Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Health Coaching Patients with Type 2 Diabetes With and Without Smartphone Support in a Lower Socioeconomic Strata Community

Background: Although the adoption of self-management behaviors is crucial for maintaining good health after a type 2 diabetes diagnosis, many individuals with T2DM fail to meet target blood glucose levels. Adherence to gluco-regulating behaviors like regular exercise and balanced diet can be challenging, especially for individuals of lower socioeconomic status (SES). Providing cost effective interventions that improve adherence to self-management behaviours is important for improving quality of life for patients and the sustainability of health care systems. Objective: To design and test a health coaching protocol administered by trained health coaches in a lower SES community aimed at improving the health profile of patients with poorly controlled T2DM, with and without smartphone connectivity. Methods: Dissertation methodology is described in two studies. The first study describes the pilot trial run at the Black Creek Community Health Centre (BCCHC) between February 2010 and March 2011which recruited a total of n=21 participants intervened with by n=1 health coach. The second study describes the randomized controlled trial conducted primarily at BCCHC from March 2012 to March 2014 and intervened with n=131 participants with n=6 health coaches. The primary outcome is change in glycated hemoglobin (HbA1c) from baseline to 6-month follow-up for each study. Secondary outcomes include changes in weight, waist circumference, and BMI, as well as within group changes of HbA1c. Psychometric measures collected pre/post for the RCT include the Satisfaction with Life Scale, Positive and Negative Affect Schedule, Hospital Anxiety and Depression Scale, and the 12-item Short Form Health Survey (SF-12v2). Hypothesis: Patients who receive health coaching with electronic support will exhibit greater reductions in HbA1c than the health coach only group. There will also be greater improvements in anthropometric and psychometric outcomes favouring the group who receives electronic support. Results: In the pilot study, a total of 21 individuals consented to participate, of whom 19 (90.4%) completed the 6 month trial; 12 had baseline glycated hemoglobin (HbA1c) levels >7.0% and these participants demonstrated a mean reduction of 0.43 (0.63) (p<.05) with minimal changes in medication. In the RCT, a total of 131 patients were randomized, with n=67 and n=64 in the intervention and control groups, respectively. Primary outcome data were available for n=97 participants (74%). While both groups reduced their HbA1c, there were no significant between-group differences in change of HbA1c at 6 months using intention to treat (LOCF) (p=.481) or per protocol (p=.825) principles. However, the intervention group demonstrated an accelerated reduction in HbA1c, leading to a significant between groups difference at 3 months (p=.032). This difference was reduced at the 6 month follow up as the control group continued to improve, achieving an HbA1c reduction of 0.81% (8.9 mmol/mol) (p=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(p=.001) in the intervention group. Intervention group participants also had significant decreases in weight (p=.006) and waist circumference (p=.011) while controls did not. Both groups reported improvements in mood, satisfaction with life and quality of life. Discussion: Health coaching with and without access to mobile technology appeared to improve gluco-regulation and mental health in a lower SES, T2DM population. The accelerated improvement in the smartphone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to deliver significant benefits for patients from lower SES with poorly controlled type 2 diabetes

Medication Safety in Municipal Health and Care Services

Medicines constitute an essential part of healthcare delivery and help to prevent or treat illness, influence quality of life, and generally increase life expectancy. However, medications can also cause harm if prescribed irrationally, dispensed or used incorrectly, and monitored or followed up insufficiently. In this anthology, we showcase the challenges of medication management and the rational use of medicines in municipal health and care services, and present various strategies and measures related to medication safety. The contributors are researchers representing a wide range of disciplines, with experience from different levels of healthcare services and different areas within the research and education sectors. We hope to raise awareness, engage and enable discussion of initiatives and strategies to improve patient safety related to medications in municipal health and care services, and create a basis for further research to promote safe medication management and rational use of medicines. This anthology will be of interest to anyone involved in or concerned with medication safety, primarily healthcare professionals, academic staff, researchers, policymakers, and managers in healthcare services

Medication Safety in Municipal Health and Care Services

Medicines constitute an essential part of healthcare delivery and help to prevent or treat illness, influence quality of life, and generally increase life expectancy. However, medications can also cause harm if prescribed irrationally, dispensed or used incorrectly, and monitored or followed up insufficiently. In this anthology, we showcase the challenges of medication management and the rational use of medicines in municipal health and care services, and present various strategies and measures related to medication safety. The contributors are researchers representing a wide range of disciplines, with experience from different levels of healthcare services and different areas within the research and education sectors. We hope to raise awareness, engage and enable discussion of initiatives and strategies to improve patient safety related to medications in municipal health and care services, and create a basis for further research to promote safe medication management and rational use of medicines. This anthology will be of interest to anyone involved in or concerned with medication safety, primarily healthcare professionals, academic staff, researchers, policymakers, and managers in healthcare services

Cross disciplinary evaluation framework for e-health services

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel UniversityE-health is an emerging field in the intersection of information systems, healthcare and business management, referring mainly to healthcare services delivered and enhanced through the use of information and communication technologies (ICT). In a broader sense, the term characterizes not only a technical development, but also a wider way of thinking, an attitude, and a commitment for a network to improve and connect provider, patients and governments. Such a network will be used to educate and inform healthcare professionals, managers and healthcare users; to stimulate innovation in care delivery and health system management; and to improve the healthcare system locally, regionally, and globally. The evaluation of e-health services in both theory and practice has proved to be important and complex. E-health evaluation will help achieve better user services utilization, justify the enormous investments of governments on delivering e-health services, and address the aspects that are hampering healthcare services from embracing the full potential of ICT towards successful e-health initiatives. The complexity of evaluation is mostly due to the challenges faced at the intersection of three areas, each well-known for its complexity; healthcare services, information systems, and evaluation methodologies. However, despite the importance of the evaluation of e-health services, literature shows that e-health evaluation is still in its infancy in terms of development and management. The aim of this research study is to develop, and assess a cross disciplinary evaluation framework for e-health services and to propose evaluation criteria for better user’s utilization and satisfaction of e-health services. The evaluation framework is criteria based, while the criteria are determined by an evaluation matrix of three elements, the evaluation rationales, the evaluation timeframes, and the evaluation stakeholders. The evaluation criteria have to be multi-dimensional as well as grounded in, or derived from, one or more specific perspectives or theories. The framework is designed to deal effectively with the challenges of e-health evaluation and overcome the limitation of existing evaluation frameworks. The cross disciplinary evaluation framework has been examined and validated by adopting an interpretive case study methodology. The chosen case study is NHS direct which is currently one of the largest e-health services in the world. The data collection process has been carried out by using three research methods; archival records, documentation analysis and semi-structured interviews. The use of multiple methods is essential to generate comparable data patterns and structures, and enhance the reliability of conclusions through data triangulation. The contribution of the research study is in bridging the gap between the theory and practice in the evaluation of e-health services by providing an efficient evaluation framework that can be applied to a wide range of e-health application and able to answer real-world concerns. The study also offers three sets of well-argued and balanced hierarchies of evaluation criteria that influence user’s utilization and satisfaction of e-health services. The evaluation criteria can be used to help achieve better user services utilization, to serve as part of e-health evaluation framework, and to address areas that require further attention in the development of future e-health initiatives

Cardiovascular prevention through improved blood pressure and cholesterol lowering

Cardiovascular disease remains the leading cause of morbidity and mortality, and high blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) are two major modifiable risk factors. This thesis explores strategies to improve cardiovascular prevention through BP and LDL-C lowering. First this thesis highlights discrepancies between guideline recommendations for BP and LDL-C lowering, and the current evidence generated from randomized clinical trials. We show that more intensive BP and LDL-C lowering beyond traditional targets are associated with further reductions in adverse cardiovascular events. We also show that the benefits of BP and LDL-C lowering appear to be additive to one another, and combination BP and LDL-C lowering can effectively reduce cardiovascular disease by more than half. This thesis also explores the cumulative risk factor hypothesis and shows that cardiovascular risk from exposure to elevated BP and LDL-C accrues over time. These findings emphasise the need for earlier and sustained risk factor control. We introduce a novel metric to quantify risk factor exposure, namely cumulative BP load, which was shown to be a superior predictor of cardiovascular events. The thesis also shows that low dose combination antihypertensives are highly efficacious and well tolerated, and have an important role in the initial management of hypertension. We highlight the alarming rates of therapeutic inertia in hypertension management, and identify two main reasons for treatment inertia; large reductions in BP from one visit to the next, and satisfaction with BP readings that are close to target. Finally, we highlight the need for a major shift in the current prescribing paradigm for hypertension management and show that BP lowering efficacy cannot be accurately measured on an individual basis because BP readings have a poor signal:noise ratio. We conduct the largest meta-analysis of BP lowering clinical trials to date to provide estimates of average BP lowering efficacy and developed the first ever BP prediction model that accounts for both regression to the mean and estimates of BP lowering efficacy for a given antihypertensive regimen. In conclusion, the present thesis offers novel strategies to improve BP and LDL-C lowering, and demonstrates the potential for these strategies to achieve major reductions in cardiovascular disease