Technology-Enhanced Practice for Patients with Chronic Cardiac Disease: Home Implementation and Evaluation

Objective: This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP). Methods: Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services. Results: Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status. Conclusion: This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care

The complexities of technology-based care : telecare as perceived by care practitioners

Telecare, which offers ‘care at a distance’ (Pols, 2012) through a variety of remote monitoring technologies, has developed rapidly across health and social care policy in many developed countries. Nonetheless, approaches to this development differ; the focus of this paper is the United Kingdom, where implementation has been particularly rapid and ambitious in scope. The paper argues that, while there are clear and tangible benefits from the use of some telecare technologies, there is insufficient research about the complexities of implementation with end users. These complexities include ethical questions raised by the use of monitoring and surveillance equipment, the ability to fine tune technologies to the needs of individuals, and the way in which care relationships may be altered by remote care mediated through technologies. This paper addresses these issues through a particularly under researched area; that is, the perceptions of care practitioners who assess for, and interact with, these technologies. The research was conducted with practitioners using qualitative research methodology. The paper concludes that Telecare practice is uneven in the way it addresses complexities and that more needs to be done to understand the way in which technologies are discussed and utilised by those charged with their implementation

eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

PERCEIVED EFFECT OF TELEMEDICINE ON MEDICAL SERVICE DELIVERY BY FEDERAL MEDICAL CENTERS IN NORTH CENTRAL ZONE OF NIGERIA

The study investigated the perceived effect of telemedicine on medical service delivery by the Federal Medical Centers in North Central Nigeria. Six objectives guided the study. The study answered six research questions and tested two null hypotheses at 0.05 level of significance. The study adopted survey research design. The research was conducted in the North Central Zone of Nigeria. The population of the study was one thousand four hundred and seven (1407) medical staff (Doctors, Nurses, Laboratory Technologists and Pharmacists). The sample size was three hundred and eleven (311) respondents comprising 97 doctors, 178 nurses, 19 laboratory technologists and 17 pharmacists; this was determined using Taro Yamane formula. The instrument used for data collection was a structured questionnaire titled: Perceived Effect of Telemedicine Questionnaire (PETQ) developed by the researcher from literature reviewed. Three experts validated the instrument while split-half method was used to determine the internal consistency of the items and a reliability co-efficient of 0.76 was obtained, indicating that the instrument is reliable for the study. The instrument was administered by the researcher and four research assistants. Descriptive statistics of mean and standard deviation were used to answer the research questions while inferential statistics of Chi-square was used to test the null hypotheses at 0.05 level of significance. The findings revealed that nine (9) Telemedicine services are available to a high extent in the Federal Medical Centers in North Central Nigeria. The findings also revealed that Telemedicine exerts twelve (12) effects on medical service delivery, fourteen (14) challenges were discovered to be associated with the use of telemedicine, while eight (8) strategies were identified to mitigate the challenges of the use of telemedicine. It was also found that availability of telemedicine significantly affects medical service delivery in Federal Medical Centers in North Central Nigeria. Further analysis of data revealed that the degree of application of telemedicine exert significant effect on medical service delivery in Federal Medical Centers in North Central Nigeria. It was recommended that Federal Medical Centers should embark on drastic development of telemedicine in line with global trend in order to promote effective utilization of telemedicine services, stake holders should establish a basic understanding of what this medical technology can lead to as it will help policy makers enlighten the telemedicine debate by turning unique insights into more adequate approaches that will enrich and humanize mediated channels of health communication, thereby offering remedies and clarifications for effective health care exchange and delivery

Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile.

PurposeWe have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants.ParticipantsThe study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample.Findings to dateClinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare.Future plansWe will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities.Trial registration numberNCT02646943; Pre-results

PERCEIVED EFFECT OF TELEMEDICINE ON MEDICAL SERVICE DELIVERY BY FEDERAL MEDICAL CENTERS IN NORTH CENTRAL ZONE OF NIGERIA

The study investigated the perceived effect of telemedicine on medical service delivery by the Federal Medical Centers in North Central Nigeria. Six objectives guided the study. The study answered six research questions and tested two null hypotheses at 0.05 level of significance. The study adopted survey research design. The research was conducted in the North Central Zone of Nigeria. The population of the study was one thousand four hundred and seven (1407) medical staff (Doctors, Nurses, Laboratory Technologists and Pharmacists). The sample size was three hundred and eleven (311) respondents comprising 97 doctors, 178 nurses, 19 laboratory technologists and 17 pharmacists; this was determined using Taro Yamane formula. The instrument used for data collection was a structured questionnaire titled: Perceived Effect of Telemedicine Questionnaire (PETQ) developed by the researcher from literature reviewed. Three experts validated the instrument while split-half method was used to determine the internal consistency of the items and a reliability co-efficient of 0.76 was obtained, indicating that the instrument is reliable for the study. The instrument was administered by the researcher and four research assistants. Descriptive statistics of mean and standard deviation were used to answer the research questions while inferential statistics of Chi-square was used to test the null hypotheses at 0.05 level of significance. The findings revealed that nine (9) Telemedicine services are available to a high extent in the Federal Medical Centers in North Central Nigeria. The findings also revealed that Telemedicine exerts twelve (12) effects on medical service delivery, fourteen (14) challenges were discovered to be associated with the use of telemedicine, while eight (8) strategies were identified to mitigate the challenges of the use of telemedicine. It was also found that availability of telemedicine significantly affects medical service delivery in Federal Medical Centers in North Central Nigeria. Further analysis of data revealed that the degree of application of telemedicine exert significant effect on medical service delivery in Federal Medical Centers in North Central Nigeria. It was recommended that Federal Medical Centers should embark on drastic development of telemedicine in line with global trend in order to promote effective utilization of telemedicine services, stake holders should establish a basic understanding of what this medical technology can lead to as it will help policy makers enlighten the telemedicine debate by turning unique insights into more adequate approaches that will enrich and humanize mediated channels of health communication, thereby offering remedies and clarifications for effective health care exchange and delivery

Morbidity and medication consumption among users of home telecare services

[Abstract] Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects’ mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years