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

Effectiveness of Telemonitoring for Respiratory and Systemic Symptoms of Asthma and COPD:A Narrative Review

Asthma and chronic obstructive pulmonary diseases (COPD) are highly prevalent chronic lung diseases that require ongoing self-management, which itself is often suboptimal. Therefore, telemonitoring has been used to help patients measure their symptoms, share data with healthcare providers and receive education and feedback to improve disease management. In this study, we conducted a narrative review of recent evidence on the effectiveness of telemonitoring for asthma and COPD in adults. Of the thirteen identified studies, eleven focused on COPD and two focused on asthma. All studies were reviewed, and effects were compared between intervention and care as usual groups. Of the study interventions, seven showed a positive outcome on at least one outcome measure, and six had no significant results on any of the outcome measures. All of the interventions with a positive outcome included an educational component, while only one of the six interventions without positive outcomes included an educational component. We conclude that telemonitoring interventions for asthma and COPD seem more effective if they included an educational component regarding different aspects of self-management

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

Telemedicine Programs in Respiratory Diseases

Telemedicine programs are widely used in respiratory diseases, more often in patients with chronic obstructive pulmonary diseases (COPD). Telemedicine platforms use several devices to measure vital signs such as heart rate, respiratory rate, pulsioximetry or blood pressure between others. It is not unusual that patients could do questionnaires about clinical situation or communicate with their nurses via telephone, video-calling and/or Skype. The majority of results has been positive, with reduction in the number of emergency visits, hospitalizations and noninvasive ventilations. Despite their promising results, telemedicine programs/platforms are slow to implement. In this chapter, we reviewed some of the factors related to telemedicine implementation such as patients’ adherence, impact of telemedicine design and professionals\u27 resistance to change between others

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 Ideal Profile of the Telemedicine User– Experience From Portugal

Over the last few years, all over the world, telemedicine has been gaining momentum, and became more accepted by both health workers and patients as an essential tool in medicine. There have been a considerable number of studies whose results show the benefits of telemedicine programmes, not only in cost reduction and decreasing the number of exacerbations and hospital admissions, but also in improving health outcomes, with the patients having a better understanding of their illness and how they can manage it. This study is based on a tele monitoring programme being carried out in the village of Sabugueiro in Portugal. This village is one the first “Smart mountain villages” in the world, and besides having the concept of Internet of Things” applied to its infrastructure, it also has a tele-monitoring component, where blood pressure, blood glucose levels and weight of part of the population are monitored, in both healthy and unhealthy individuals. Abnormal changes of these parameters are very prevalent in our society, being responsible for a great deal of the national health system expenditure and being an important risk factor for cardiovascular events, the number one cause of death in Portugal. Therefore, their correct management is of vital importance in order to reduce costs, morbidity and mortality related to these events. However, this programmes results fell short of what was desired, with low compliance by the patients, who did not make the recommended number of measurements. The main goal of this study was to understand what can improve the compliance of a telemonitoring patient, what they find the most difficult to cope with, and when this kind of programme is useful

Understanding intention to use telerehabilitation : applicability of the Technology Acceptance Model (TAM)

Indiana University-Purdue University Indianapolis (IUPUI)Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation

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