Evaluation of Medication Adherence through the use of Home Assisted Telemanagement

Medication nonadherence can have serious consequences for patient outcomes. Home-automated telemanagement systems have supported increased levels of adherence among patients. This project explored whether the use of a home telemanagement program (HTM) would improve medication adherence in clinic patients diagnosed with hypertension (HTN). The health belief model, social learning theory, the self-regulation model and the theory of reasoned action guided this project. Providers in a primary care clinic completed the 4-question Morisky, Green, and Levine adherence scale with 50 HTN patients previously enrolled in a HTM. Survey results revealed that after 2 years in the program, patients were still forgetting to take their medications (56%), stopped taking their medications when they felt better (54%), stopped taking their medications when they felt worse (66%), or were careless at times about taking medications (38%). Data collection did not take place prior to beginning the HTM program; therefore, pre- and postdata for medication adherence behaviors were not compared. Project data support the importance of medication adherence and the consequences of nonadherence for all patients taking HTN medications. Monitoring of these patients is recommended to continue exploring if participation in HTM programs can support positive social change by improving health outcomes for HTN patients

Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors

Peters C, Drees A, Leppert F, et al. Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors. In: Ganz W, Kicherer F, Schletz A, eds. Productivity of services NextGen : beyond output/input ; RESER 2011, conference proceedings, September 8th - 9th 2011, Hamburg, Germany. Stuttgart: Fraunhofer-Verl.; 2011

The reality of home remote patient monitoring: A thesis on the nature, dynamics and effects of telehealth

Chronic diseases are very complex conditions in which two or m ore disease processes may coexist. Managing patients with chronic conditions represents a major challenge to public health, since eighty per cent of GP consultations are related to these groups. Further more, five per cent of them represent roughly forty two per cent of the total acute day bed occupancy. Nowadays, the tendency is to bring patients from high levels of care to primary care and home settings. In this scenario, telehealth is one of the methods that can be used to improve and provide access to remote patient monitoring at home. This is important for patients with chronic diseases as it can help to recognise any signs of deterioration, provide health education and support management of their condition. Potentially, telehealth can reduce deaths, emergency visits, A&E visits, elective admissions, bed stays and costs. This can be done by designing and implementing telehealth interventions that help reduce unnecessary referrals to specialised services and monitor patients remotely at home. However, there is not a unique framework for designing telehealth interventions. In order to design a robust, accurate and reliable telehealth intervention, a number of important factors have to be taken into account. A review of three systematic reviews, and an in-depth investigation of a case study based on an EU funded project, were used to gather the evidence for telehealth interventions. These were used to identify the main components of the framework proposed. The investigation focused primarily on home monitoring for patients with diabetes, asthma, hypertension and COPD. We concluded that factors such as usability, safe intervention, patients’ individual requirements, training, safe interventions, ease of use, data integration, development of procedures and allocation of appropriate staff are important components that need to be considered in order to satisfy a robust framework

A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting.

Background: There is currently a need for high quality evaluations of new mobile health, telehealth, smart pump and monitoring technologies undertaken in a pharmacy-related setting. We aim to evaluate the use of these monitoring technologies performed in this setting. Methods: A systematic searching of English articles that examined the quality and the design of technologies conducted in pharmacy-related facilities was performed using the following databases: MEDLINE and Cumulative index to Nursing and Allied Health Literature (CINAHL) to identify original studies examining the quality and the design of technologies and published in peer-reviewed journals. Extraction of articles and quality assessment of included articles were performed independently by two authors. Quality scores over 75% are classed as being acceptable using a "relatively conservative" quality benchmark. Scores over 55% are included using a "relatively liberal" cut-off point. Results: Screening resulted in the selection of 40 formal evaluations. A substantial number of studies (32, 80.00%) were performed in the United States, quantitative in approach (33, 82.50%) and retrospective cohort (24, 60.00%) in study design. The most common pharmacy-related settings were: 22 primary care (55.00%); 10 hospital pharmacy (25.00%); 7 community pharmacy (17.50%); one primary care and hospital pharmacy (2.50%). The majority of the evaluations (33, 82.50%) reported clinical outcomes, six (15.00%) measured clinical and economic outcomes, and one (2.50%) economic only. Twelve (30.00%) quantitative studies and no qualitative study met objective criteria for "relatively conservative" quality. Using a lower "relatively liberal" benchmark, 27 quantitative (81.82%) and four qualitative (57.41%) studies met the lower quality criterion. Conclusion: Worldwide, few evaluations of mobile health, telehealth, smart pump and monitoring technologies in pharmacy-related setting have been published.Their quality is often below the standard necessary for inclusion in a systematic review mainly due to inadequate study design

Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Market Structure and Innovation Dynamics

Personal Health Systems (PHS) and Remote Patient Monitoring and Treatment (RMT) have the potential to alter the way healthcare is provided by increasing the quantity and quality of care. This report explores the current status of PHS and, more specifically of the RMT market in Europe. It addresses the question of how these technologies can contribute facing some of the challenges standing in front of the European healthcare delivery systems causes by higher demand pressures through chronic diseases and demographic change combined with diminishing resources for health care. An uptake and diffusion of these services would potentially lead to benefits through a reduction in death rates, and avoid recurring hospitalisation in a cost-effective manner. Yet the report identifies different categories of barriers hampering a full deployment of RMT in Europe. In the concluding part the reports provides a number of tentative policy options specifically aimed at fostering EU-wide deployment of RMT/PHS.JRC.DDG.J.4-Information Societ

Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship

In the past 20 years, the use of telemedicine has increased, with telemedicine programs increasingly being conducted through the Internet and ISDN technologies. The purpose of this dissertation is to examine the discourse community of telemedicine. This study examined the published literature on telemedicine as it pertains to quality of care, defined as correct diagnosis and treatment (Bynum and Irwin 2011). Content analysis and bibliometrics were conducted on the scholarly discourse, and the most prominent authors and journals were documented to paint and depict the epistemological map of the discourse community of telemedicine. A taxonomy based on grounded research of scholarly literature was developed and validated against other existing taxonomies. Telemedicine has been found to increase the quality and access of health care and decrease health care costs (Heinzelmann, Williams, Lugn and Kvedar 2005 and Wootton and Craig 1999). Patients in rural areas where there is no specialist or patients who find it difficult to get to a doctor’s office benefit from telemedicine. Little research thus far has examined scholarly journals in order to aggregate and analyze the prevalent issues in the discourse community of telemedicine. The purpose of this dissertation is to empiricallydocument the prominent topics and issues in telemedicine by examining the related published scholarly discourse of telemedicine during a snapshot in time. This study contributes to the field of telemedicine by offering a comprehensive taxonomy of the leading authors and journals in telemedicine, and informs clinicians, librarians and other stakeholders, including those who may want to implement telemedicine in their institution, about issues telemedicine

Pediatric Asthma Telemonitoring: Literature, Theory, and Application to Practice

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of symptoms, contributes to delays in seeking treatment, leading to higher acuity visits, increased costs, and poorer outcomes. Meanwhile the field of telemonitoring is evolving. New technologies offer patients and providers novel ways of communicating between visits. This is supported by telemonitoring literature and theoretical frameworks, which will be addressed in this manuscript. It is the assertion of this project that asthma symptom telemonitoring holds promise as a way for patients to conveniently and more adequately manage symptom fluctuations from home. The first paper in this manuscript surveys the existing literature on asthma telemonitoring modalities. The second paper examines the problem of symptom minimization and uncertainty through the framework of Symptom Management Theory. Finally, the third paper is a technical report describing a pilot study that used the AsthmaChecker app among children with asthma and their caregivers to assess linkages to Symptom Management Theory and Diffusion of Innovation Theory. This project and these writings offer new insights into the emerging field of telemedicine and its potential usefulness in the context of pediatric asthma management