices among quality differentiated sites.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, I1,

How can rural health be improved through community participation?

Executive summary Rural Australians generally experience poorer health than their city counterparts. Rural Australia is a vast geographical region, with significant diversity, where there is good health and prosperity, as well as disadvantage. The purpose of this issue brief is to provide evidence on how the health of rural Australians can be improved through community participation initiatives, which are currently being funded and delivered by health services and networks. Rural Australians need innovative health services that are tailored to the local context and meet increasing healthcare demands, without increases to expenditure. There are community participation approaches supported by research that can improve existing practice. Avoiding duplication, including the current work of Medicare Locals and Local Hospital Networks, is important for ensuring good outcomes from community participation initiatives. The following recommendations are made to improve practice: New ways to contract and pay for health services are needed, which use ideas developed with communities, within current budgets State and federal government competitive grants and tenders should prioritise proposals that demonstrate effective community participation approaches Community-based services, such as community health centres, Medicare Locals and Local Health Networks, have an important role to play in facilitating community participation, including: Building partnerships between existing services and leveraging existing participation strategies, rather than developing new services or standalone initiatives—to leverage available funds and maximise outcomes Employment of a jointly-appointed, paid community leadership position across existing community-based health services, to avoid duplication and overcome barriers of over-consultation and volunteer fatigue Formal and robust evaluation of initiatives is necessary to guide future policy and research A national innovative online knowledge sharing portal is required to share best practice in rural community participation, save time and money on ineffective approaches, and to support the rural health workforce

EVALUATING TELEMEDICINE TECHNOLOGIES IN RURAL SETTINGS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distance separates the participantshas significantly impacted the delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, and issues that need to be addressed in designing an economic framework to evaluate the net benefits of telemedicine to rural communities and consumers. Federal and state governments have invested millions of support dollars in the form of equipment, infrastructure, and incentives for consumers and providers to expand the use of telecommunications in medical care. Since disbursement of these funds is already underway, it only makes sense to develop a method to determine both where and whether an additional dollar of funding for telemedicine development would be of the greatest benefit to society. If telemedicine can prove itself as a useful method for improving the likelihood of survival of rural hospitals, then, in the interest of rural development, it may be a technology worth investing in; i.e., the social benefits, measured as the sum of the private and public benefits, may outweigh the costs. According to its supporters, telemedicine systems have the potential to simultaneously address several problems characteristic of health care in rural areas, including access to care, cost containment, and quality assurance. Access can be improved by linking providers in remote areas with specialists in metropolitan centers or peers in rural areas. Telemedicine not only enables a wider range of services to be offered in the local community but may have the added effect of improving physician retention in isolated areas, one of the primary challenges in maintaining access for frontier medical centers. Telemedicine can promote cost containment through the substitution of lower-cost rural providers and facilities. Ideally, improved quality will be achieved by the ready availability of consultations and referrals. These are the potential benefits of telemedicine implementation, but they have not yet been verified by research in a field setting. An evaluation framework for telemedicine needs to be capable of modeling changes in the behavior of health care consumers (i.e., altered visitation patterns), recognizing differences in quality of service, and finally, quantifying the value of these changes. This is no small task, and obtaining the required data will likely require the cooperation of many parties, including health care providers, patients, hospital and program administrators, and policymakers. These are the same groups that could benefit greatly from a better understanding of how telemedicine technologies affect health care delivery, but a meaningful framework for analysis needs to capture the many aspects of telemedicine implementation.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, Research and Development/Tech Change/Emerging Technologies, I1,

Patient and provider acceptance of telecoaching in type 2 diabetes : a mixed-method study embedded in a randomised clinical trial

Background: Despite advances in diagnosis and treatment of type 2 diabetes, suboptimal metabolic control persists. Patient education in diabetes has been proved to enhance self-efficacy and guideline-driven treatment, however many people with type 2 diabetes do not have access to or do not participate in self-management support programmes. Tele-education and telecoaching have the potential to improve accessibility and efficiency of care, but there is a slow uptake in Europe. Patient and provider acceptance in a local context is an important precondition for implementation. The aim of the study was to explore the perceptions of patients, nurses and general practitioners (GPs) regarding telecoaching in type 2 diabetes. Methods: Mixed-method study embedded in a clinical trial, in which a nurse-led target-driven telecoaching programme consisting of 5 monthly telephone sessions of +/- 30 min was offered to 287 people with type 2 diabetes in Belgian primary care. Intervention attendance and satisfaction about the programme were analysed along with qualitative data obtained during post-trial semi-structured interviews with a purposive sample of patients, general practitioners (GPs) and nurses. The perceptions of patients and care providers about the intervention were coded and the themes interpreted as barriers or facilitators for adoption. Results: Of 252 patients available for a follow-up analysis, 97.5 % reported being satisfied. Interviews were held with 16 patients, 17 general practitioners (GPs) and all nurses involved (n = 6). Themes associated with adoption facilitation were: 1) improved diabetes control; 2) need for more tailored patient education programmes offered from the moment of diagnosis; 3) comfort and flexibility; 4) evidence-based nature of the programme; 5) established cooperation between GPs and diabetes educators; and 6) efficiency gains. Most potential barriers were derived from the provider views: 1) poor patient motivation and suboptimal compliance with "faceless" advice; 2) GPs' reluctance in the area of patient referral and information sharing; 3) lack of legal, organisational and financial framework for telecare. Conclusions: Nurse-led telecoaching of people with type 2 diabetes was well-accepted by patients and providers, with providers being in general more critical in their reflections. With increasing patient demand for mobile and remote services in healthcare,the findings of this study should support professionals involved in healthcare policy and innovation

The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation

Explores how North Dakota has met the healthcare challenges of rural communities with support for primary care and the idea of a medical home, organization of care through coordination and cooperation networks, and the innovative use of technology

Co-innovation: the future of telemedicine in developing countries

Telemedicine which has been widely adopted in developed countries to reach all its citizens irrespective of their location is only being used for education purposes or disaster relief in developing countries. Since developing countries already suffer inadequate healthcare provision especially in remote areas, it would be essential to implement telemedicine practices for daily clinical uses rather than education use. This research argues that to understand the future of telemedicine in developing countries, both well-established technology innovations adoption factors as well as co-innovation factors should be addressed. In the context of healthcare provision, we propose a conceptual framework that integrates the healthcare resources and the organisational affiliations in co-innovation