Alcuni abstract di articoli che trattano argomenti relativi all'eHealth

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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

Towards a Smarter organization for a Self-servicing Society

Traditional social organizations such as those for the management of healthcare are the result of designs that matched well with an operational context considerably different from the one we are experiencing today. The new context reveals all the fragility of our societies. In this paper, a platform is introduced by combining social-oriented communities and complex-event processing concepts: SELFSERV. Its aim is to complement the "old recipes" with smarter forms of social organization based on the self-service paradigm and by exploring culture-specific aspects and technological challenges.Comment: Final version of a paper published in the Proceedings of International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (DSAI'16), special track on Emergent Technologies for Ambient Assisted Living (ETAAL

Complex Care Management Program Overview - Technology

This report provides an overview of technology based complex care management programs, including:Cook County Health and Hospitals System - Computer Assisted Quality of Life and Symptom Assessment of Complex PatientsUniversity of Missouri - TigerPlaceWenatchee Valley Medical Center - Health Buddy -- Patient Telemonitoring Progra

How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews

INTRODUCTION: Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. METHODS: Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. RESULTS: None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0-4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. CONCLUSIONS: Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work

How Does the Use of Telemonitoring in Adult Patients with Uncontrolled Hypertension Improve Blood Pressure Control? An Integrative Review

Hypertension is an evolving problem worldwide and it constitutes a great risk for cardiovascular diseases. Despite the research and new drugs on the market to manage high blood pressure, hypertension remains the leading cause of disability-adjusted life and death worldwide. With many people suffering from hypertension around the world, and the burden of uncontrolled hypertension, it is imperative to find an intervention that can improve blood pressure control. To better target uncontrolled hypertension, the conventional method of management of high blood pressure based on in-person visits has shown some limitations and it must be combined with a contemporary approach that allows for fast decision-making and fast results. One measure that has been identified to improve blood pressure control is the use of telemonitoring. Telemonitoring is a remote delivery of care that provides a quick transfer of information between a healthcare professional and a patient. Telemonitoring improves access to care, patient education, counseling, medication management, and titration, improve adherence to care plans, improves healthcare cost, speeds up healthcare delivery and decision-making strategies, and improves the overall health of patients. There is strong evidence in research studies showing that telemonitoring can improve blood pressure control and prevent cardiovascular events in patients with uncontrolled hypertension. However, challenges remain relating to the sustainability and long-term clinical effectiveness of telemonitoring

Home Telemonitoring in Heart Failure

Heart failure (HF) exacerbation is a major source of hospitalization, mortality, and healthcare cost to home health agencies. Unmonitored accumulative fluid retention between skilled nurse visits, base knowledge deficits in HF pathophysiology and dietary restrictions, and lack of basic monitoring equipment such weighing scales are primary contributors to HF related hospitalizations in the home health setting. It has been discovered that early recognition of decompensating HF can reduce or eliminate HF related hospitalization, mortality, and healthcare costs associated with the management of exacerbation. When a patient is sent to the emergency room (ER) for fluid overload secondary to HF, massive costs are generated including ER transportation, ER consultation fees, hospital stay fee if admitted, and increased home health visit fees for adding additional skilled nurse visits for follow up assessments. Having a method of filling in the monitoring gaps of this patient population can reduce negative outcomes associated with managing HF in home health. The current method of monitoring weekly or bi-weekly by a skilled nurse in these complex HF patients is not best practice. For patients to receive improved and effective HF monitoring on non-skilled nurse days, additional monitoring options should be implemented. Technological advancement in modern healthcare allows the integration of technology to aide in reducing the negative impact HF exacerbation has on home health agencies. Telemonitoring (TM) heart failure in the home health setting is an evidence-based implementation option to reduce patient mortality, decrease healthcare costs, and assist healthcare providers in accessing current and relevant data for point-of-care decision making. TM devices should be installed in the homes of patients who meet the HF exacerbation risk criteria to reduce hospitalization, mortality, and healthcare costs