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Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review
Background: It is important that people with SMI receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly used to assist healthcare delivery (‘telehealth’) , providing service users with immediate real-time information to improve the management of chronic health conditions. Telehealth has been found to be successful in improving management and symptoms across a number of health conditions, whilst also being acceptable to users. Initial findings suggest technology could improve quality of life in people with SMI.
Objectives: This systematic review aimed to identify the variety of uses and efficacy of teleheal th technology for SMI.
Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, AMED, He alth Techno logy Assessment, CINAHL plus and NHS EED ) for randomised controlled trials (RCTs) evaluating telehealth for adults with SMI , published in English. Additional literature was identified by searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias.
Results: The search identified 31 eligible articles, describing 29 trials. The included studies evaluated the use of computers to deliver cognitive rehabilitation (1 5 trials), patient education (3 trials), online self- management interventions (2 trials), and to support consultations (1 trial). Virtual reality (VR) was used to simulate work and social sit uations (2 trials ) and to deliver cognitive training (1 trial). Telephones were used to prompt medication use (3 trials ) and report SMI symptoms to healthcare teams (1 trial ). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective for improving medication adherence and reducing symptom severity and inpatient days. Computer assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. Few studies evaluated the 3 use of remote medication telemonitoring, VR, online self-management and computer -mediated consultations, suggesting these are novel technologies for managing SMI, although all were found effective for improving psycho social and behavioural outcomes. The results of this review should be taken in the context of varied quality in study design, with only five studies demonstrating a low risk of bias.
Conclusions : A growing variety of telehealth technologies are used to support SMI. Specific types of technology have been found to be effective for som e outcomes, for example telephone prompts for medication adherence, while other types of telehealth had no benefit over traditional methods and were less acceptable to patients. Few studies found benefits for telehealth on quality of life, except for novel technologies with a limited number of trials. Further research is warranted to establish the full potential benefits of telehealth for improving quality of life in SMI, acceptability from the service user perspective, and cost-effectivenes
Telehealth Utilization in Low Resource Settings
Chapter in Sustainable Community Health Systems and Practices in Diverse Settings, edited by Elias Mpofu.
Chapter Description:
In response to health access barriers, telehealth and telemedicine have grown as a supplemental healthcare delivery system to mainstream medical care. For rural and remote communities, which are mostly less well resourced, telehealth and telemedicine is increasingly a major system enabling health access and availability, bridging population health disparities by geography and socioeconomic gradients. People in low resources settings have less access to health care, while commuting for health services to the cities would be costly in terms of time, effort, and money, resulting in health inequities and social injustices on them. In this chapter, we examine the role of telehealth and telemedicine as health systems for providing sustainable community health in low resource settings. In doing so, we provide a historical overview of the research and practice in telehealth and telemedicine, followed by a discussion of current leading practices in telehealth and telemedicine. We consider the cultural and legal influences on telehealth and telemedicine services across jurisdictions highlighting responsiveness to local contexts and needs. Finally, we consider the issues for research and practice in telehealth and telemedicine, including security and privacy associated with telehealth; education for sustaining telehealth delivery; engaging high-risk populations from low-resource settings in telehealth services; and use of social networks to ensure telehealth care access for poor and remote regions.
Book description:
Applying a trans-disciplinary approach, this book provides a comprehensive, research-based guide to understanding, implementing, and strengthening sustainable community health in diverse international settings. By examining the interdependence of environmental, economic, public health, community wellbeing, and development factors, the authors address the systemic factors impacting health disparities, inequality, and social justice issues.
The book analyzes strategies based on a partnership view of health, in which communities determine their health and wellness working alongside local, state, and federal health agencies. Crucially, it demonstrates that communities are themselves health systems and their wellbeing capabilities affect the health of individuals and the collective alike. It identifies health indicators and tools that communities and policy makers can utilize to sustain truly inclusive health systems. This book offers a unique resource for researchers and practitioners working across psychology, mental health, rehabilitation, public health, epidemiology, social policy, healthcare, and allied health.https://digitalcommons.usm.maine.edu/facbooks/1554/thumbnail.jp