Hindawi Publishing CorporationInternational Journal of Telemedicine and ApplicationsVolume 2013, Article ID 461829, 31 pageshttp://dx.doi.org/10.1155/2013/461829

Review ArticleUsing Information and Communication Technology inHome Care for Communication between Patients, FamilyMembers, and Healthcare Professionals: A Systematic Review

Birgitta Lindberg, Carina Nilsson, Daniel Zotterman, Siv Söderberg, and Lisa Skär

Division of Nursing, Department of Health Science, Lulea University of Technology, 971 87 Lulea, Sweden

Correspondence should be addressed to Birgitta Lindberg; birgitta.lindberg@ltu.se

Received 18 November 2012; Revised 17 January 2013; Accepted 3 February 2013

Academic Editor: Carlos De Las Cuevas

Copyright © 2013 Birgitta Lindberg et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for deliveringand giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studiesdescribing the use of ICT in home care for communication between patients, family members, and healthcare professionals.Methods.A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted,which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the useof ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data,terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICTwas performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responsesin the use of ICT. Conclusion.The use of ICT applications in home care is an expanding research area, with a variety of ICT toolsused that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control oftheir illness that promotes self-care.

1. Introduction

Due to an ageing population and a shortage of hospitalbeds, it has become a challenge to find new ways to supportand care for people with chronic illness living at home.Living with chronic illness changes the lives of those affected,who are often in need of support and nursing care in theirhomes [1–3]. eHealth has the potential to become a meansof providing good care at home [4], which is especiallychallenging with regard to this emerging field [5]. eHealthrefers to information and communication technology (ICT)tools and services for health, whether the tools are usedbehind the scenes by healthcare professionals or directly bypatients and their relatives [6]. ICT tools can be used to accessa wide variety of technological solutions for communication,including text messaging, gathering and monitoring data,diagnosis and treatment at distances, and retrieving elec-tronic health records [5, 7]. According to the World HealthOrganization (WHO) [8], eHealth is used in the healthcarefor transmission of digital data, including data stored and

retrieved electronically to support healthcare, both at thelocal site and at a distance.

E-Health includes the interaction between patients andhealth service providers or peer-to-peer communicationbetween patients and/or health professionals. Interest hasprimarily focused on the use of ICT tools in the care of older[9] and severely chronically ill people [10]. Although ICT hasbeen increasingly used in healthcare in recent years, effortsacross countries have been fragmented and could benefitfrom improved cross-border coordination. eHealth toolsand services have been widely introduced and implemented,and the potential benefits ICT can bring people with chronicillness will increase significantly [6].

2. Aim

The aim was to review existing studies describing the useof ICT in home care for communication between patients,family members, and healthcare professionals.

2 International Journal of Telemedicine and Applications

The particular objectives of the reviewwere the following:

(i) to provide an overview of characteristics of studiesdescribing the use of ICT in home care,

(ii) to describe how ICT was used for communication inhome care,

(iii) to describe the benefits and drawbacks of the use ofICT in home care.

3. Method

The design for conducting this systematic review was guidedby DiCenso et al. [11], with the following steps taken: forformulating a research question, conducting a literaturesearch, applying inclusion and exclusion criteria, abstractingdata, and undertaking an analysis.

3.1. Selection Criteria. The inclusion criteria for this literaturereview were set as follows: (1) ICT interventions; (2) com-munication between any healthcare professionals, patients,and/or family members; (3) studies published in scientificjournals; (4) studies published between 2000 and 2010; and(5) in the English language. Criteria for exclusion were ICTinterventions that included technological systems not involv-ing people (no active patient acceptance) such as monitoringby camera, alarm systems, and use of ordinary telephones,noting that telephones can be used complementarily to othertechniques. Letters, editorials, and news items were alsoexcluded.

3.2. Search Strategy. In the literature search the followingelectronic bibliographic databases were used: PubMed, Sco-pus, and CINAHL. Search limits were set to English languagestudies published in scientific journals from 2000 to June2010. The search terms and search strategy were customizedfor each database to search completely and exactly. Thesearch strategy included thesaurus terms (MeSH terms andsubject headings) combined with free-text words. Examplesof main search terms used were telemedicine, informationand communication, ICT, technology, e-health, home care,home, and nursing. To maximize the search results, multiplesets of search terms were used. The search was done untilan overlap in the studies was observed. All studies retrievedfrom the search in databases were imported into a referencemanager (EndNote). The literature searches resulted in 1,276studies; after duplicates were discarded by EndNote, 923studies remained. A search alert was created to get the latestpublished studies, which resulted in 11 additional studies.The final total to be reviewed was 934. The literature searchwas performed with support from librarians.

3.3. Selection Process. A first selection was based on titlesand abstracts of the 934 studies to identify whether or notthey were within the scope of the research question. Next,a selection based on inclusion criteria was conducted, withfocus on studies of ICT applications used in home care. Afterthis selection, a total of 320 studies remained for closer review.The full-text version of the studies was then read and initially

categorized based on type of communication applied in thestudies. Two authors read all the studies independently. Toincrease reliability they discussed ambiguities of inclusioncriteria until consensus was reached. This reduced the num-ber to 139 studies relevant to the research question. However,nine relevant studies were unavailable both electronicallyand in paper form, which thereby were excluded from thisstudy, leaving 130 studies.The selection process for the studiesreviewed is presented in Figure 1.

3.4. Quality Appraisal. All eligible studies (𝑛 = 130) wereevaluated for scientific quality on a three-grade scale: highscientific quality, good scientific quality, and fair scientificquality. The grading system is used by The Swedish Councilon Technology Assessment in Health Care (SBU) for system-atic reviews [12–14]. The quality appraisal was performed inaccordance with a previously presented method for qualityappraisal [15–18], which was chosen to be appropriate. Inappraising the scientific quality of each study, protocolswere used to extract data. Different protocols were usedfor studies with a quantitative approach and for studieswith a qualitative approach. In the protocol for quantitativestudies the items focused mainly on exclusion, sample pro-cedures, intervention, dropouts, randomization, similarityof groups, blinding, outcomes, statistical procedures, ethicalconsiderations, validity and reliability of instruments used,and possibility of generalization of results. In the protocolfor qualitative studies the items focused mainly on context,ethical reasoning, procedure of sample, data collection,analysis procedures, saturation, clarity and logic of results,theoretical framework, theory generation, and descriptionof main results. The protocols contained questions to beanswered with yes/no/unclear and additional space to com-ment on the relevance of each item and for the extracteddata. The number of questions answered yes was dividedby the total number of questions and thereafter convertedto percentage. Willman et al. [15] state that the use ofpercentage makes it possible to weight and compare differentstudy’s methodologies. As recommended [15] the percentagewas transformed to high scientific quality (80–100%), goodscientific quality (70–79%), and fair scientific quality (60–69%). The studies that scored less than fair were excluded(𝑛 = 23), as they were considered not to be of sufficientscientific quality to be included. The quality appraisal wasperformed by two of the authors, initially together to obtainan equal assessment, but thereafter independently. Whenuncertainties arose, the authors discussed the result of thequality appraisal until consensus emerged. After the qualityappraisal was undertaken, 107 studies remained.

3.5. Data Abstraction. The remaining 107 studies were clas-sified as relevant to the research question and met theinclusion and quality criteria for being included in the dataabstraction. A list of all included studies can be found inTable 6. Each of the included studies was given an indexationand then categorized according to a number of different areasbased on the following characteristics: country of origin,year of publication, study approach, journal, communication

International Journal of Telemedicine and Applications 3

The literature search in databasesyields potentially relevant studies

Studies screened after excluding duplicates and includingfrom the created search alert

Studies remaining relevant tothe aim of the studies

Studies undergoing qualityappraisal

Studies excluded due tounavailability electronically or by paper

Studies excluded as notmeeting criteria for inclusion

Studies excluded afterexamining titles and abstract

Studies excluded as duplicates

Studies included in the finalreview

Studies remaining for closerreview

Studies not measuring up tothe quality

𝑛 = 1276

𝑛 = 934

𝑛 = 320

𝑛 = 130

𝑛 = 139

𝑛 = 107

𝑛 = 23

𝑛 = 9

𝑛 = 181

𝑛 = 614

𝑛 = 353

Figure 1: Flow chart of search result.

strategies, type of technology, type of communication, diseasediagnosis, and quality appraisal.Thereafter, data from each ofthe included studies were extracted and entered into amatrix.

4. Results

The result presentation is divided in two parts; general andspecific results.

4.1. General Results. The general results give an overview ofcharacteristics of studies describing the use of ICT appli-cations in home care. The results are summarized in areasincluding study approach, quality appraisal, publicationsdata, terminology used for defining the technology, anddisease diagnosis.

4.1.1. Studies’ Approach. Most of the included studies had aquantitative approach. Only about one-fifth had a qualitativeapproach. Further, some of the studies used mixed methods,with both qualitative and quantitative approaches (Table 1).Twenty-one studies were part of larger projects.

4.1.2. Quality Appraisal. In the critical quality appraisal of all107 studies, just under half were rated as high scientific quality(𝑛 = 48). That number was compared to studies rated asgood scientific quality (𝑛 = 23) and fair to good scientificquality (𝑛 = 36) (Table 1). When comparing the qualityappraisal between qualitative and quantitative approaches,

differences could be noted. A greater proportion of thequalitative studies were rated as high scientific quality. Incomparison, less than half of the quantitative studies wererated as high scientific quality. The opposite was the casewith qualitative and quantitative studies rated as fair scientificquality. Good scientific quality ratings were found in bothqualitative and quantitative studies.

4.1.3. Publication Data. All of the 107 included studies werepublished between January 2000 and June 2010, so only partof year 2010 was included. During this period the numberof publications increased by time, with about half of theincluded studies (𝑛 = 53) published between 2007 and2009. Note that 2009 alone represents 23 studies of the totalpublications (Figure 2).

The studies included were published in 69 different scien-tific journals.The twomost common journals were Journal ofTelemedicine andTelecare (𝑛 = 15) andTelemedicine Journaland e-Health (𝑛 = 12), together representing almost one-quarter of the total number of studies. The rest of the studies(𝑛 = 80)were spread over a variety of other journals (𝑛 = 67).The impact factor in the journals ranged between 0.348 and14,293.

The majority of the studies were performed in NorthAmerica (𝑛 = 67). About one-third of the studies were donein Europe (𝑛 = 34), with United Kingdom, Sweden, and Italybeing the most prominent. Only a few studies (𝑛 = 6) wereconducted outside North America and Europe; those weredone in Asia (𝑛 = 5) andAustralia (𝑛 = 1).Three studies were

4 International Journal of Telemedicine and Applications

25

20

15

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0

3

11

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810

4

1214

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1

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2000 2002 20032001 2004 2005 2006 2007 2008 2009 2010

The studies’ year of publication

Figure 2: Number of studies published per year between 2000 andJune 2010.

Table 1: Sample data representation.

Study quality Study method (number of studies)Qualitative

(21)Quantitative

(74) Mixed (12)

High scientific quality 15 (71%) 29 (39%) 4 (33%)Good scientific quality 4 (19%) 17 (23%) 2 (17%)Fair scientific quality 2 (10%) 28 (38%) 6 (50%)

carried out in cooperation between different countries, butonly one studywas a combined study involving the continentsof North America and Europe (Table 2).

4.1.4. Terminology Used for Defining the Technology. Theresults show that 13 different terms were used to define thetechnology utilized to increase accessibility to home careservices and home nursing. The most frequently used termswere telehealth, telemedicine, technology, and telecare. Tele-health and telemedicine together (𝑛 = 59) account for morethan half of the terms used in the included studies. Otherterms used three times or more were e-Health, ICT/IT, tele-healthcare, telemonitoring, and telenursing. Further, in somestudies other terms were used as follows: e-rehabilitation,teleassistance, and telerehabilitation (Table 3).

4.1.5. Disease Diagnosis. The ICT applications were used inhealthcare for a wide range of different conditions throughthe life span. In the majority of the studies (𝑛 = 86), thetechnology was developed specifically for supporting peoplewith chronicle illness living at home. The most frequent dis-eases studied were heart and lung diseases, chronic wounds,diabetes, cancer, and stroke. Chronic illness was used in 12studies without any definition of the specific disease. Otherconditions were, for example, infectious diseases, spinal cordinjuries, and end-of-life care. A number of studies includeddid not specify the diagnoses (Figure 3).

4.2. Specific Results. The specific results describe how ICTwas used for communication in home care and benefits

Table 2: Number of studies per country.

Country Number of studiesUSA 62UK 12Sweden 7Italy 5Canada 4China 2Japan 2Australia 1Austria 1Belgium 1Denmark 1Finland 1Germany 1Netherlands 1Norway 1Poland 1South Korea 1Denmark/Norway 1UK/Germany/Netherlands 1USA/Netherlands 1Total of studies 107

Table 3: Number of studies per terminology.

Terminology Number of studiesTelehealth 32Telemedicine 27Technology 11Telecare 10ICT/IT 7Telemonitoring 6Telenursing 4e-Health 3Telehealthcare 3Telerehabilitation 2e-rehabilitation 1Teleassistance 1Total of studies 107

and drawbacks within the use of ICT in home care. Theresults are summarized in the following main areas: typeof technology, communications between participants, andbenefits and drawbacks of the use of ICT.

4.2.1. Types of Technology. Three fields of applications werefound to be prominent in the use of ICT in homecare: videotechnology, text messages and health monitoring. An impor-tant result was that a mix of more than one ICT applicationswas used in several studies (𝑛 = 31). A small numberof studies included all types of ICT applications above. Insome of the studies, a mix of text and pictures and/or audiowas used. In a few studies digital images were used. Some

International Journal of Telemedicine and Applications 5

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Figure 3: Number of studies per disease diagnosis.

studies did not specify the used ICT application (Table 4).

Video Technology. The most frequently used type of technol-ogy was video technology (𝑛 = 53); the number includesstudies using more than one ICT application. In several ofthose studies (𝑛 = 31), the main focus of the interventionwas the use of videophones or videoconferencing. Anotheruse of video technology was to complement patient healthmonitoring (𝑛 = 22). It is notable that web-based videoconferencing was used only in a small number of studies(𝑛 = 3). In all studies involving parents of children withchronicle illness, video technologywas used to communicate.

Video technology was used with different types of appli-cations. Examples of use were guiding patients in their useof medical equipment and to improve self-management,via video-based home telecare services. Another use wasteleadvice given by clinical nurse specialists in different areasto community nurses. Videoconferencing was used betweenpatients/family members and healthcare personnel for edu-cation and psychosocial or emotional support. Another wayto use videoconferencing was to enable interactions betweenpatients and nurses. Consultation via videoconferencing inthe patient’s home was used instead of visits to the hos-pital, which enabled access to experts to a greater extent.Virtual nurse visits after, for example, discharge from thehospital, were offered to both patients and family members.

TextMessages.As shown inmany studies (𝑛 = 30), a commonway of communicating was via text messages. For sendingtext messages, websites or web-based programs were usedin some studies (𝑛 = 10). Handheld platforms, such asmobile phones, laptop computers, or text telephones, wereused by patients to both send and receive information aswell as to communicate (𝑛 = 12). In other studies (𝑛 = 8),mobile phones or hand held equipment was used to send textmessages.

For example, text messages were used for sending mes-sages to patients with self-care advice as a response to symp-toms and test results they had reported. Another way to use

Table 4: Overview of ICT applications used in homecare.

Number of studies(main focus for thestudy)

Fields of application∗

Videotechnology(𝑛 = 53)∗∗

Textmessages(𝑛 = 30)∗∗

Healthmonitoring(𝑛 = 52)∗∗

Type of technology 49 26 17All types 4Mix of text andpicture and/oraudio∗∗∗

6

Digital images 3Not specified type oftechnology 2

Total of studies 107∗Type of technology is divided into three fields of application (mostprominent in the included studies).∗∗Total number of studies including this type of technology. The numberincludes studies using more than one type of technology.∗∗∗Included in health monitoring.

text messages was by electronic diary for home monitoringto improve communication between patients and healthcareprofessionals. An electronic messaging programme via com-puters and mobile phones or e-mail and video mail messageswas used, enabling nurses and patients to exchange messagesto and from anywhere. Via a symptom management system,patients can receive messages in their daily management ofsymptoms.

Health Monitoring. About half of the total studies (𝑛 = 52)included health monitoring, focusing on patients who senthealth data to be analyzed by healthcare professionals. Inmost of the studies that looked at monitoring patient health,textmessaging or video technologywas used to communicatethe data (𝑛 = 35). Other forms of communication werealso used, including the telephone (𝑛 = 17). Health Buddy,was the most commonly used device for monitoring patienthealth (𝑛 = 8). Health Buddy, a system that connects patientsin their homes with care providers, is a telehealth devicethat collects and transmits disease management informationabout a patient’s condition including vital signs, symptoms,and behaviors. Types of patient health data collected fromhealth monitoring systems in real time were, for example,weight, blood pressure, heart rate, and pulse.

4.2.2. Communication between Participants. Different typesof communication via ICT were described as being usedbetween participants, who were typically nurses, healthcareprofessionals, patients, or familymembers.Themost frequentline of communication in the studies was between patientsand nurses or other healthcare professionals. ICT was usedmost for communication between nurses and patients. In 24studies, the patient was not the focus for communication.Instead, it was common for the technology to be used forcommunication with family members. In five of the studieswith a focus on family members, the ICT was developedfor healthcare personnel giving support to parents. In somestudies, the communication was merely between healthcare

6 International Journal of Telemedicine and Applications

Table 5: Communication between participants.

Communication Number of studiesPatient-nurse 49Patient-other healthcare professionals 34Family members-healthcare professionals 14Between healthcare professionals 10Total of studies 107

professionals and neither patients nor family members werepart of the communication. The review shows that peopleliving with illnesses at home and healthcare professionalsgave positive responses from using different ICT applicationsfor healthcare in communication with each other (Table 5).

4.3. Benefits and Drawbacks with the Use of ICT in HomeCare. Results of the included studies were predominated bypositive responses from the use of different ICT applicationsin home care from both people living with chronic illnessesand healthcare professionals. For example, healthcare profes-sionals’ opinions were that their work was facilitated. Moststudies show that communication between healthcare profes-sionals and patients living at home was improved by usingvarious ICT applications, as improvement in managementof symptoms in daily life. It was revealed that various ICTapplications can be advantageous to use in follow-up care ofpatients at home.Another benefit of using ICT applications inhome care was found to be an improved accessibility. Resultsfrom studies show that using ICT in communication in homecare can be cost saving but also the opposite. However, theuse of ICT cannot replace a face-to-face encounter but can beused as a complement.

5. DiscussionTheaimof this studywas to review existing studies describingthe use of ICT in home care for communication betweenpatients, family members, and healthcare professionals. Thisreview provides an overview of characteristics of studiesdescribing the use of ICT applications in home care. Theresults show that ICT in home care is an expanding fieldof interest, with a variety of ICT tools beginning to beevaluated significantly. Half of the included studies reviewedrepresent the year between 2007 and 2009. This may reflectthe increased use of the Internet and ICT tools for care man-agement with involvement of patients and family members’participation in care processes. Previous research [19] statedthat focus has emerged from being technology focused totaking the users’, that is, the patient, family members, andhealthcare professionals, perspective into account.

The review shows a trend that most studies were accom-plished in North America and Europe, where the UnitedKingdom, Sweden, and Italy were most prominent. This isnoticeable since Italy is one of the European countries inwhich less than 30 percent of the population uses the Interneton a daily basis. The maturity of the Internet use in daily lifeis an indicator of how far the digitalization of the healthcaresector should have come [19]. For instance, despite Sweden

being a small country, seven of the studies included in thisreview were performed there, which might be explained bythe fact that 75 percent of the population uses the Internet ona daily basis.

This review shows that a wide variety of terms were usedin the reviewed studies to define ICT. Most frequently useddefinitions were telehealth and telemedicine. This is in linewith Koch’s [7] review of the current state and future trendsin home telehealth. The term telehealth has been broadlydefined as the use of telecommunication and informationtechnologies for provision of healthcare to individuals at ageographical distance [20]. Telehealth involves a wide varietyof specificmodalities including telephone-based interactions,Internet-based information, still and live imaging, personaldigital assistants, and interactive audio-video communica-tion or television [21]. Furthermore, eHealth is describedas the overall umbrella field that includes both ICT andtelehealth, combining use of electronic communication andinformation technology in healthcare [22]. This may explainthe results of this review with many different terms used todefine the technology.

This review describes how ICT was used for commu-nication in home care, and an interesting result found wasthat the most frequent type of communication was betweenpatients and healthcare professionals.This indicates that userfocus needs to be shifting from tools for professionals to toolsfor patients and family members. This is in accordance withKoch [7], describing trends toward tools and services not onlyfor professionals, but also for patients and citizens. Howeverfrom a nursing perspective, there is a lack of knowledgeabout how to use ICT solutions to meet the needs of peoplewith chronic illness. In specific, by performing qualitativestudies people’s needs related to living with chronic illnesscan be elucidated. A challenge in home care will thereforebe to use existing ICT tools to meet caring needs of peoplewith chronic illness based on their experiences [23]. From acaring perspective, it is important to understand ICTs impacton quality of life, quality of care, and medical impact ofmeasureable parameters [24].

This review describes benefits and drawbacks when ICTwas used for communication in home care. A variety ofICT applications are described in the review. Bardram et al.[23] stated that ICT applications used in home care musttake into consideration the role technology should play inthe use of patient and healthcare professionals. Neglectingthis aspect may lead to technology that not provide theneeded support for communication. According to Koch et al.[25], research and practice of health-enabling and ambient-assistive technologies may significantly contribute to thattechnical solutions are explored in a social context andin relation to individual needs. Telehealth systems in theform of online and mobile tools are already opening upthe possibilities for reduced hospitalization and an increasedhome care [26]. Various ICT applications will thereby offerhealthcare professionals to become more flexible and able toaddress the differing needs of individual patients [27], that is,a more person-centred care.

The results of this review show that people living withchronic illnesses and healthcare professionals were positive to

International Journal of Telemedicine and Applications 7Ta

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m.

Ther

esultsweree

ncou

raging

andsuggestthatw

eb-based

commun

icationcan

improvethe

quality

ofcare

forp

atientsw

ithlegwou

ndsa

ndcanredu

cecosts

.

Barnason

etal.[34]

Effecto

faho

mec

ommun

icationinterventio

n(H

CI)toaugm

ent

homeh

ealth

care

(HHC)

onfunctio

ning

andrecovery

outcom

esof

elderly

patie

ntsu

ndergoingcoronary

artery

bypassgraft

.The

experim

entalgroup

inthisstu

dyreceived

HCI

usingatechn

olog

ydevice

calledtheH

ealth

Budd

y.Th

eHealth

Budd

ydevice

isas

mall,

simplec

ommun

icationdevice,app

roximately6×9inches,w

ithan

illum

inated

screen

andfour

largeb

uttons

forthe

patie

ntto

useto

interactwith

messagesv

iewed

onthes

creen.

HCI

subjects,

comparedwith

theH

HCgrou

pon

ly,hadas

ignificantly

high

eradjuste

dmeangeneralh

ealth

functio

ning

score.Th

erew

eres

ignificanttim

eeffectson

physical,role-ph

ysical,and

mentalh

ealth

functio

ning

,ind

icating

thatbo

thgrou

psim

proved

over

time.Th

egroup

sreportedsim

ilar

posto

perativ

eproblem

s;ho

wever,the

controlgroup

hadmoree

mergency

departmentv

isitsthan

theH

CIgrou

p.

8 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Barnason

etal.[35]

Theh

omec

ommun

icationinterventio

n(H

CI)w

asdelivered

tocoronary

artery

bypassgraft

patie

ntsw

ithisc

hemicheartfailure,

usingad

evicec

alledtheH

ealth

Budd

y.Th

issm

alld

evicea

ttaches

tothep

atient’steleph

onea

sameans

ofcommun

icationandprovides

healthcare

professio

nalswith

assessmento

fpatient

symptom

s(e.g

.,fatig

ueor

sleep

prob

lems)andstrategies

tomanager

eported

symptom

s.

Find

ings

demon

stratep

romise

forthe

potentialu

sefulnesso

fatargeted

interventio

nfora

vulnerablesubsam

pleo

fcoron

aryartery

bypassgraft

patie

ntsd

uringthee

arlyrecovery

perio

d.Fu

rtherm

ore,theu

niqu

enesso

fthe

telehealth

device

used

provided

cliniciansw

ithanotherp

otentia

loptionfor

maintaining

contactw

ithhigh

-risk

patie

nts.Self-effi

cacy

isak

eycompo

nent

toself-care

anddiseasem

anagem

ent.

Benatare

tal.[36]

Care

was

delivered

bytheh

omenurse

visit

orthen

urse

telem

anagem

entm

etho

d.In

thelatter,patientsu

sedtrans-telep

honic

homem

onito

ringdevicestomeasure

theirw

eight,bloo

dpressure,

heartrate,andoxygen

saturatio

n.Th

esed

ataw

eretransmitted

daily

toas

ecureInternetsite.A

nadvanced

practic

enurse

worked

collabo

rativ

elywith

acardiologist

andsubsequentlytre

ated

patie

nts

viatele

phon

e.

Ther

esultsdemon

stratesig

nificantimprovem

entsin

outcom

esandqu

ality

ofcare

forp

atientsw

ithsevere

heartfailure

usingaggressiv

erem

ote

tele-m

onito

ringversus

tradition

alho

menurse

visits.Th

edatap

rovide

evidence

thattheintrodu

ctionof

currentstate-of-the-artcompu

teriz

edtechno

logies

allowsrapid

andaccuratemon

itorin

gof

patie

ntsw

ithsevere

heartfailure.Th

ecom

binatio

nof

thesetechn

ologiesa

ndheartfailure

managem

entb

yan

advanced-practicen

urse

underthe

guidance

ofa

cardiologistiscosteffectiv

eand

leadstoim

proved

outcom

esandcare.

Bend

ixen

etal.[37]

Thee

ffectso

nhealthcare

costs

ofaV

eteransA

dministratio

ntelerehabilitationprogrammew

eree

xamined.L

AMP(Low

Activ

ities

ofDailyLiving

(ADL)

Mon

itorin

gProgramme)isbasedon

arehabilitativem

odelof

care.L

AMPpatie

ntsreceivedadaptiv

eequipm

entand

environm

entalm

odificatio

ns,w

hich

focusedon

self-care

andsafetywith

intheh

ome.LA

MPcare

coordinators

remotely

mon

itoredtheirp

atients’vitalsigns

andprovided

education

andself-managem

entstrategiesfor

decreasin

gthee

ffectso

fchron

icillnesses

andfunctio

nald

eclin

e.

Nosig

nificantd

ifferencesw

ered

etectedin

poste

nrollm

entcostsbetween

LAMPandthem

atched

comparis

ongrou

p.Fo

rLAMPpatie

nts,thep

rovisio

nof

adaptiv

eequ

ipmentand

environm

entalm

odificatio

ns,plusintensiv

ein-hom

emon

itorin

g,ledto

increasesinclinicv

isitsaft

erinterventio

nwith

decreasesinho

spita

land

nursingho

mes

tays.

Bohn

enkampetal.

[38]

Afterd

ischargefrom

theh

ospital,cancer

patie

ntsw

ithnewostomies

were

assig

nedto

oneo

ftwo

grou

ps:hom

ehealth

visitso

nlyor

home

health

plus

telenu

rsingcontact.Th

ehom

ehealth

grou

preceived

homeh

ealth

visitations

byan

urse

who

continuedevaluatio

nsand

educationaccordingto

currentm

anagem

entp

rotocols.

Thetele

nursinggrou

pwas

mores

atisfi

edwith

care

after

dischargefrom

the

hospita

land

requ

iredfewer

pouchchanges,so

care

was

lessexpensiveb

ecause

ofthed

ecreased

numbero

fpou

ches

used.Th

etele

nursingpatie

ntgrou

pbelievedthattheo

stomynu

rseu

ndersto

odtheirp

roblem

sbetterthanthe

homeh

ealth

nursed

id,and

they

werem

orec

omfortablewith

inform

ation

provided

bytheo

stomynu

rse.Th

etele

nursinggrou

preceived

care

from

nurse

specialistswho

werea

bletoindividu

alizep

atient

care,decreasec

ost,and

improvep

atient

satisfaction.

Bowlesa

ndDansky

[39]

Nursesinalarge,urban

homecarea

gencyused

televideotechno

logy

toim

provethe

self-managem

ento

fdiabetesfor

oldera

dults

who

were

admitted

forskilledho

mec

are.

Teleh

omecareisa

newteaching

andmon

itorin

gtoolthathelpsp

atients

improvetheirkn

owledgea

ndself-managem

ento

fdiabetes.Teleh

omecare

visitsa

reeffectiv

efor

reinforcingpatie

nteducationandachieves

ignificant

improvem

entsin

self-managem

ent.Patie

ntsinthev

ideo

grou

preceived

more

contactw

iththeirn

ursesinperson

andviav

ideo

visitsv

ersusin-person

visits.

International Journal of Telemedicine and Applications 9Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Bowlese

tal.[40]

Effectsof

evidence-based

diseasem

anagem

entg

uidelin

eswere

delivered

topatie

ntsw

ithheartfailure

anddiabetes

usingthree

different

mod

alities:in-person

visitsa

lone

(con

trol),

in-personvisits

andatele

phon

eintervention(te

leph

one),and

in-personvisitsa

ndtele-m

onito

ring(te

le-m

onito

ring).Th

reed

ifferentk

inds

ofteleh

ealth

mon

itorswereu

sed.Tw

omon

itorsprovided

physiological

mon

itorin

g,with

ablood

pressure

cuff,

body

weightscale,

glucom

eter,

andpu

lseoxim

eter.Th

ethird

mon

itorp

rovidedtheseinadditio

nto

adigitalstethoscope

andvideocon

ferencing.Th

etele

health

inform

ationwas

transm

itted

tothea

gencywhere

itwas

mon

itored

daily

bythen

urses.Nursesa

ssessedph

ysicalandem

otionalstatus,

review

edmedications,and

instructed

thep

atientso

nself-care

and

diseasem

anagem

ent.

Therew

asno

differenceb

etweentheg

roup

sinthep

rimaryou

tcom

e(rehospitalization),alth

ough

therew

asatrend

towardincreasedho

spita

lreadmissions

inthetelepho

nepatie

ntsv

ersusc

ontro

l.Havingheartfailure

andreceivingmorein-person

visitsw

eres

ignificantly

related

toreadmiss

ion

andtim

etoreadmiss

ion.

How

ever,the

differences

betweenthethree

grou

psweren

onsig

nificant.Th

erew

asatrend

forincreased

riskof

readmissionfor

thetele

phon

egroup

andforreadm

issionsoon

er.Patient

reho

spita

lizationand

emergencydepartmentvisitrates

werelow

erthan

then

ationalaverage,

makingitdifficultto

detectad

ifference

betweengrou

ps.

Brennanetal.[41]

Nursin

gpractic

ecapita

lizes

onaw

eb-based

resource

(HeartCa

reII)to

supp

ortp

atient

self-managem

ent,symptom

interpretatio

n,and

self-mon

itorin

g.Re

search

staff

provided

compu

tersandtechnical

assistance;visitingnu

rses

trained

patie

ntsinthec

ompo

nentso

fthe

HeartCa

reIIwebsitem

ostrele

vant

totheirc

aren

eeds.

Thed

urationof

visitingnu

rsea

ssociatio

n(V

NA)service

anduseo

fHeartCa

reIIresourcesv

aryacrosspatie

ntsa

ndnu

rses.

Buckleyetal.[42]

Remotem

onito

ringequipm

entand

avideo-pho

neop

eratingover

asta

ndardteleph

onelinew

ereinstalledin

theh

omes

ofpatie

ntsw

ithdiabetes,and

they

weretrained

intheiru

seandop

eration.

Resid

ents

perfo

rmed

daily

mon

itorin

gof

bloo

dpressure

and/or

bloo

dglucose

usingthee

quipment.Th

eresidentsreceived

weeklyvideovisitsfrom

then

urse

educators.

Ther

esultsdemon

strated

atrend

inredu

ctionof

HbA

1cforthe

resid

entswith

diabetes,but

therew

asno

significantimprovem

entinHbA

1c,blood

glucose,

orbloo

dpressure

measurement.Kn

owledgeo

fdiabetesa

ndhypertensio

n,self-effi

cacy,and

perceptio

nof

telehealth

significantly

increasedfollowingthe

protocol.

Buckleyetal.[43]

Thew

ound

,osto

my,andcontinence

(WOC)

nursefi

rstcom

pleted

awou

ndassessmentand

recommendatio

nform

basedon

averbal

repo

rtfro

mtheh

omecaren

urse

then

accessed

digitalimages

ofthe

wou

ndsa

ndmadea

nyindicatedmod

ificatio

nsto

theo

riginal

assessmentand

managem

entp

lan,

providingar

ationalefora

nychanges.Com

paris

onsw

erem

adeb

etweenthea

ssessm

entcom

pleted

bytheh

omecaren

urse

andtheW

OCnu

rse’s

assessmentand

between

theW

OCnu

rse’s

assessmentand

recommendatio

nsbasedon

lyon

averbalrepo

rt,and

hiso

rher

assessmentand

recommendatio

nsbased

onthec

ombinatio

nof

averbalreportand

adigita

lpho

tograph.

Therew

asah

ighpercentage

ofagreem

entb

etweenthew

ound

assessments

completed

bytheh

omecaren

urse

andthosec

ompleted

bytheW

OCnu

rse;

areaso

fdisa

greemento

ftenim

pacted

theo

verallassessment.WOCnu

rses

who

provider

emoten

urse-to

-nurse

consultatio

nswith

outd

irectlyvisualizing

thep

atients’wou

ndsthrou

ghdigitalimages

area

trisk

foru

nder-o

rovertre

atingpatie

nts’wou

nds.Digita

limages

also

providea

nop

portun

ityfor

theW

OCnu

rsetomentorh

omecaren

ursesinwou

ndassessmentand

care.

Buckleyetal.[44

]

Thetele

health

nurses

cheduled

aserieso

ftwoinitialho

mev

isitsto

strokep

atientsa

thom

eand

follo

w-upweeklyteleh

ealth

visitsw

itheach

caregivero

vera

six-w

eekperio

d.Th

etele

health

equipm

entw

asinstalledin

thep

atient’sho

me.

Major

factorsrela

tedto

ther

eceptiv

enesso

ftele

health

werethe

timingof

whenitwas

offered

after

dischargea

ndthelevelof

caregiverb

urden.

Caregiversexpressedtheo

pinion

thattheo

ptionof

usingtelehealth

shou

ldbe

intro

ducedatthetim

eofthe

stroke

survivors’discharge,whenthey

were

trying

tocope

with

newneedsa

ndrespon

sibilitie

s.Th

emajority

ofcaregivers

who

hadele

cted

tousethe

teleh

ealth

repo

rted

having

amod

eratelevelof

patie

ntdepend

ence

upon

them

andalow

-to-m

oderatelevelof

burden

was

consistentw

iththec

aregivers’commentsof

needingadditio

nalsup

port

offered

bytelehealth

andof

beingmod

erately

comfortablewith

andintereste

din

techno

logy.

10 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Cardozoand

Steinb

erg[45]

Recentlydischarged

olderp

atientsreceivedan

urse

visit

upto

3tim

es/w

eekandho

metele

medicinem

onito

ringon

adailybasis.Th

etelem

edicinec

ompo

nent

used

remotem

onito

ringto

assessthe

patie

nt’shealth

status.Ithadthec

apabilityto

mon

itorrespiratory

rate,blood

pressure,pulse

oxim

etry,and

patie

ntweightand

continually

graphandup

datethee

lectronicp

atient

record.Th

esed

ata

werea

vailabletotheh

ealth

care

team

andallowed

them

toim

prove

care

coordinatio

nandprovidep

roactiv

eand

individu

alized

managem

ent.Italso

inclu

dedtheH

ealth

Budd

yappliancethat

provided

impo

rtantp

atient

health

educationandself-regu

latin

gdiseasem

anagem

entinformation.

Amajority

ofpatie

ntssho

wedim

proved

quality

ofhealth

perceptio

n,bette

rdiseaseu

nderstanding

,and

high

satisfactionratesw

ithtelemedicine.A

home-based,case-m

anaged

telemedicinec

ares

ystem

iscost-

effectiv

eand

improves

health

outcom

esin

olderp

atientsw

hoarea

trisk

from

deterio

ratin

ghealth

andfurtherd

econ

ditio

ning

asac

onsequ

ence

ofrepeated

hospita

ladmissions.Telem

edicineisw

ellacceptedby

thee

lderlyas

acom

plem

entary

mod

ality

ofcare.

Chae

etal.[46

]

Inho

meh

ealth

services

(HHS)

fore

lderlypatie

nts,atele

medicine

syste

mwith

a33-kbsn

arrow-bandapproach

todeterm

inethe

effectiv

enessinprovidingqu

ality

services

was

implem

entedand

evaluated.Acompu

ter-basedpatie

ntrecord

was

also

developedto

view

apatient

summaryandto

documentencou

ntersa

tthe

patie

nt’s

home.

Telemedicinew

aseffectiv

einterm

sofreducingthen

umbero

fclin

icvisitsa

ndachievingpatie

ntsatisfaction;

72%of

patie

ntsw

eres

atisfi

edwith

telemedicine,bu

tpatient

locatio

nshow

edas

ignificantd

ifference

forp

atient

satisfaction.

Patie

ntsintheirh

omes

werem

ores

atisfi

edthan

patie

ntsin

nursingho

mes.O

ffou

rtypes

ofservices

provided,m

edicalconsultatio

nwas

them

osth

ighlysatisfactoryservicew

ithtelemedicine,follo

wed

byph

ysical

therapy.Alth

ough

thes

atisfactio

nscores

didno

tind

icatea

significant

differenceinthes

ystem

characteris

tics,theq

ualityof

verbalcommun

ication

appeared

tobe

amoreimpo

rtantfactorininflu

encing

patie

ntsatisfaction

than

set-u

ptim

eorq

ualityof

image.Th

isapproach

enabledap

hysic

ianto

accuratelyassesseld

erlypatie

ntsintheirh

omes

ornu

rsingho

mes

andto

treat

them

with

theh

elpof

ahom

e-visitingnu

rse.

Cham

bersand

Con

nor[47]

Aninteractives

oftwarep

rogram

mew

asdesig

nedto

providefam

ilycaregiverswith

inform

ation,

advice,and

psycho

logicalsup

portby

way

offeedback

oftheirc

opingcapacity.Th

emultim

ediaprogramme

consistso

faninform

ation-basedpackagethatp

rovidesc

aregivers

with

advice

onhealth

prom

otionandrelaxatio

nandoff

ersthem

arangeo

fcop

ingstr

ategies(e.g

.,po

sitives

elf-talk,assertiveness

training

,and

relaxatio

ntapesa

ndvideos).Th

eprogram

mea

lsoinclu

desa

caregiver’s

self-assessmentinstrum

ent,desig

nedto

provide

both

family

andprofessio

nalcaregiversw

ithinform

ationto

assess

howfamily

caregiversarec

opingwith

theirc

aregivingroles.

Thep

rogram

meisu

sefultocaregiversandof

high

quality

andeffi

cientin

relatio

nto

utilityandusability.Th

eprogram

mew

ashigh

lyratedin

term

sof

glob

alusabilityandits

fivec

ompo

nent

scales

ofattractiv

eness,controllability,

efficiency,help

fulness,andlearnability.Th

isillustrates

thatthep

rogram

meis

visuallypleasant,easily

understood

,respo

ndsq

uickly,

andcorrespo

ndsw

ithuser’sexpectations.U

sersfelttherew

asroom

forimprovem

entinthe

navigatio

nof

thep

rogram

me.

Cham

bersand

Con

nor[48]

Theinteractiv

eapp

licationconsisted

ofan

inform

ation-based

packagethatp

rovidedcaregiverswith

advice

onthep

romotionof

psycho

logicalh

ealth

,including

relaxatio

nandotherc

opingstr

ategies.

Thes

oftwarea

pplicationalso

inclu

dedac

aregiver

self-assessment

instrument,desig

nedto

provideb

othfamily

andprofessio

nal

caregiverswith

inform

ationto

assessho

wfamily

caregiverswere

coping

with

theirc

aregivingrole.

Thefi

ndings

evidencedthatthem

ajority

ofusersfou

ndthes

oftwaretobe

usableandinform

ative.Somea

reas

wereh

ighlighted

forimprovem

entinthe

navigatio

nof

thes

oftware.

International Journal of Telemedicine and Applications 11

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Changetal.[49]

Telehealth

andteleph

onec

ommun

icationtechno

logies

wereu

sedby

nursep

ractition

erstoprovideind

ividualized

diabetes

care

managem

entand

tohave

similare

ffectso

nglycem

iccontrol.

Then

umbero

fdayso

fpartic

ipationin

thep

rogram

mew

asgreaterfor

the

telehealth

grou

pthan

theg

roup

receivingthetelepho

nicintervention,

butthis

differencew

asno

tstatistic

allysig

nificant.Ap

proxim

ately

75%of

thep

atients

workedwith

nursep

ractition

ersa

ndhadreachedindividu

alized

glycem

icgoalsa

tdise

nrollm

ent.Amon

gthesep

atients,thoser

eceiving

thetelehealth

interventio

nhada3

.1%redu

ctionin

HbA

1c,and

thoser

eceiving

the

teleph

oneinterventionhada2

.7%redu

ctionin

HbA

1c,overa

meanperio

dof

204days.A

fterd

isenrollm

ent,HbA

1cincreasedslightly,sug

gestingthat

veterans

need

continuo

usindividu

alized

care,inadditio

nto

routinefollowup

,to

managetheirdiabetes.

Clelandetal.[50]

Patie

ntsw

ithar

ecentadm

issionforh

eartfailu

reandleftventric

ular

ejectio

nfractio

nwe

reassig

nedrand

omlyto

hometele

-mon

itorin

g,nu

rsetele

phon

esup

port,oru

sualcare.H

ometele

-mon

itorin

gconsisted

oftwice-daily

patie

ntself-measuremento

fweight,bloo

dpressure,heartrate,and

rhythm

with

automated

deviceslinkedto

acardiology

center.Th

enurse

teleph

ones

uppo

rt(N

TS)con

sistedof

specialistn

ursesw

howerea

vailabletopatie

ntsb

yteleph

one.Prim

ary

care

physicians

delivered

usualcare.

During240days

offollo

wup

,19.5

%,15.9%

,and

12.7%of

days

werelostasthe

resultof

deathor

hospita

lizationforu

sualcare,nurse

teleph

ones

uppo

rt,and

hometele

-mon

itorin

g,respectiv

ely(nosig

nificantd

ifference).Th

enum

bero

fadmissions

andmortalityweres

imilara

mon

gpatientsrando

mlyassig

nedto

nursetele

phon

esup

portor

hometele

-mon

itorin

g,bu

tthe

meandu

ratio

nof

admiss

ions

was

redu

cedby

6days

with

hometele-mon

itorin

g.Patie

nts

rand

omlyassig

nedto

receiveu

sualcare

hadhigh

eron

e-year

mortalitythan

patie

ntsa

ssignedto

receiven

urse

teleph

ones

uppo

rtor

hometele-mon

itorin

g.Fu

rtherinvestig

ationandrefin

emento

fthe

applicationof

home

tele-m

onito

ringarew

arranted

becauseitm

ayplay

avaluabler

oleinthe

managem

ento

fsele

cted

patie

ntsw

ithheartfailure.A

lthou

ghmanypatie

nts

weree

lderly,

theira

cceptancea

ndabilityto

cope

with

theh

ome

tele-m

onito

ringtechno

logy

wereh

igh.Fewpatie

ntsa

sked

forthe

equipm

ent

tobe

removed

orfailedto

complywith

daily

measurements.

Goo

dor

very

good

satisfactionwith

hometele

-mon

itorin

gwas

repo

rted

by96%of

patients.

Improved

accessto

care,eith

erby

nurses

orby

tele-m

onito

ring,appeared

tolead

toan

increase

inpatie

ntcontacts.

Clem

ensenetal.[51]

Videoconsultatio

nsin

theh

omeo

fthe

patie

ntwereintrodu

ced.Th

evideoconsultatio

nsetupconstitutes

anew

organisatio

nalw

ayof

working

,described

as“anewtriang

le”basedon

immediate

interin

dividu

alcoop

erationandteam

work.In

thetria

ngle,

competences

werec

ombined,which

ledto

amoreh

olistictre

atment

andam

orea

ctivep

atient

role.

Com

petences

werec

ombined,which

ledto

amoreh

olistictre

atmentand

amorea

ctivep

atient

role.

Aspreadingof

know

ledgea

mon

gallp

artic

ipantswas

seen,resultin

gin

anup

gradingof

thec

ompetences

ofthev

isitin

gnu

rse

especially.

Theintrodu

ctionof

areal-tim

e,on

linelinkbetweenho

spita

land

homec

onstitutesthe

basis

forsim

ultaneou

scom

mun

icationbetweenall

participants,resultin

gin

a“witn

essin

g”situatio

npo

tentially

securin

gor

even

enhancingqu

ality

oftre

atment.

Dangetal.[52]

Aprogrammec

alledteleph

one-lin

kedcare

ford

ementia

was

cond

ucted.Th

isprogrammeo

fferedaccessto

resources,as

inthe

REAC

Htrialand

also

provided

caregivere

ducatio

nandperio

dic

mon

itorin

gqu

estio

nnairesu

singas

creen-ph

one.Th

eintervention

was

delivered

viaa

CTIS

screenph

one.Th

esystem

allowed

usersto

makea

ndreceivec

allsandmessages.

Ther

espo

ndentswerem

ores

atisfi

edwith

thec

arec

oordinationaspectof

the

programmethanthee

ducatio

nor

them

onito

ring.Th

eprojectsuggeststhat

care

coordinatio

naidedby

screen-pho

nesm

aybe

ausefulm

odelforc

aregiver

supp

ortinam

anaged

care

setting

.

12 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

DanskyandVa

sey

[53]

Patientsw

ithheartfailure

received

theH

ealth

Budd

yandused

itfor

thed

urationof

homeh

ealth

services.Th

eHealth

Budd

ywas

programmed

toaskpatie

ntsq

uestions

related

toheartfailure

inclu

ding

symptom

s,self-care

practic

es,and

medicationcompliance.

Duringtheformalepiso

deof

care,allpatie

ntsreceivedsta

ndardcare.

Patie

ntsw

hocontinuedusingteleh

ealth

beyond

theformalepiso

deof

care

show

edgreaterimprovem

entsin

respira

tory

statusa

ndactiv

ities

ofdaily

living.Non

eofthe

patie

ntsw

housed

telehealth

durin

gthissta

gehadany

hospita

lizations

orem

ergencydepartmentevents,while28.3%of

thec

ontro

lgrou

ppatie

ntsrequiredho

spita

lizationand26.1%

hadatleasto

neem

ergency

departmentvisit.Teleh

ealth

patie

ntsw

erem

orelikely

torepo

rtthatthey

measuredtheirw

eightsdaily

andmorelikely

torepo

rtan

increase

indiuretic

dose

followingsudd

enweightg

ain,

ankles

welling,or

shortnesso

fbreath.

Danskyetal.[54]

“Telehom

ecare”isatelepho

ne-based

commun

icationsyste

mwith

medicalperip

heralsthatisused

intheh

omes

ettin

g.Patie

ntsu

sethe

medicaldevicestoassesstheirh

ealth

statusa

ndtransm

itthed

atato

cliniciansfor

review

andactio

n.Nursesa

ndotherc

linicians

usethe

datato

mon

itorp

atients’health

andteachpatie

ntsa

ndtheir

caregiversself-managem

entb

ehaviours.Measurementand

transm

issionof

bloo

dpressure,tem

perature,w

eight,bloo

dglucose

levels,

andpu

lseoxim

etry

arep

ossib

le.Th

eone-w

aysyste

msa

reused

independ

ently

bythep

atient

andaretypicallyprogrammed

tobe

used

everydayatap

redeterm

ined

time.Ifthen

urse

who

checks

the

transm

itted

dataob

serves

abno

rmalvalues,heo

rshe

may

callthe

patient

ortheh

omecaren

urse

forfurther

inform

ationor

interventio

n.Th

etwo-way

syste

madds

avideo

cameraa

nddigital

stethoscope

tothem

onito

ringdevice,permittingtwo-way

synchron

ousinteractio

nbetweennu

rsea

ndpatie

nt.

Patie

ntsinthetele

homecareg

roup

hadalow

erprob

abilityof

hospita

lizations

andem

ergencydepartmentvisitsthan

didpatie

ntsinthec

ontro

lgroup

.Differencesw

eres

tatistic

allysig

nificantat6

0days

butn

otat120days.R

esults

show

agreater

redu

ctionin

symptom

sfor

patie

ntsu

singteleho

mecare

comparedto

controlp

atients.Th

etechn

olog

yenablesfrequ

entm

onito

ringof

clinicalind

ices

andperm

itstheh

omeh

ealth

care

nursetodetectchangesin

cardiacs

tatusa

ndintervenew

hennecessary.

Danskyetal.[55]

Telehealth,a

clinicalinformationsyste

mthattransm

itsdataover

ordinary

telep

hone

lines,w

asused

byindividu

alsintheirh

omes

tocommun

icatee

lectronically

with

healthcare

providers.Th

isstu

dyinvestigated

theinfl

uenceo

ftelehealth

onself-managem

ento

fheart

failu

rein

asam

pleo

folder

adults.

Con

fidence

isap

redictor

ofself-managem

entb

ehaviors.Patientsu

singa

video-basedtelehealth

syste

mshow

edtheg

reatestg

ainin

confi

dencelevels

with

time.Managersa

ndpo

licymakersrespo

nsibleforc

reatingandfund

ing

programmes

thatsupp

ortthe

useo

fhealth

-inform

ationtechno

logies

byolder

adultscanbenefit

from

theser

esults.

Danskyetal.[56]

Theh

omeh

ealth

agency

used

atele

homecarem

odelas

acom

plem

ent

totradition

alho

mev

isits.

Thes

ystem

conn

ectsac

entralstationwith

patie

nts’un

itsoverordinary

teleph

onelinesusinga

ninternalmod

em.

Thec

entralstationcombinesa

windo

ws-basedPC

with

atou

ch-to

neteleph

onetodeliver

full-colorv

ideo

andteleph

one-qu

ality

audio.

Teleh

omecareish

ighlystr

ucturedandmod

erately

complex.N

ursesb

egin

with

simpletasks

andmovetomorec

omplex

activ

ities.Th

epatient

andthe

family

arec

learlythefocus

ofteleho

mecareintervention.

Darkins

etal.[57]

TheV

eteransH

ealth

Administratio

nintro

ducedan

ationalh

ome

telehealth

programme,Ca

reCoo

rdination/Hom

eTele

health

(CCH

T).

Itspu

rposew

asto

coordinatethec

areo

fveteran

patie

ntsw

ithchronic

cond

ition

sand

avoidtheiru

nnecessary

admissionto

long

-term

institu

tionalcare.Afte

rapatie

ntisenrolledin

thep

rogram

me,the

care

coordinatorsele

ctsthe

approp

riateho

metele

health

techno

logy,

givesthe

requ

iredtraining

tothep

atient

andcaregiver,review

steleh

ealth

mon

itorin

gdata,and

provides

activ

ecareo

rcase

managem

ent(inclu

ding

commun

icationwith

thep

atient’sph

ysician).

Routinea

nalysis

ofdataob

tained

forq

ualityandperfo

rmance

purposes

show

stheb

enefitsof

a25%

redu

ctionin

numbero

fbed

days

ofcare,a

19%redu

ction

inthen

umbero

fhospitaladm

issions,and

ameansatisfactionscorer

atingof

86%aft

erenrollm

entinthep

rogram

me.Th

ecosto

fCare

Coo

rdination/Hom

eTele

health

islessthan

theo

ther

noninstitutionalcare

programmes

andnu

rsing-ho

mec

are.Th

eVeteransH

ealth

Administratio

nexperie

nceisthatanenterpris

e-wideh

ometele

health

implem

entatio

nisan

approp

riateandcost-

effectiv

eway

ofmanagingchronic-care

patie

ntsinbo

thurbanandruralsettin

gs.

International Journal of Telemedicine and Applications 13

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

deLu

signanetal.[58]

Theu

seof

thep

rogram

mea

llowed

mon

itorin

gof

vitalsigns,suchas

pulse

,blood

pressure,and

weight,of

patientsw

ithchronich

eart

failu

re.D

ataw

asthen

transfe

rred

toatele-mon

itorin

gserver

ata

hospita

land

couldbe

view

edby

clinicians.Th

etelem

edicineg

roup

hasthe

abilityto

videoconsult.Acomparis

onwas

madew

itha

controlgroup

(tradition

alcare).

Com

pliancew

ithmeasurin

gweight,pu

lse,and

BPremainedhigh

throug

hout

thes

tudy.Th

edatac

ollectionsyste

mandsecure

web

server

werer

eliable.

The

tele-m

onito

ringgrou

pcompliedbette

rwith

collectingprescriptio

nsfortheir

cardiacd

rugs.V

ideo-con

sulting

started

with

enthusiasm

butb

ecam

eless

useful.Th

erew

eren

osig

nificantd

ifferencesintheq

ualityof

lifea

ndCh

ronic

HeartFailu

reQuestionn

aire

scores

betweenthetele-mon

itoredgrou

pandthe

controls.

DelliFrainee

tal.[59]

Ther

elationshipbetweentelem

edicinek

nowledgem

anagem

ent

activ

ities

andnu

rses’perceived

efficiency

andeffectiv

enesso

ftelemedicineinho

meh

ealth

was

investigated.K

nowledge

managem

entenh

ancesthe

processeso

fcarefor

avarietyof

services

indifferent

setting

s,with

varyingdegreeso

fusage

byclinicalstaff.

Thesek

nowledgem

anagem

entactivities

areintendedto

facilitate

commun

icationandinform

ationexchange

betweenph

ysicians,

nurses,and

patie

nts,which

inturn

enhances

patie

ntcare

delivery.

Results

indicateas

ignificantassociatio

nbetweencombinedexplicitandtacit

know

ledgem

anagem

entactivities

usingtelemedicinea

ndperceivedeffi

ciency

andeffectiv

enesso

ftelem

edicine.Telemedicinek

nowledgem

anagem

ent

activ

ities

might

have

apositive

impacton

perceivedeffi

ciency

and

effectiv

enesso

fcareinho

meh

ealth

.

Dem

irise

tal.[60]

Videocon

ferencingandInternetequipm

entw

ereu

sedto

enable

interactions

betweenpatie

ntsa

ndnu

rses.A

ninstr

umentthat

measuresp

erceptions

ofteleho

mecarew

asused.

Therew

asno

statistic

allysig

nificantchangeo

fperceptionin

thec

ontro

lgrou

p.Th

eexp

erim

entalgroup

show

edan

overall,morep

ositive

perceptio

nof

thes

ystem,and

them

eanscored

ifference

was

high

ercomparedto

thec

ontro

lgrou

p.Elderly

patie

ntse

valuated

theirtelehom

ecaree

xperiencea

sbeing

positive,andthey

feltmorec

omfortablewith

thetechn

ology,believing

that

then

urse

canun

derstand

theirm

edicalprob

lemso

verthe

televisio

n.Th

estu

dysuggestedthatpatie

ntstendto

becomem

orefam

iliar

with

andconfi

dent

intechno

logy

after

participationin

atele

homecares

ystem,and

thes

ubjects

seem

edles

scon

cerned

abou

ttele

homecarev

iolatin

gtheirp

rivacy.Th

einitia

lfearso

fsom

epatients,lik

epriv

acy,seem

edto

diminish

.Som

eother

original

perceptio

nsof

teleho

mecared

idno

tholdaft

erexpo

sure

tothes

ystem.

Patients’overallimpressio

nsof

atele

homecares

ystem

werem

orep

ositive

after

they

hadexperie

nced

it.Th

eyevaluatedthisexperie

ncea

spositive

and

beneficialfor

theiro

wnhealth

aswellastim

esavingforthe

nurses.Th

eyfelt

thatan

urse

couldgeta

good

understand

ingof

theirm

edicalprob

lemso

ver

thetelevision

and,therefore,accepted

theu

nderlyingconcepto

ftelehom

ecare.

Ellio

ttetal.[61]

Toexam

inethe

effectiv

enesso

fanindividu

alized

prob

lem-solving

interventio

ndelivered

invideocon

ferencingsessions

with

family

caregiversof

person

slivingwith

aspinalcordinjury

andpo

ssible

contagioneffectson

care

recipients.

Family

caregiverswerer

ando

mly

assig

nedto

aneducation-on

lycontrolgroup

oran

interventio

ngrou

pin

which

participantsreceived

prob

lem-solving

training

inmon

thly

videocon

ferences

essio

nsfora

year.

Older

caregiverswerem

orelikely

than

youn

gerc

aregiverstoremainin

the

study.Intent-to-tre

atanalyses

projectedas

ignificantd

ecreaseindepressio

nam

ongcaregiversreceivingprob

lem-solving

training

;efficacy

analyses

indicatedthiseffectw

aspron

ounced

atthes

ixth-m

onth

assessment.Care

recipientsof

caregiversreceivingprob

lem-solving

training

repo

rted

gainsin

socialfunctio

ning

over

time.Com

mun

ity-based,telehealth

interventio

nsmay

benefit

family

caregiversandtheirc

arer

ecipients,bu

tthe

mechanism

sof

thesee

ffectsa

reun

clear.

14 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Fink

elstein

etal.[9]

Thes

tudy

demon

stratesthattele

homecarelinking

homebou

ndpatie

ntsw

iththeirh

omeh

ealth

care

nurses

over

astand

ardteleph

one

syste

mprovides

high

-quality,clinically

useful,and

patie

ntsatisfactoryinteractions.V

irtualvisits,

consistingof

two-way

audio

andvideointeractions

betweenthec

entralsite,ho

meh

ealth

care

nurses,and

subjectsatho

mew

erec

omparedfortechn

icalqu

ality

and

clinicalu

sefulnessb

ytheh

omeh

ealth

care

nurses

who

perfo

rmed

the

virtualvisits.

Allsubjectsweres

atisfi

edwith

theirh

omeh

ealth

care;satisfactio

nincreased

with

anincreasin

gleveloftelehom

ecareintervention.

Subjectsreceiving

physiologicalm

onito

ringandvideocon

ferencing/Internetaccessin

additio

nto

stand

ardcare

were

mostsatisfi

edwith

theirc

are.Virtualvisitscanbe

cond

uctedover

ordinary

telep

hone

syste

ms.Patie

ntsc

anusetele

homecare

with

mod

eratelevels

oftraining

.Thesep

rogram

mes

canprovidetim

elyand

quality

homeh

ealth

nursingcare

with

virtualvisitsaugm

entin

gtradition

alho

mev

isits.

Fink

elstein

etal.[62]

Patie

ntou

tcom

esandcostwerec

omparedwhenho

meh

ealth

care

was

delivered

bytelemedicineo

rbytradition

almeans

forp

atients

receivingskilled

nursingcare

atho

me.Arand

omized

controlledtrial

was

establish

edusingthreeg

roup

s.Th

efirstg

roup

received

tradition

al,skillednu

rsingcare

atho

me.Th

esecon

dgrou

p,thev

ideo

interventio

ngrou

p,received

tradition

al,skillednu

rsingcare

atho

me

andvirtualvisitsusingvideocon

ferencingtechno

logy.Th

ethird

grou

p,them

onito

ringinterventio

ngrou

p,received

tradition

al,

skilled

nursingcare

atho

me;virtualvisitsusingvideocon

ferencing

techno

logy;and

physiologicm

onito

ringfortheirun

derly

ingchronic

cond

ition

.

Virtualvisitsbetweenas

killedho

meh

ealth

care

nursea

ndchronically

illpatie

ntsa

thom

ecan

improvep

atient

outcom

esatlower

costs

than

tradition

al,

skilled

face-to

-face

homeh

ealth

care

visits.Subjectswho

wereb

othmon

itored

andused

videocon

ferencinghadab

etterA

DLratin

gatdischargethandidthe

controlgroup

.

Forbatetal.[63]

Aninterventio

nwith

utilityof

ahandh

eldsid

e-effectm

onito

ring

syste

mforp

eopler

eceiving

chem

otherapy

intheh

omecares

ettin

g.

Peop

leaffectedby

cancer

werer

eflectin

gon

issuessuchas

power

and

surveillanceincancer

care.W

hilethesetermsa

reordinarilyconsidered

toreflectnegativ

eelementsof

care,theywereu

sedby

participantsin

anem

poweringmanner.Patie

ntsreceiving

cancer

care

atho

mer

eportedpo

sitive

perspectives

ontheu

seof

healthcare

techno

logy,thereby

subvertin

gtheidea

ofsurveillancea

snegative.Use

ofhealth

surveillancetechn

ologies,which

enablepeop

leto

remainin

theiro

wnho

mes

durin

gtre

atment,arelikely

tobe

wellreceived.

Grayetal.[64

]

AnInternet-based

telemedicinep

rogram

me,Ba

byCa

reLink

,was

desig

nedto

redu

cethec

ostsof

care

andto

providee

nhancedmedical,

inform

ational,andem

otionalsup

portto

families

ofvery

low-birthw

eightinfantsdu

ringandaft

ertheirn

eonatalintensiv

ecare

unitsta

y.Ba

byCa

reLink

isam

ultifaceted

telemedicinep

rogram

me

thatincorporates

videocon

ferencingandWorld

WideW

eb(W

WW)

techno

logies

toenhanceinteractio

nsam

ongfamilies,staff,

and

commun

ityproviders.

Families

intheC

areLinkgrou

prepo

rted

high

eroverallqualityof

care

and

significantly

fewer

prob

lemsw

iththeo

verallqu

ality

ofcare

received

bytheir

family.Th

eyalso

repo

rted

greatersatisfactio

nwith

theu

nit’sph

ysical

environm

entand

visitationpo

licies.Th

efrequ

ency

offamily

visits,teleph

one

calls

tothen

eonatalintensiv

ecareu

nit,andho

ldingof

theinfantd

idno

tdifferb

etweengrou

ps.Th

edurationof

hospita

lizationun

tilultim

ated

ischarge

totheh

omew

assim

ilarinthetwogrou

ps.A

llinfantsintheC

areLinkgrou

pwered

ischarged

directlyto

homew

hereas

20%of

controlinfantswere

transfe

rred

tocommun

ityho

spita

lsbefore

ultim

ated

ischargeh

ome.

Guilfo

ylee

tal.[65]

Aprotocolforthe

useo

fvideoph

ones

incommun

ityhealth

was

developed.Clientsw

ithar

ange

ofhealth

needsw

eree

quippedwith

acommerciallyavailablev

ideo-pho

neconn

ectedusingthec

lient’s

hometele

phon

eline.Ahand

s-fre

espeakerph

onea

ndam

iniature

videocamera(forclose-upview

s)werec

onnected

tothev

ideo-pho

ne.

Both

clientsandnu

rses

ratedthee

quipmentassatisfactory

orbette

r.Non

eof

then

ursesfelt

thatthee

quipmentw

asdifficultto

use,inclu

ding

unpackingit

andsetting

itup

;onlyon

eclient

foun

ditdifficult.

Taking

into

accoun

tthe

clients’

respon

ses,inclu

ding

theirfree-text

comments,

ajud

gementw

asmade

asto

whether

thev

ideo-pho

nehadbeen

useful

totheirn

ursin

gcare.Inseven

cases,itwas

feltto

beun

helpful,andin

threec

ases,itw

asjudged

helpful.

International Journal of Telemedicine and Applications 15Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Haubera

ndJones

[66]

Telerehabilitationwas

used

tosupp

ortfam

ilies

carin

gatho

mefor

individu

alsw

ithprolon

gedstates

ofredu

cedconsciou

sness.Patie

nts

wered

ischarged

homew

ithfamily

mem

bersas

thep

rimary

caregivers.Th

eirfam

ilies

werefollowed

for4

to8weeks

via

video-ph

one.Fo

llow-upteleph

ones

urveys

werec

ondu

cted

with

afamily

mem

ber6

to9mon

thsa

fterd

ischargea

ndcomparedto

surveyso

fasim

ilarg

roup

thathadno

treceivedthev

ideo-pho

nefollo

wup

.

Morep

atientsinthev

ideoconferencing

grou

pwe

restilllivingatho

mea

ndhadreturned

forrehabilitatio

n.Families

inthev

ideo-pho

negrou

prepo

rted

moreo

ftheirneedsm

etthan

families

inthec

omparis

ongrou

p.Th

euse

ofvideocon

ferencingto

bridge

thetransition

toho

mefor

families

carin

gfora

family

mem

berm

ayassistfam

ilies

insuccessfu

llycarin

gforthe

individu

alin

theh

omea

ndredu

cing

then

umbero

fperceived

family

needs.

Hira

kawae

tal.[67]

Thea

imwas

toclarify

thep

ossib

lechangesb

roug

htabou

tbythe

intro

ductionof

thelon

g-term

care

insurances

ystem

interm

sof

numbero

fcom

mun

ication/recordingtasks,related

nursingservices

inuse,andwhenandwhere

thesetasks

werep

erform

ed.Itw

asalso

toexplorethe

advantages

ofintro

ducing

inform

ationtechno

logy

(IT)

syste

msintonu

rsingservices

ettin

gs.Th

estudy

was

desig

nedas

abefore-and

-afte

rstudy

intwosessions,nam

ely,beforea

ndaft

erintro

ductionof

alon

g-term

care

insurances

ystem.D

ifferent

measurementswerep

erform

eddu

ringtheintervention.

Follo

wingthea

doptionof

then

ewsyste

m,these

taskstendedto

occurm

ostly

arou

ndthes

tartingtim

eofservices.As

forthe

staff,

theinvolvemento

fthe

professio

nalcaregiversincreased.R

egarding

contento

fcommun

ication/recording,repo

rts,confi

rmation,

andinstructionincreased.

Hofmann-Wellenho

fetal.[68]

Thefeasib

ilityandacceptance

oftelederm

atolog

yforw

ound

managem

ento

fpatientsw

ithchronicleg

ulcersby

homecaren

urses

weree

xamined.Patientsw

ithchronicleg

ulcersof

different

origin

wereincluded.In

initialin-personvisits,legulcerswerea

ssessedand

classified

andun

derly

ingdiseases

noted.Fo

llow-upvisitsw

ered

one

byho

mecaren

urses.Oncea

week,digitalimages

ofthew

ound

and

surrou

ndingskin

andrelevant

clinicalinformationweretransmitted

viaa

secure

websitetoan

expertatthew

ound

care

centre.Th

eexp

erts

provided

anassessmento

fwou

ndstatus

andtherapeutic

recommendatio

ns.

In89%of

the4

92tele-con

sultatio

ns,the

quality

ofim

ages

was

sufficiento

rexcellent,and

expertsw

erec

onfid

entabo

utgiving

therapeutic

recommendatio

ns.Treatmentm

odalities

werec

hanged

oradaptedin

one-third

ofthec

onsultatio

ns.Th

erew

asas

ignificantd

ecreaseinvisitstoa

generalphysic

ianor

thew

ound

care

centre.Th

eacceptanceo

ftelederm

atolog

ywas

high

inpatie

nts,ho

mecaren

urses,andwou

ndexperts.

Horton[69]

Telecare

servicew

asgivento

patie

ntslivingatho

mew

ithchronic

obstr

uctiv

epulmon

arydisease(CO

PD)b

yah

omec

areteam

using

telecare

service.Telecare

servicec

omprise

dthefollowingelem

ents:

daily

mon

itorin

gof

thep

atient’scond

ition

andmon

itorin

gto

investigatea

nddeterm

inea

nyph

ysiologicalchanges

viap

aram

eters

asoxygen

saturatio

n,pu

lse,and

respira

tory

rate.

Thee

xperiencea

ndexpectationin

telecare,the

usabilityof

equipm

ent,and

changesinpractic

ecan

impactCO

PDcare.Th

eoutcomeh

ighlighted

thatthe

rapidaccessto

care,anincreasedsenseo

fpersonalsafetyandsecurity,andthe

continuityof

care

arep

erceived

asbenefits.How

ever,the

equipm

entw

asperceivedas

bulkyandno

tuserfrie

ndly.

Hud

dlestonandKo

bb[70]

Older

veterans

with

chronicd

iseases

andhigh

healthcare

utilizatio

nwerefollowed

with

anin-hom

etechn

ologydevice,thatis,theH

ealth

Budd

y,andris

kmanagem

entsoft

ware.Programmes

taffcould

identifyat-risk

patie

ntsb

ased

ontheirrespo

nses

toas

erieso

fqu

estio

nsabou

tsym

ptom

s,behavior,and

know

ledge.Patie

ntsw

ere

follo

wed

inthep

rogram

mefor

atleastsixmon

ths.

Theo

utcomes

howed

a45%

decrease

inho

spita

ladm

issions,a

67%decrease

innu

rsing-ho

mea

dmissions,a

54%decrease

inem

ergencydepartmentvisits,

anda3

8%decrease

inph

armacyprescriptio

ns.Th

epatientsa

lsodemon

strated

improved

compliancew

ithtre

atmentregim

ens,andbo

thpatie

ntsa

ndprovidersreportedhigh

levelsof

programmes

atisfactio

n.

Jenk

insa

ndMcSweeney[71]

Acomparis

onam

ongthee

ffectivenesso

fthree

hospita

ldisc

harge

care

mod

elsfor

redu

cing

congestiv

eheartfailu

re–rela

tedreadmiss

ion

charges.Th

ecarem

odels

—ho

metele

care

delivered

via2

-way

videocon

ferenced

evices

with

integrated

stethoscope,nurse

telep

hone

calls,and

usualoutpatie

ntcare—werec

ompared.

Theo

utcomes

howed

thattheb

etween-grou

pdifferencew

asno

tstatistically

significantand

cann

otoff

erincrem

entalbenefitsbeyond

teleph

onefollowup

;itisalso

moree

xpensiv

e.

16 International Journal of Telemedicine and ApplicationsTa

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Jerant

etal.[72]

Thetria

lcom

pared3po

stho

spita

lizationnu

rsing-care

mod

elsfor

redu

cing

congestiv

eheartfailu

re(C

HF)

readmissionchargesd

uring

180days

offollo

wup

.Sub

jectsreceivedin-personvisitsa

tbaseline

and

at60

days,pluso

neof

threec

arem

odalities

intheinterim

:video-basedho

metelecare,teleph

onec

alls,

orusualcare.

CHF-related

readmiss

ionchargesw

erem

orethan80%lower

inthe

telenu

rsinggrou

pscomparedto

usualcare,andtheseg

roup

salso

had

significantly

fewer

CHF-related

emergencyvisits.In-personvisitsw

erem

ore

than

threetim

eslonger

than

telenu

rsingvisits(𝑃<0.0001),on

lypartially

due

toaddedtraveltim

e.Patie

ntself-care

adherence,medications,health

status,

andsatisfactiondidno

tsignificantly

differb

etweengrou

ps.Tele

nursingcan

redu

ceCH

Fho

spita

lizations

andallowincreasedfre

quency

ofcommun

icationwith

patie

nts.

Jerant

etal.[73]

Hom

enurse

visitsa

fterd

ischargec

anredu

cereadmiss

ions

forp

ersons

with

congestiv

eheartfailu

re(C

HF),but

theinterventioncosts

are

high

.Tocompare

thee

ffectivenesso

fthree

hospita

ldisc

hargec

are

mod

elsfor

redu

cing

CHF-related

readmissioncharges:(1)h

ome

telecare

delivered

viaa

two-way

video-conference

device

with

anintegrated

electro

nics

tethoscope;(2)

nursetele

phon

ecalls;

and(3)

usualoutpatient

care.

CHF-related

readmiss

ionchargesw

ere8

6%lower

inthetelecareg

roup

and

84%lower

inthetele

phon

egroup

than

intheu

sualcare

grou

p.How

ever,the

between-grou

pdifferencew

asno

tstatistic

allysig

nificant.Bo

thinterventio

ngrou

pshadsig

nificantly

fewer

CHF-related

emergencydepartmentvisitsand

chargesthantheu

sualcare

grou

p.Trends

favouringbo

thinterventio

nswere

notedfora

llotheru

tilizationou

tcom

es.

Kawaguchi

etal.[74]

TheInternet-b

ased

syste

mallowsp

atients(equipp

edwith

alaptop

compu

ter),nurses,andph

ysicians

toaccessinform

ationfro

ma

centrald

atabasethrou

ghaw

irelessnetwork.E-mailand

videomail

messagesa

swellasv

italsigns

datacanbe

sent

daily

bythep

atient

toa

server

atar

egionalh

ealth

care

centre

andcanbe

accessed

byan

urse

orph

ysician,

who

canthen

decide

onapprop

riatecare.

Thes

ystem

was

teste

dby

amalep

atient

with

type

2diabetes

mellitus

tosee

whether

itwou

ldenhanceh

isow

nmanagem

ento

fhiscond

ition

.Duringa

71-day

perio

d,educationalm

aterialw

asprovided.Th

etele

nursingsyste

mhelped

thep

atient

tomanageh

iscond

ition

,assho

wnby

significant

improvem

entsin

hislevelso

fblood

glucosea

ndglycosylated

haem

oglobin

(HbA

1c)a

ndin

bloo

dpressure.Finding

ssug

gestthatthes

ystem

isfeasible.

Kearneyetal.[75]

Thea

cceptabilityof

usinghand

held

compu

tersas

asym

ptom

assessmentand

managem

enttoo

lfor

patie

ntsreceiving

chem

otherapy

forc

ancerw

asevaluated.Th

epatientsu

sedthe

hand

held

compu

tertorecord

andsend

daily

symptom

repo

rtstothe

cancer

centre

andreceiveinstant,tailoredsymptom

managem

ent

advice

durin

gtwotre

atmentcycles.

Patie

ntsb

elieved

theh

andh

eldcompu

terh

adim

proved

theirsym

ptom

managem

entand

feltcomfortableusingit.

Theh

ealth

professio

nalsalso

foun

dtheh

andh

eldcompu

tertobe

helpfulinassessingandmanagingpatie

nts’

symptom

s.Th

ehand-held,com

puter-basedsymptom

managem

enttoo

lwas

feasibleandacceptableto

both

patie

ntsa

ndhealth

professio

nalsin

complem

entin

gthec

areo

fpatientsreceiving

chem

otherapy.

Keaton

etal.[76]

Caregiversansw

ered

questio

nsthroug

htheu

seof

Carin

g-web,w

hich

isaw

eb-based

interventio

nforc

aregiverso

fpeoplew

ithstr

oke.Th

ee-mailm

essagesfrom

caregiverswerethenansw

ered

byan

urse

specialistand

mem

bersof

ane-rehabilitationteam

.(Ca

ring-web

enablestoprovided

ifferenttypes

ofeducationandsupp

orttoassist

caregivers’needs.)

Theo

utcomes

howed

thatthec

aregivers’qu

estio

nscentered

onmedication

managem

ent(19%),commun

ityandgovernmentservice

(23%

),andstr

oke

andrelated

issuesindealingwith

stroke(58%).Th

isindicatedthatthe

caregiversweres

eeking

newkn

owledges

othey

couldmaintainthem

selves

andtheirc

arer

ecipients.

KleinpellandAv

itall

[77]

Theinterventionconsisted

ofin-hospital-b

ased

screeningfor

dischargen

eeds.A

hometele

health

mon

itorin

gsyste

mfor

transm

issionof

weight,blood

pressure,heartrate,and

pulse

oxim

etry

was

installedin

thep

atient’sho

me.Telep

hone

follo

wup

was

cond

uctedwhenparametresw

ereo

utof

presetandforp

ostdisc

harge

follo

wup

ondays

1and

3andweeklyfor4

weeks.

Subjectswerer

eceptiv

etohaving

thetele

health

techno

logy

intheh

omea

ndrelated

positivee

xperiences

tohaving

teleph

onefollowup

toreinforcethe

dischargep

lanandto

mon

itorp

ostoperativ

erecovery.

Kobzaa

ndScheurich

[78]

Theu

tilizationof

telemedicineinsituatio

nswhere

wou

ndspecialists

consultedwith

theh

omeh

ealth

nurseinthep

atient’sho

mer

egarding

care

ofchronicw

ound

swas

exam

ined.D

uringthetwo-way

video

visit,the

wou

ndspecialistassessedthep

atient

andthew

ound

sand

mader

ecom

mendatio

nsfortreatment.Th

ewou

ndspecialistalso

collected

outcom

edatad

uringthev

isits.

Thisdatawas

then

comparedwith

liked

atac

ollected

asab

aseline

priortothe

telemedicineintervention.

Results

revealed

improved

healingrates,decreasedhealingtim

e,decreased

numbero

fhom

ehealth

visits,andad

ecreased

numbero

fhospitalizations

related

towou

ndcomplications.Tele

medicinew

asdeem

edav

iableo

ptionfor

deliveringqu

ality,cost-e

ffectivec

aretochronic-wou

ndpatie

ntsinthe

homecares

ettin

g.

International Journal of Telemedicine and Applications 17Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

LaFram

boise

etal.

[79]

Thefeasib

ilityof

providingah

eartfailu

rediseasem

anagem

ent

programmew

asstu

died

throug

han

in-hom

etele

health

commun

icationdevice

(thatis,

Health

Budd

y).Th

eeffectivenesso

ftheH

ealth

Budd

ywas

comparedwith

tradition

alho

mem

anagem

ent

strategies

(teleph

onic,hom

evisit)in

achievingselected

patie

ntou

tcom

es(self-e

fficacy,fun

ctionalstatus,depressio

n,and

health-related

quality

oflife).

Thosew

horeceived

teleph

onicdiseasem

anagem

entexp

erienced

decreased

confi

denceintheira

bilityto

managetheirheartfailure,w

hereas

allother

grou

psexperie

nced

increasedconfi

dence.Th

eresultsalso

indicated

improvem

ento

vertim

ewith

nogrou

pdifferences

forfun

ctionalstatus,

depressio

n,or

health-rela

tedqu

ality

oflife.Th

esefi

ndings

suggestthat

deliveringad

iseasem

anagem

entp

rogram

methrou

ghatelehealth

commun

icationdevice

isfeasibleandmay

beas

effectiv

eastraditio

nal

metho

ds.

LaFram

boise

etal.

[80]

Patie

ntsw

ithheartfailure

used

aHealth

Budd

yforself-m

anagem

ent.

They

werea

sked

sevenqu

estio

nsdaily

abou

theartfailu

resymptom

status

andabilityto

follo

wthep

rescrib

edregimen.

Participantsfoun

dthattheH

ealth

Budd

yistechnically

easy

touse;thatit

prom

oted,taught,andsupp

ortedheartfailure

self-managem

ent;andthatit

was

even

a“lifesaver,”bu

tthatitcou

ldbe

bothersome,complex,and

atoo

leng

thyinterventio

n.

Larsen

etal.[81]

UniversalMob

ileTeleph

oneS

ystem

(UMTS

)mob

ileph

ones

forv

ideo

consultatio

nsin

theh

omew

eretested.Patientsw

ithdiabeticfoot

ulcerswereo

fferedthreev

ideo-con

sultatio

nsinste

adof

visitstothe

hospita

loutpatie

ntclinic.Th

econ

sultatio

nstook

from

5to

18minutes.Inallcon

sultatio

ns,the

hospita

lexp

ertswerea

bletoassess

theu

lcer

incoop

erationwith

thev

isitin

gnu

rsea

ndto

decide

ontre

atment.

Technicalproblem

ssom

etim

esmadeitd

ifficult.

Even

conn

ectiv

ityprob

lems

occurred

inabou

thalfo

fthe

cases.In

additio

n,thea

udio

signalw

asrather

unstableattim

es.Inallsitu

ations

except

one,thec

linicians

werea

bletoreach

adecision

thatthee

xpertfelt

confi

dent

abou

t.Afte

rallconsultatio

ns,the

atmosph

erea

ndparticipants’

attitud

eswerev

erypo

sitive.

Lillibridge

andHanna

[82]

Ateleh

ealth

techno

logy

was

used

toassistcasem

anagerstoeffectiv

elymanagetheircaseloadso

fHIV

/AID

sclients,increase

respon

siveness

toclients’

changing

medicalcond

ition

s,andservea

sapartialsolution

totheo

ngoing

nursingshortage.Tele

health

mon

itorswerep

lacedand

used

inthec

lients’ho

mes

fora

perio

dof

four

mon

ths.

Thefi

ndings

suggestthatthe

useo

ftelehealth

techno

logy

hasthe

potentialto

effectiv

elyassistcasem

anagem

entand

homeh

ealth

agencies,m

anagetheir

caseloads,increase

respon

sivenesstoac

lient’schanging

medicalcond

ition

s,andaddressthe

ongoingnu

rsingshortage.

LinandYang

[83]

Asthmac

arem

obile

service(AC

MS)

was

perfo

rmed

inthec

arrying

outo

fthe

interventio

n.AC

MSisac

arep

latfo

rmfora

sthm

apatients

thatuses

mob

ileph

ones

tomon

itora

sthm

apatients’real-time

cond

ition

s.Th

epatient’sbreathing,coug

hing

extent,sleep

quality,

anddaily

routinec

ircum

stances

were

recorded

usingthem

obile

phon

e,andthed

ataw

eres

enttoNCH

C’snetworkplatform

.General

practitionerscoulddetectthelocationof

thep

atient

and,in

realtim

e,ob

tain

inform

ationon

thelocalclimatea

ndairq

uality.NCH

Canalysed

andrecorded

theinformation.

Physicians

couldevaluate

whether

orno

tthere

was

adise

asec

risison

theb

asisof

datachanges.

Ifan

asthmae

vent

occurred,itw

aspo

ssibleto

inform

thep

atient

tocometotheh

ospitalbyusingthes

amec

ommun

icationsyste

m.Th

ehealth

educationcenter

provided

medicalinform

ationto

patie

ntsso

they

couldbette

rund

erstandchangesintheird

iseases

andtheir

doctors’recommendatio

ns.

Ther

esultsindicatedthatthem

ostcriticalfactor

affectin

gbehavioral

intentions

related

toAC

MSisuser

attitud

e,follo

wed

byperceivedusefulness,

subjectiv

enorm,perceived

ease

ofuse,andinno

vativ

eness.Th

eresults

provideg

overnm

entsdeveloping

high

-tech,preventivem

edicines

trategies

with

then

ecessary

datato

defin

eanapprop

riatepo

licyto

useinattractin

ggreaterp

artic

ipationin

thee

ffort.

Lind

berg

etal.[84]

Thee

xperienceo

fcertifi

edpaediatricnu

rses

(CPN

s)with

theu

seof

videocon

ferencingbetweenthen

eonatalintensiv

ecareu

nitand

the

families’hom

eshasb

eenstu

died.Fam

ilies

wereg

iven

ahom

evideocon

ferencingun

it,which

allowed

them

tohave

contactand

commun

icatew

ithsta

ffatthen

eonatalu

nitd

ayandnight.

Ther

esultsshow

edthatthen

ursesfou

ndthatvideocon

ferencinghelped

them

toassesstheo

verallsituatio

natho

mea

ndfacilitated

ther

elatio

nshipbetween

parentsa

ndtheinfant.Th

eCPN

sfelt

thatthey

werea

bletoprovides

ecurity

tothefam

ily.Th

euse

ofvideocon

ferencingwas

considered

tobe

agenerally

positivee

xperiencea

ndatoo

ltoim

proven

ursin

gcare

atho

me.

18 International Journal of Telemedicine and ApplicationsTa

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Lind

berg

etal.[85]

Parentso

fpreterm

infantsu

sedreal-timev

ideoconferencing

between

theirh

omea

ndthen

eonatalintensiv

ecareu

nit(NICU)a

sasupp

ort

after

taking

theirinfanth

ome.Viav

ideo

andsoun

din

real-time,

parentsh

adaccess,day

andnight,to

NICUsta

ff.

Ther

esultsshow

edthatsecurityprovided

accessto

thes

taffandface-to

-face

supp

ortiv

emeetin

gs.Parentsexperie

nced

videocon

ferencingas

positive,

which

empo

wered

them

andgave

them

confi

denceintheirn

ewsituatio

nof

beingatho

mew

iththeirinfant.

Lind

berg

etal.[86]

Videocon

ferencingwas

used

betweenmidwives

andparentsa

thom

ein

ordertosupp

ortp

arentswho

wered

ischarged

early

afterchild

birth.

Them

ainreason

sfor

contactw

erer

outin

eand

them

ostfrequ

entadvice

concernedbreastfeeding.Th

equalityof

soun

dandpicturew

asjudged

tobe

good

andvery

good

.Ther

esultsshow

edthatthem

eetin

gswith

videocon

ferencingweree

asyto

hand

leanduseful

form

akingassessmentsand

werea

valuableandfunctio

nalcom

plem

enttousualpractice,almostlikea

real-lifeencoun

ter.Th

eresultssuggestthatvideoconferencing

may

beau

seful

toolin

postp

artum

care.

Lutzetal.[87]

Thefeasib

ilityof

usingah

ometele

health

syste

mfora

ssessin

gstr

oke

patie

nts’ph

ysicalfunctio

ns,depression,

fear

offalling

,and

their

family

caregivers’burdens

was

exam

ined.A

hometele

health

programmethatw

asas

troke-specific,carec

oordination,

hometele

health

(CCH

T)programmew

asused.D

ataw

ere

transm

itted

viah

ometele

phon

elines,w

hich

interfa

cedwith

aweb-based

programmethatcon

nected

with

registe

rednu

rses

who

review

edthed

ataa

ndrecorded

inform

ationin

thec

ompu

teriz

edpatie

ntrecord

syste

m.

Theo

utcomeind

icated

tailo

ringCC

HTto

individu

alneeds.Th

epatients

believedtheh

omeh

ealth

programmew

asbeneficialand

served

asan

impo

rtantsafetynetand

assuranced

uringtheinitia

lperiodof

returning

homea

fterd

ischarge.Th

eresultsprovideo

pportunitie

sfor

tailo

ringthe

programme’s

implem

entatio

n.

Lutzetal.[88]

Thep

urpo

sewas

toidentifypo

stdisc

hargen

eeds

ofstr

okep

atients;

theirc

aregiversd

escribed

theire

xperiences

ofusinga

care-coo

rdinationho

metelehealth

(CC/HT)

programmetoaddress

theirn

eeds.

Allstu

dyparticipantsbelievedthatah

ometele

health

programmec

ould

bebeneficialtotheirstro

kerecovery

atho

me,andthatitprovided

asafetynet

andas

ense

ofsecuritythatah

ealth

care

professio

nalw

asmon

itorin

gtheir

health.Th

efind

ings

suggestthata

comprehensiv

ecare-coordinatio

nprogrammethatincludesh

ometelehealth

couldaidveterans

andtheir

caregiversin

managingstroke

recovery

acrossthec

ontin

uum

ofcare

atho

me

andwith

inthec

ommun

ity.

Maire

tal.[89]

Anethn

ograph

icstu

dyem

bedd

edin

anRC

Tof

home-

telecare

for

peop

lesufferin

gacutee

xacerbationof

chronico

bstructiv

epulmon

ary

disease(CO

PD)w

ascond

ucted.Participantswerer

ando

mized

toreceivee

ither

face-to

-face

homen

ursin

gsupp

orto

raho

me-

telecare

supp

ortservice.Th

etelecares

ervice

consisted

ofav

ideo-pho

nelin

kandattachmentsthatperm

itted

remotep

hysio

logicalm

onito

ringof

bloo

dpressure,pulse,tem

perature,and

pulse

oxim

etry.B

oth

specialistrespiratory

nurses

andpatie

ntstoo

kpartin

thetria

land

repo

rted

theire

xperiences.

Thetele

care

serviced

idno

tprovide

aninteractionaladvantage

forthe

nurses

providingthisservicea

nddidno

tfitw

iththen

urses’view

softhe

most

approp

riateor

preferreduseo

ftheirskills.Th

etele

care

services

eemed

unlik

elyto

becomen

ormalized

aspartof

routineh

ealth

care

deliverybecause

then

ursin

gteam

lacked

confi

dencethatitw

asas

afew

ayto

provide

healthcare

inthiscontext,anditwas

notp

erceived

asim

provingeffi

ciency.

Marineau[90]

Peop

lewith

acuteinfectio

nstransitioning

intheh

omew

ithsupp

ort

byan

advancep

racticen

urse

used

atelehealth

syste

mwith

advanced

practicen

urses(APN

s)as

asup

portwhenthey

werea

cutelyill.A

PNs

used

equipm

enttoassessthep

hysio

logicaland

psycho

logicalstatuso

findividu

alstransition

ingfro

man

acuteinfectio

nin

theirh

ome.Th

iscare

inclu

dedinterventio

nscond

uctedby

theA

PNviatele

health,

which

mim

ickedallthe

essentialcom

ponentsthatw

ould

beaccomplish

edin

theh

ospitalw

iththee

xceptio

nof

beingableto

physicallytouchthep

artic

ipant.

Thetransition

thatoccurred

whenan

individu

alwith

anacuteinfectio

nwas

discharged

from

theh

ospitaltotheh

omes

uppo

rted

byteleh

ealth

techno

logy

revealed

anoverallp

ositive

experie

nce.Th

efind

ings

high

lighted

the

impo

rtance

ofthep

artic

ipantshaving

asense

ofcontrolw

henrecoverin

gfro

mtheirilln

esses,which

couldbe

achieved

atho

mew

ithafam

ilymem

ber

actin

gas

asub

stitutenu

rse.Th

eparticipantsshared

thattheh

ospital

environm

entm

ayno

tbeo

ptim

alforrecoveringfro

man

illness.

International Journal of Telemedicine and Applications 19Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

McC

alletal.[91]

Thefeasib

ilityof

usingmob

ileph

one-basedtechno

logy

(thatis,

Advanced

Symptom

Managem

entSystem

inPalliativeC

are

(ASyMSp))was

teste

dto

mon

itora

ndmanages

ymptom

sreportedby

patie

ntsb

eing

caredfora

thom

einthea

dvancedstages

oftheirilln

ess

andwas

carriedou

tintworuralcom

mun

ities.

Thes

ystem

was

usableandacceptableto

patientsa

ndtheh

ealth

professio

nals

who

caredforthem.

McC

annetal.[92]

Amob

ileph

one-basedadvanced

symptom

managem

entsystem

(ASyMS)

onchem

otherapy-rela

tedtoxicityin

patie

ntsw

ithlung

,breast,

orcolorectalcancer

was

evaluated.Patie

ntsu

sedthem

obile

phon

etorecord

theirsym

ptom

s,send

ingtheirreportsdirectlyto

the

nurses

attheirc

linicalsite.

Patie

ntsreportedmanybenefitso

fusin

gASyMSinclu

ding

improved

commun

icationwith

health

professio

nalsandim

provem

entsin

the

managem

ento

ftheirsymptom

s.ASyMShasthe

potentialtopo

sitively

impact

them

anagem

ento

fsym

ptom

sinpatie

ntsreceiving

chem

otherapy

treatment.

McG

eeandGray[93]

Asymptom

managem

entsystem

was

developedandim

plem

entedon

person

aldigitalassistants(PDAs

)for

useb

ycancer

outpatientsin

theird

ailymanagem

ento

fchemotherapy

symptom

s.Th

esystem

allowed

patientstorecord

theirsym

ptom

sath

omea

ndsend

these

datato

theirc

ancerc

entre

.Patientsc

ould

view

person

alized

self-care

advice

andmoreg

eneralmedicalinform

ation.

Inadditio

n,cancer

care

nurses

werea

lerted

abou

tsignificantly

high

symptom

scores

and

couldcontactthe

patie

ntby

phon

e.

Thep

atientsfelt

thes

ystem

was

rewarding

,valuable,educational,and

interestingbu

tsho

uldbe

treated

cautiously.

Patie

ntse

xpectedthatusingthe

syste

mwou

ldbe

morec

halleng

ingthan

they

infactrateditaft

erthetria

l.Th

eyrateditmoree

ducatio

naland

morer

ewarding

than

tradition

almeetin

gs.

Thes

taffanticipated

thatthes

ystem

wou

ldbe

useful

form

onito

ringpatients’

symptom

s.Afte

rthe

trial,mosto

fthe

staffsuggestedthatthes

ystem

had

improved

commun

icationbetweenthem

andthep

atients,andthatthe

patie

ntsh

adim

mediateaccessto

andcontactw

iththeh

ospital.

Miller

etal.[94]

Theinterventionwas

delivered

byway

ofad

evicec

alledtheH

ealth

Budd

yto

patientsw

hohadun

dergon

ecoron

aryartery

bypassgraft

(CABG

)with

diabetes,w

hich

delivers“daily

sessions”o

rscriptand

was

used

forsixweeks

with

assessmento

fsym

ptom

ssuchas

fatig

ueandpain.

Nostatisticaldifferences

betweentheinterventionandthec

ontro

lgroup

swerefou

nd.Improvem

entsin

psycho

socialfunctio

ning

werec

omparable

betweenthetwogrou

ps.

Morenoetal.[95]

Theimpactso

nMedicarec

ostsof

providingap

artic

ular

type

ofho

me

telemedicinetoeligibleM

edicareb

eneficiariesw

ithtype

2diabetes

weree

stim

ated.Twocoho

rtso

fbeneficiarieslivingin

twomedically

underservedareasw

erer

ando

mized

tointensiven

urse

case

managem

entviatelevisitso

rusualcare.

Inform

aticsfor

DiabetesE

ducatio

nandTelemedicine(ID

EATel)didno

tredu

ceMedicarec

ostsateither

site.To

talcostswereh

igherfor

thetreatment

grou

pthan

forthe

controlgroup

.Alth

ough

thetele

health

syste

mhadmod

est

effectson

clinicaloutcomes

(reportedels

ewhere),itdidno

treduceM

edicare

useo

rcostsforh

ealth

services.

Mullanetal.[96]

Anelectro

nicd

iary

forh

omem

onito

ringby

lung

transplant

cand

idates

toim

provec

ommun

icationbetweencand

idates

andthe

transplant

team

was

used.C

andidatesw

erer

ando

mized

into

control

(follo

wingsta

ndardteleph

one-repo

rtingprocedures)a

ndinterventio

n(usin

gan

electronicd

iary

torecord

andtransm

itar

ange

ofhealth-related

measures)grou

ps.

Subjectsused

thed

iary

with

outd

ifficulty

andwith

good

compliancea

ndwere

positiver

egarding

contactb

ased

ondiaryuse.Th

erew

eren

osig

nificant

differences

inclinicaloutcomes

betweengrou

ps.C

hang

ingdiaryqu

estio

nsmight

improvethe

effectiv

enesso

felectronicm

onito

ringforlun

gtransplant

cand

idates.

Myersetal.[97]

Impactof

home-basedmon

itorin

gon

thec

areo

fpatientsw

ithcongestiv

eheartfailu

rewas

exam

ined.H

ome-basedtele-m

onito

ring

asatherapeutictoolwas

used.Th

eeffectivenesso

fhom

etele-m

onito

ringin

patie

ntsrecently

discharged

from

theh

ospitalw

asassessed.Patientsw

erep

rovidedho

metele-mon

itorin

gfora

two-mon

thperio

dfollo

wingho

spita

ldisc

harge.Hom

evisit

frequ

ency,patient

reho

spita

lizationrate,emergencydepartmentu

se,

quality

oflife,andhealthcare

costs

werec

omparedto

thosea

similar

usualcare.Patie

ntsinthetele-mon

itorg

roup

transm

itted

their

weight,blood

pressure,and

oxygen

saturatio

ndaily

toatele

-mon

itor

nurse,who

evaluatedeach

patie

ntwith

afollow-upteleph

onec

all.

Dailyho

mecaretele-mon

itorin

gredu

cedthefrequ

ency

ofho

me-nu

rsing

visits,provided

costsaving

s,andwas

associated

with

improved

self-perceived

quality

oflife.

20 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Nilssonetal.[98]

Distric

tnurses’(D

N)exp

eriences

ofusinginform

ationand

commun

icationtechno

logy

(ICT

)tocommun

icatew

ithchronically

illpeop

lein

theirh

omes

wered

escribed.A

nelectro

nicm

essaging

programmev

iacompu

tersandmob

ileph

ones

with

anInternet

conn

ectio

nwas

used,enablingDNsa

ndtheillpeop

leto

exchange

messagestoandfro

manyw

here.Th

eprogram

mec

omprise

ddifferent

virtualroo

ms,andcommun

icationwas

viatextm

essages.

TheD

Nsfelt

thatthetechn

olog

yincreasedaccessibilityto

nursingcare

throug

ham

ored

irectcommun

icationwith

theillperson

,meaning

thata

moretrustingrelationshipcouldbe

created.Th

eDNsa

lsoexperie

nced

that

theu

seof

ICTsavedworking

time.Th

isstu

dyindicatesthatthe

useo

fICT

for

commun

icationallowed

theD

Nto

bette

rsup

portac

hron

icallyill

person

atho

me,leadingto

improved

homen

ursin

gcare.Th

ismetho

dof

commun

icationcann

otreplacep

hysic

alpresence

butcan

beseen

asa

complem

enttonu

rsingcare

atho

me.

Nilssonetal.[10]

Peop

lewith

serio

uschronicilln

essesw

housed

inform

ationand

commun

icationtechno

logy

(ICT

)tocommun

icatew

iththeird

istric

tnu

rsew

eres

tudied.Th

einterventionwas

perfo

rmed

usingan

electronicm

essaging

programme.Th

eprogram

mew

asaccessibleto

anycompu

terw

ithan

Internetconn

ectio

n.Th

eprogram

mec

onsisted

ofdifferent

virtualroo

ms,where

peop

lecouldcommun

icateu

sing

text

messages.

Thep

artic

ipants’

commun

icationwith

thed

istric

tnurse

was

improved

becauseo

feasyaccessibilityandbecausetheyfeltincreasedsecurity.Th

eyfelt

therew

erefew

erlim

itatio

nsandthattheire

verydaylifew

asim

proved,w

hich

canalso

beseen

asan

improvem

entincare.

Pang

arakisetal.[99]

Lung

transplant

recipientsused

atelem

edicined

evice,thatis,

anelectro

nich

omes

pirometer,togaugethe

functio

nof

theirlun

gswhen

they

werea

way

from

theh

ospitalorc

linicsetting

.Health

care

providersreviewtransm

itted

spiro

metry

tests

anduser’ssymptom

respon

sestodetectearly

signs

ofinfectionandor

rejection.

Current

homes

pirometry

usersh

aveq

uestions,con

cerns,andpreferences

abou

tspirometry

thatmay

influ

ence

theird

ailyadherence.Th

espiro

meter

hadthec

apabilityto

deliver

feedback

messagesto

potentially

addressthese

questio

nsandconcerns.

Find

ings

revealed

categorie

sfor

feedback

messaging

contentsuchas

education(general,lifesty

le,andinfection),goals,

timing,techniqu

e,mon

itorin

g,andreminders(times

ensitive,po

sitive).M

essagesw

erec

reated

accordingto

leng

th,feasib

ility,pastexp

erience,andneutralityfore

lectronic

implem

entatio

n.Itisbelievedthatpertinentautom

ated

electronicfeedb

ack

messagesw

illenhanceh

omes

pirometry

conn

ectio

n,raise

confi

dencein

spiro

metry

usage,andinflu

ence

daily

adherencetothes

pirometry

protocol.

Thec

ontent

additio

nally

serves

asafou

ndationfore

stablishing

aplanof

care

individu

alized

toeach

homes

pirometry

user.

Phillipse

tal.[100]

Telehealth

interventio

nswered

esignedto

redu

cetheincidence

ofsecond

arycond

ition

samon

gpeop

lewith

mob

ilityim

pairm

ent

resulting

from

spinalcord

injury.Patientsreceivedav

ideo-based

interventio

nforn

inew

eeks,a

teleph

one-basedinterventio

nforn

ine

weeks,orstand

ardfollo

w-upcare.Partic

ipantswerefollowed

fora

tleasto

neyear

tomon

itord

ayso

fhospitalization,

depressiv

esymptom

s,andhealth-related

quality

oflife.

Health

-related

quality

oflifew

asmeasuredusingtheQ

ualityof

Well-B

eing

(QWB)

scale.QWBscores

didno

tdiffer

significantly

betweenthethree

interventio

ngrou

psatthee

ndof

theinterventionperio

d.At

year

onea

fter

discharge,scores

fortho

secompletingon

eyearo

fenrollm

entw

ere

significantly

high

erforthe

interventio

ngrou

pscomparedto

stand

ardcare.

Meanannu

alho

spita

ldaysw

ere3

.00forthe

videogrou

p,5.22

forthe

teleph

oneg

roup

,and

7.95forthe

stand

ardcare

grou

p.

Pierce

etal.[101]

Asiteo

ntheW

orld

WideW

eb,calledCa

ringW

eb,for

onlin

eeducationandsupp

ortfor

caregiversof

individu

alsw

ithstr

okew

asdevelopedto

providew

eb-based,in-ho

mes

uppo

rtandeducationfor

caregiversof

person

swith

stroked

uringthefi

rstyeara

fter

hospita

lization.

Thee

ducatio

naln

eeds

ofsurvivorso

fstro

keandtheirc

aregiversw

ere

identifi

edandinform

ationthattheseind

ividualssoug

htwas

developedinto

aneducationalT

ipof

theM

onth

compo

nent

forC

aringW

eb.Th

etop

12topics

repo

rted

wereu

sedto

createeducationalT

ipso

fthe

Mon

thon

CaringW

eb.

Proctera

ndSing

le[102]

Remoted

evices

ford

ailyho

me-mon

itorin

gof

vitalsigns

ofpatie

nts

livingwith

multip

lecomplex

cond

ition

swereimplem

ented.Th

eequipm

entw

asinsta

lledin

thep

atient’sho

mea

ndprogrammed

toprom

ptthep

atient

toun

dertakethese

observations

onad

ailybasis

atan

agreed-upo

ntim

e.Re

sults

wered

ownloadedto

acentral

web-based

server,w

hich

was

accessed

daily

bythep

rojectnu

rse.

Thes

ervice

redu

cedoverallh

ospitaladm

issions

durin

gtheintervention

comparedto

thoseb

eforethe

interventio

n.Th

epatients’andcaregivers’

confi

denceinmanagingdiseases

was

increased.Hom

emon

itorin

ghelped

patie

ntstocommun

icatem

oree

ffectively

with

thep

rimarycare

team

,which

was

therebyenabledto

providem

oree

ffectiver

espo

nses

topatie

nts.

International Journal of Telemedicine and Applications 21Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Przybylsk

ietal.[10

3]

Patie

ntsw

ithim

plantablec

ardioverterd

efibrillatorsw

erep

rovided

with

remotem

onito

ringto

increase

theirsafetyby

early

detectionof

technicalorm

edicalmalfunctio

nsandto

decrease

then

umbero

ffollo

w-upvisits.Medicalandtechnicaleventsw

erer

eportedby

the

remotem

onito

ringsyste

mas

wellas

interrup

tions

inmon

itorin

glonger

than

14days.

Ther

emote-mon

itorin

gsyste

mrepo

rted

medicaleventsin

48%of

patie

nts.In

total,32

eventreportswereg

enerated

duetothed

etectio

nof

ventric

ular

tachycardia,ventric

ular

fibrillation,

ineffectiv

edefibrillationwith

maxim

alenergy,and

supraventricular

tachycardia.Th

erew

eren

orepo

rtso

ntechnical

abno

rmalities

oftheimplantablec

ardioverter-defib

rillator

syste

m.Th

elon

gest

breakwas

caused

bythep

atient’sstay

abroad.Th

erem

aining

interrup

tions

werec

ausedby

travel,

hospita

lisations,and

atem

porary

stay

inap

lace

with

outsuffi

cientG

SMcoverage.D

uringthefollow-upperio

d,therew

eren

ointerrup

tions

inmon

itorin

gcaused

bytransm

itter

orim

plantable

cardioverter-defibrillator

failu

re.R

emotem

onito

ringof

implantable

cardioverter-defibrillator

recipientsdo

esno

tpresent

technicald

ifficulties

and

enablese

arlydetectionof

serio

useventsin

patie

nts.

Quinn

[104]

Low-te

chno

logy

equipm

entw

asused

toim

provec

arefor

patie

nts

with

heartfailure

enrolledin

ahom

ehealth

agency.Th

enine-week

interventio

nwas

targeted

towardtheh

omeh

ealth

nurses

and

inclu

dedteleph

onea

ndho

mev

isits,

ateachingtool,digita

lscales,and

alog/noteboo

kfilledou

tbythep

atientsinthes

tudy.

Theinterventionou

tcom

esinclu

deddecreasedpatie

ntreho

spita

lisation,

decreasedsymptom

sofh

eartfailu

re,and

increasedqu

ality

oflife;italso

improved

theo

rganizationof

nursingcare

forp

atientsw

ithheartfailure.Th

ecommon

symptom

sofh

eartfailu

resuch

asfatig

ue,sho

rtnessof

breath,and

sleep

distu

rbancesw

erev

alidated.Th

eemergent

care

visitsa

ndredu

ced

nursingvisitsa

llowprovision

ofthec

arefor

patie

ntsw

ithheartfailure

ina

moree

ffectivea

ndeffi

cientm

annerthanusualcare.

Reisetal.[105]

Aninteractivem

ultim

ediaprogram

isdescrib

edthatwou

ldassessthe

patie

ntandfamily

mem

ber’s

levelofp

reparedn

essfor

specific

caregiving

functio

nsforp

rosta

tecancer

andprovidetailored

skill-buildingvign

etteso

ncaregiving

techniqu

es.Th

isprogram

isdesig

nedfora

hybrid

deliveryutilizing

both

web-based

resourcesa

ndaC

D-ROM.

Feedback

from

prostatepatie

ntsa

ndfamily

mem

bersfro

mac

ancerc

entero

nperceivedneedsfor

caregiving

training

underscoresthe

potentialvalue

ofa

compu

ter-supp

ortedinterventio

nforsom

epatientsa

ndfamilies.

Implem

entatio

nof

thes

oftware,marketin

g,anddistrib

utionwill

beguided

inpartby

recent

e-health

experie

nces

thatleavem

anyhealth

professio

nals

approp

riatelyskeptic

alabou

tthe

utilityof

such

prod

ucts.

Thec

oncept

ofprovidingele

ctronich

ealth

commun

icationforc

onsumers,particularlyin

the

area

ofprostatecancer

caregiving

,isc

learlyvalid

forn

umerou

sreasons.

Safran

etal.[106]

Parentaluseo

fanInternet-based

educationaland

emotionalsup

port

syste

m,B

abyCa

reLink

,inar

egionalN

ICUprogramme.Ba

byCa

reLink

was

insta

lledin

NICUsinfour

area

hospita

ls.Parentsw

ere

offered

accessfro

mho

spita

lterminalsa

ndfro

manyotherInternet

accesspo

int.Datao

nuseo

fthe

programmew

ascollected

bythe

compu

tersystem.

Medicaidfamilies

who

accessed

threeo

rmoreB

abyCa

reLink

web

pagesp

erdaytook

theirinfantsho

me17.5

days

soon

erthan

families

who

used

Baby

CareLink

lessoft

en.A

mon

gno

n-Medicaidfamilies,m

ore-fre

quentu

sersof

Baby

CareLink

took

theirinfantsho

me14.3days

soon

er.Self-help

toolsfor

parentsm

ayfre

eupnu

rsingresourcesfor

families

with

greatern

eeds.

Sand

berg

etal.[107]

Patie

ntsw

ithdiabetes

werep

rovidedwith

aspeciallydesig

nedho

me

telemedicineu

nitthatallo

wed

them

tovideocon

ferencew

ithnu

rse

case

managers(NCM

s)anddietitians,up

load

bloo

dglucosea

ndbloo

dpressure

readings,and

accesseducationalm

aterialsand

individu

alized

datadisplay

s.SubjectsandNCM

s/dietitians

participated

invideocon

ferences

every4to

6weeks

(with

significant

need,every

2weeks)toeducatep

atients,facilitateg

oal

setting

/self-m

anagem

ent,anddiscussc

oncerns.Supp

ortiv

einteractions

provided

contacttailoredto

individu

alneedstow

ardthe

goalso

fimproved

glycem

iccontrol,diabetes

self-care,and

other

health

outcom

es.

Providersw

erev

erysatisfiedwith

theire

xperiencea

ndfelttheire

ffortsw

ithpatie

ntsw

ereg

enerallysuccessfu

l.Providersa

lsoidentifi

edan

umbero

fun

ique

benefitso

ftelehealth

interventio

ns,suchas

oppo

rtun

ities

form

ore

frequ

entcon

tactwith

patie

nts,greaterrelaxationandinform

ationdu

etothe

abilityto

interactwith

thep

atientsintheiro

wnho

mes,increased

abilityto

reachtheu

nderserved,m

oretim

elyandaccuratemedicalmon

itorin

g,and

improved

managem

ento

fdata.Th

eprim

arydisadvantagesidentified

were

techno

logy

prob

lemsa

ndac

oncern

abou

tthe

lack

ofph

ysicalcontactw

ithpatie

nts.

22 International Journal of Telemedicine and ApplicationsTa

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

Scalvini

etal.[108]

Generalpractitionersreceived

aportablee

lectrocardiographthat

transm

itted

a12-lead

ECGreadou

ttoar

eceiving

stationviaa

mob

ileor

fixed

teleph

one.EC

Gtraces

recorded

weretransferred,inreal

time,to

receivingstations

where

cardiologists

werea

vailable2

4ho

urs

aday

forE

CGreferralandinteractivetele

-con

sultatio

ns.Patientsin

theh

ome-basedtele-m

onito

ringgrou

preceived

aportabled

evicethat

transfe

rred

bymob

ileor

fixed

teleph

onetoar

eceiving

stationwhere

anu

rsew

asavailablefor

repo

rtingandinteractivetele-consultatio

n.Th

epatient

couldcallthec

entre

whenneeded

(teleassis

tance)or

the

clinicalteam

couldcallthep

atient

fora

schedu

ledappo

intm

ent

(tele-m

onito

ring).

Atthefi

rsttelepho

necontact,alow

ernu

mbero

fgeneralpractitioners’

patie

ntsthantheh

ome-basedtele-m

onito

ringpatie

ntsw

ereo

nbetablocker,

diuretic,and

angiotensin

-con

vertingenzyme(AC

E)-in

hibitortherapy.Th

emeannu

mbero

ftele

phon

ecallswas

2.6perp

atient

intheg

eneralpractitioner

grou

pand16.6perp

atient

intheh

ome-basedtele-m

onito

ringgrou

p.Th

isprogram,involving

thep

atientsd

irectly,

isableto

redu

ceho

spita

lizations

and

decompensationepiso

des.Th

etelecardiolog

yserviceisa

bletosolvethe

majority

ofGPs’questions,com

bining

theirk

nowledgeo

ftheirpatie

nts,with

thec

ardiologists’expertise

inprob

lemsc

onnected

with

CHF.In

thiscase,

telemedicinec

ould

bean

oppo

rtun

ityforthe

GPs

tofollo

wtheirp

atients,

contrib

utingto

improved

managem

ent,therapy,andapprop

riatenessof

hospita

ladm

issions.

Scalvini

etal.[109]

Thefeasib

ilityof

home-basedtele-cardiolog

yforp

atientsw

ithchronich

eartfailu

re(C

HF)

was

assessed.C

HFpatie

ntsw

eree

nrolled

into

aprogram

meo

ftele

phon

efollowup

andsin

gle-lead

electro

cardiography

(ECG

)mon

itorin

g.Th

epatientstransmitted

theirE

CGdataby

fixed

teleph

onelinetoar

eceiving

station,

where

anu

rsew

asavailablefor

aninteractivetele

-con

sultatio

n.

Atotalof124

cardiovascular

eventswerer

ecorded.Mod

ificatio

nsto

therapy

weres

uggeste

din

respon

seto

119calls;hospitaladm

issions

weres

uggeste

dfor

13patie

nts,furtherinvestig

ations

for7,and

acon

sultatio

nwith

thep

atient’s

generalpractition

erfor13.Tw

enty-tw

oEC

Gabno

rmalities

werer

ecorded.In

63patie

ntsreceiving

theb

eta-blockerc

arvedilol,them

eando

sage

increased

from

36to

42mg.In

thep

reviou

syear,therew

ere1.8ho

spita

lizations

per

patie

nt,w

hilein

thefollow-upperio

dtherew

as0.2ho

spita

lizationper

patie

nt.Followingup

CHFpatie

ntsu

singan

urse-le

dtele-cardiolog

yprogrammes

eemstobe

feasibleanduseful.

Schw

arze

tal.[110]

Thep

urpo

sewas

toexam

inew

hether

tele-m

onito

ringby

anadvanced-practicen

urse

redu

cedsubsequent

hospita

lreadm

issions,

emergencydepartmentvisits,

costs

,and

riskof

hospita

lreadm

ission

forp

atientsw

ithHF.Patie

nt/caregiver

dyadsw

erer

ando

mized

into

twogrou

psaft

erdischarge.Participantswereinterview

edsoon

after

dischargea

nd3mon

thslater

abou

teffectso

ftele

-mon

itorin

gon

depressiv

esym

ptom

s,qu

ality

oflife,andcaregiverm

astery.

Therew

eren

osig

nificantd

ifferencesrela

tedto

tele-m

onito

ringfora

nyou

tcom

es.C

aregiver

mastery,informalsocialsupp

ort,andelectro

nich

ome

mon

itorin

gweren

otsig

nificantp

redictorso

frisk

ofho

spita

lreadm

ission.

Furtherstudies

shou

ldaddressthe

interactionbetweenthea

dvanced-practic

enu

rsea

ndfollo

w-upinterventio

nwith

tele-m

onito

ringof

patie

ntsw

ithHFto

bette

rtargettho

sewho

arem

ostlikely

tobenefit.

Sevean

etal.[111]

Patie

nts’andfamilies’exp

eriences

with

videotelehealth

consultatio

nsas

ametho

dof

healthcare

deliveryin

rural/rem

otec

ommun

ities

were

accessed.

Patie

nts’andfamilies’exp

eriences

oftheirtelehealth

visitsw

erec

enteredon

threek

eythem

es:lessening

theb

urdens

(costsof

travel,

accommod

ations,lost

wages,losttim

e,andph

ysicallim

itatio

ns);maxim

izingsupp

orts(accessto

family,frie

nds,familiar

homee

nviro

nment,nu

rses,and

otherc

arep

roviders);

andtailo

ringspecifice

-health

syste

mstoenhancep

atient

andfamily

needs.

Shea

etal.[112]

Participantsin

theinterventiongrou

preceived

ahom

etele

medicine

unit(H

TU)d

evelo

pedspecifically

forIDEA

Tel(American

Telecare,

Inc.,

Eden

Prairie

,MN,U

SA).Th

eHTU

consisted

ofaw

eb-enabled

compu

terw

ithmod

emconn

ectio

nto

anexistingtelep

hone

line.Th

eHTU

provided

four

major

functio

ns:videoconferencing

over

standard

teleph

ones

ervice

(POTS

),allowingpatie

ntstointeractwith

nursec

asem

anagers;remotem

onito

ringof

glucosea

ndbloo

dpressure

with

electronicu

ploadandintegrationwith

dial-upInternet

service-provider

accessto

aweb

portalprovidingaccessto

patie

nts’

ownclinicald

ata;secure

web-based

messaging

with

nursec

ase

managers;andaccessto

aneducationalw

ebsite.

Telemedicinec

asem

anagem

entimproved

glycem

iccontrol,bloo

dpressure

levels,

andtotaland

LDLcholesterollevels

aton

eyearo

ffollowup

.

International Journal of Telemedicine and Applications 23

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Smith

etal.[113]

Thes

tudy

determ

ined

thefeasib

ilityof

usingho

mea

udio/video

telehealth

equipm

entfor

administeringnu

rsinginterventio

nsto

families,observing

thec

lient

respon

se,and

collectingresearch

data

over

specificintervalsof

time.Th

esub

jectsw

erea

dultpatie

nts’

nighttimem

echanicalventilatorsfor

obstructives

leep

apnea.Skin

color,vitalsigns,spirometry,and

pulse

oxim

etry

datacollected

simultaneou

slythroug

hteleh

ealth

equipm

entand

throug

hnu

rse

observationin

theh

omew

erethe

same.

Nursin

ginterventio

ns,equ

ipmentd

emon

strations,visu

alillustrations,and

audiotaped

educationald

irections

wereu

sedto

facilitatep

atient

care;they

weretransmitted

acrossteleh

ealth

with

afew

exceptions.C

ostsof

teleh

ealth

visitsw

erelessthantradition

alho

mev

isits,

andclientevaluations

ofteleh

ealth

werep

ositive.

Smith

etal.[114

]

Whether

atele

health

interventio

ncouldim

provec

ompliancew

ithcontinuo

uspo

sitivea

irway

pressure

(CPA

P)by

patie

ntsw

ithsle

epapneaw

asteste

d.Th

esep

atientsh

adbeen

nonadh

erenttotheinitia

lthreem

onthso

ftherapy,evenaft

erreceivingtheinitia

lstand

ardand

then

supp

lementalaud

iotaped/videotaped

patie

nteducationfor

adherin

gto

CPAPnightly.Interventions

wered

elivered

bynu

rses

totwogrou

psin

theirh

omes

byteleh

ealth

over

a12-weekperio

d.

Both

grou

psratedteleh

ealth

deliverypo

sitively

.Tele

health

interventio

nsarea

potentially

cost-

effectiv

eservice

forincreasingadherencetoprescribed

medicaltre

atments.

Stric

klin

etal.[115]

Patie

ntrespon

seisac

riticalaspectof

successfu

lPOCtechno

logy

(point

ofcare

techno

logy)implem

entatio

n.Th

eresultsof

apilo

tPOC

patie

ntsatisfactionstu

dycond

uctedatfour

homeh

ealth

agencies

werep

resented.

Results

supp

ortp

atient/caregiver

satisfactionwith

POCtechno

logy

use

durin

gtheh

omev

isit.Th

etop

varia

bles

influ

encing

patie

ntreceptivenessto

then

urse’suseo

fthe

compu

terintheh

omea

rethosethatcloselyrelateto

generalsatisfactio

nwith

homecares

ervices.Th

epatientsw

anttobe

the

nurse’s

firstpriorityandfocus;they

dono

twanttobe

upsta

gedby

the

compu

ter.Provided

thec

ompu

terd

oesn

otcreatethep

erceptionof

taking

timeo

ratte

ntionfro

mthep

atient

orinhibitverbalinteractio

n,patie

ntsa

relik

elyto

accept

then

urse’suseo

faPO

Ccompu

ter.

Tang

etal.[116

]

Apilotstudy

ontelepsychiatry

was

cond

ucted.Avideocon

ferencing

linkwas

establish

edbetweenar

egionalh

ospitaland

acarea

ndattentionho

me.Usin

gthissyste

m,a

psycho

geria

tricou

treachteam

provided

psychiatric

assessmentsto

resid

entsof

thec

area

ndattentionho

meo

ver11m

onths.

Videocon

ferencingwas

foun

dto

behigh

lyfeasible.

Itwas

acceptableto

staff

andpatie

ntsa

ndmorec

ost-e

ffectivethanon

-site

visits.

Terryetal.[117

]Th

eaim

was

toevaluatethee

ffectivenesso

ftelem

edicine(TM

)with

digitalcam

eras

intre

atingwou

ndsinah

omecares

ettin

g.Subjects

werer

ando

mlyassig

nedto

oneo

fthree

grou

ps.

Telemedicineisa

useful

commun

icationtoolin

wou

ndmanagem

entb

utwith

limitedpo

wer

whenrand

omizationdo

esno

tinclude

wou

ndsiz

eortype.Tw

oim

portantb

enchmarks

weree

stablishedforh

omec

are.

Torp

etal.[118

]

Apilotstudy

ofho

winform

ationandcommun

icationtechno

logy

(ICT

)may

contrib

utetohealth

prom

otionam

ongeld

erlyspou

sal

caregivers.Th

eobjectiv

ewas

toexplorew

hether

useo

fICT

byinform

alcaregiversof

frailelderlypeop

lelivingatho

mew

ould

enable

them

togain

morek

nowledgea

bout

chronicilln

ess,carin

g,and

coping

;esta

blish

aninform

alsupp

ortn

etwork;andredu

cestr

essa

ndrelatedmentalh

ealth

prob

lems.Po

tentialp

artic

ipantswerec

lose

relativ

esof

aneld

erlyperson

with

adiagn

osisof

achron

icillness

dwellin

gin

thes

ameh

ouseho

ldwho

wish

edto

continue

carin

gfor

theirrelativea

thom

e.

Results

didno

trevealany

redu

ctionin

caregivers’stre

ssor

mentalh

ealth

prob

lems.Ca

regiversrepo

rted

extensiveu

seof

theICT

service,mores

ocial

contacts,

andincreasedsupp

ortand

lessneed

forinformationabou

tchron

icillnessandcarin

g.Con

tactwith

andsupp

ortfrom

otherc

aregiversw

ithsim

ilare

xperiences

werep

artic

ularlyvalued

byparticipants.Th

eintervention

enhanced

contactswith

family

andfriend

soutsid

ethe

caregivern

etwork.

Thus,itcan

beseen

thatICThasthe

potentialtocontrib

utetohealth

prom

otionam

ongelderly

spou

salcaregivers.

24 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Wakefield

etal.[119

]

Aho

me-basedinterventio

nforh

eartfailu

rewas

evaluated.

Differencesinnu

rsea

ndpatie

ntcommun

icationprofi

lesb

etweentwo

telehealth

mod

eswerec

ompared:teleph

onea

ndvideo-ph

one;

long

itudinalchanges

incommun

ication,

nursep

erceptions,and

patie

ntsatisfactionweree

valuated.

Nursesw

erem

orelikely

touseo

pen-endedqu

estio

ns,back-channel

respon

ses,friend

lyjokes,andchecks

foru

ndersta

ndingon

thetele

phon

ecomparedto

video-ph

one.Com

plim

entswereg

iven

andpartnershipwas

morec

ommon

onthev

ideo-pho

ne.Patientsw

erem

orelikely

togive

lifestyle

inform

ationandapprovalcommentson

thetele

phon

e,andmore

closed-endedqu

estio

nson

thev

ideo-pho

newereu

sed.Nurses’perceptio

nsof

theinteractio

nsweren

otdifferent

betweenthetelepho

neandvideo-ph

one,

nord

idtheirp

erceptions

change

significantly

over

thec

ourseo

fthe

interventio

n.Th

erew

eren

osig

nificantd

ifferencesinpatie

ntsatisfaction

betweenthetele

phon

eand

video-ph

one.

vandenBe

rgetal.

[120]

TheG

P(generalpractitioner)delegatedroutineh

omev

isitsto

qualified

practic

eemployees(registe

rednu

rses).Eligiblepatie

nts

werep

rovidedwith

telecare

devicestomon

itord

isease-related

physiologicalvalues.

TheG

Psagreed

thatdelegatin

gtaskstoaq

ualifi

edpractic

eassistantrelieves

them

intheird

ailywork.

Varis

etal.[121]

Atelemedicines

ystem,thatis,Doc@ho

me,was

evaluatedto

assist

bloo

dpressure

treatmenttoreachbette

rblood

pressure

control

amon

ghypertensiv

epatients.

Bloo

dpressure

controlw

asim

proved

durin

gthethree-m

onth

follo

wup

.Patie

nt-to

-Doc@ho

mec

ompliancew

asgood

,but

study

physicians

foun

dthe

syste

mtim

econ

sumingin

theb

eginning

.TheD

oc@ho

metele

medicine

syste

mshow

edap

romising

approach

inhypertensio

ntre

atmentb

utneeds

somefurther

developm

entand

trainedstaff

tobecomea

stillmorep

ractical

alternative.

Whitte

netal.[122]

Ateleh

ospice

projectw

ascond

uctedin

urbanandruralregions.D

ata

from

patie

ntsreceiving

tele-hospice

services

intheirh

omes

was

collected.N

ursesw

erethe

prim

aryproviderso

ftele

-hospice

services

andinitiated

them

ajority

ofroutinetele

visits.

Patie

ntsw

eree

xtremely

satisfiedwith

tele-hospice

andoft

enexpressed

frustrationthatnu

rses

didno

tuse

thetele

-hospice

equipm

entm

ore

frequ

ently.

Whitte

nandMicku

s[123]

Aho

metelehealth

program

forp

atientsw

ithchronico

bstructiv

epu

lmon

arydisease(CO

PD)a

nd/orc

ongestive

heartfailure

(CHF)

was

evaluated.Patie

ntsd

iagn

osed

with

COPD

and/or

CHFwho

were

prescribed

homeh

ealth

care

services

werer

ando

mlyassig

nedto

anexperim

entalgroup

where

they

received

homeh

ealth

care

throug

ha

combinatio

nof

tradition

alface-to

-face

andtelemedicinev

isitsanda

controlgroup

where

onlyconventio

nalh

omec

arew

asem

ployed.

Inregard

topatie

ntperceptio

nsof

hometelecare,patie

ntsw

eres

atisfi

edwith

thetechn

olog

yandthew

aythatcare

was

delivered

viathism

odality.

Willem

setal.[124]

Anu

rse-ledtele-m

onito

ringinterventio

ncomparedwith

regu

larc

are

inasthmaw

asevaluated.Th

econ

trolgroup

received

regu

lar

outpatient

care,w

hiletheinterventiongrou

pused

anasthmam

onito

rwith

mod

ematho

me,with

anasthman

urse

asthem

aincaregiver.

Clinicalasthmas

ymptom

sand

medicalconsum

ptionwerem

easured

byusingdiaries.As

thma-specificq

ualityof

lifew

asalso

measured.

Improvem

entinfollo

wup

butn

ostatisticallysig

nificantd

ifference

between

theg

roup

swas

observed.A

tele-m

onito

ringprogrammeo

nits

ownisno

taguaranteeo

fsuccess.Th

epatient’sperceptio

nsof

asthma-specificq

ualityof

life(daily

functio

ning

)sho

uldbe

akey

elem

entinasthmatele-mon

itorin

gprogrammes.

International Journal of Telemedicine and Applications 25Ta

ble6:Con

tinued.

Stud

ies

Interventio

nMainresults

J.M.W

intersandJ.

M.W

inters[125]

Avarie

tyof

experie

nced

healthcare

practitionersperfo

rmed

functio

nalassessm

entsof

strokes

ubjectsu

singac

ollectionof

valid

ated

scales

byvaryingapproaches

(face-to

-face,low

-bandw

idth,

andhigh

-bandw

idth

videocon

ferencing)

inar

ando

mized

order.In

asecond

study,und

ergraduatenu

rsingstu

dentsp

erform

edsim

ilar

perfo

rmance

measuresa

ndtaug

htan

unfamiliar

individu

alho

wto

programmea

ndusea

nintravenou

spum

pdevice,takea

tympanic

temperature,ord

rawup

insulin

inas

yringe.Inthethird

study,

advanced-practicen

ursin

gstu

dentsa

ssessedvitalsigns

and

perfo

rmed

cardiopu

lmon

aryassessmentson

commun

ity-dwelling

subjectsusinglow-bandw

idth

andface-to

-face

approaches.

Health

care

practitionersandstu

dentsg

enerallypreferred

high

-bandw

idth

approaches

over

low-bandw

idth

alternatives

when

videocon

ferencingwas

used.

Mostp

artic

ipantsandpractitionersweres

atisfi

edwith

thee

ncou

nters,

regardles

softhe

leveloftechn

ologyused.

Viscoetal.[126]

Teleh

ealth

Wou

ndCa

reProgram

implem

entedatah

ospitalh

ome

health

agency

andah

ospitalw

asused

wherethew

ound

careprovided

foro

nepatie

ntwas

inclu

dedanddescrib

edin

thec

ases

tudy.

Manybenefitso

ftelehealth

asan

adjuncttousualtherapy

inwou

ndcare

were

noted.

Vitaccae

tal.[127]

Thefeasib

ilityof

telem

edicinefor

homem

onito

ringof

patie

ntsw

ithchronicr

espiratory

failu

re(C

RF)d

ischarged

from

hospita

lwas

assessed.Th

epatientstransmitted

pulse

darteria

lsaturation(pSat)

dataviaa

teleph

onem

odem

toar

eceiving

stationwhere

anurse

was

availablefor

atele

consultatio

n.Arespira

tory

physicianwas

also

available.Schedu

ledandad

hoca

ppointmentswerec

ondu

cted.

Theh

omem

onito

ringwas

feasibleanduseful

fortitrationof

oxygen,

mechanicalventilationsetting

,and

stabilizatio

nof

relap

ses.

Vitaccae

tal.[128]

Thea

imwas

prim

arily

toevaluateredu

ctionin

hospita

lisations

and,

second

ly,exacerbatio

ns,generalpractitioner(GP)

calls,and

related

costeffectiv

enesso

ftele

assistance(TA

)for

patie

ntsw

ithchronic

respira

tory

failu

re.Patientsw

erer

ando

mise

dto

twogrou

ps:an

interventio

ngrou

penteredao

ne-yearT

Aprogrammew

hilecontrols

received

tradition

alcare.

TheT

Agrou

pexperie

nced

significantly

fewer

hospita

lisations,urgentG

Pvisits,andacutee

xacerbations.C

OPD

patie

nts,as

aseparateg

roup

,had

fewer

hospita

lisations,emergencyroom

admissions,urgentG

Pcalls,or

exacerbatio

ns.A

fterd

eductio

nof

TAcosts

,the

averageo

verallcostfore

ach

patie

ntwas

lessthan

thatforu

sualcare.Inchronicr

espiratory

failu

repatie

nts

onoxygen

orho

mem

echanicalventilation,

nurse-centredteleassis

tance

preventsho

spita

lisations,w

hileitiscost-

effectiv

e.Th

echron

icob

structive

pulm

onarydiseaseg

roup

seem

stohave

agreater

advantagefrom

teleassistance.

Vitaccae

tal.[129]

Theu

seof

telemedicineinsupp

orto

fweaning

from

invasiv

emechanicalventilationon

awom

anatho

meb

ymeans

ofa

telep

neum

ologyprogramme(TP

P)isdescrib

ed.U

nder

telep

hone

assistanceo

fapu

lmon

ologist

andaT

PPnu

rsetutor,the

pulse

darteria

lsaturim

etric

(pSaT),heartrate(H

R),and

breathingpatte

rntracingmon

itorin

gweretransmitted

viaa

hometele

phon

elinea

ndthea

idof

thec

aregiver.

Manypatientsa

thom

eonventilatorscouldpo

ssiblybe

weanedthroug

hthe

useo

frem

otem

onito

ringandcallcenter

respon

se,w

ithon

lyfamily/caregiverso

n-site.

Woo

dend

etal.[130]

Theimpactof

threem

onthso

ftele

homem

onito

ringon

hospita

lreadmiss

ion,

quality

oflife,andfunctio

nalstatusinpatie

ntsw

ithheartfailure

orangina

was

teste

d.Th

einterventionconsisted

ofvideocon

ferencingandph

onelinetransmissionof

weight,bloo

dpressure,and

electrocardiogram

s

Tele-hom

emon

itorin

gsig

nificantly

redu

cedthen

umbero

fhospital

readmiss

ions

anddays

spentintheh

ospitalfor

patie

ntsw

ithangina

and

improved

quality

oflifea

ndfunctio

nalstatusinpatie

ntsw

ithheartfailure

orangina.Patientsfou

ndthetechn

olog

yeasy

tousea

ndweres

atisfi

ed.

Telehealth

techno

logies

area

viablemeans

ofprovidingho

mem

onito

ringto

patie

ntsw

ithheartd

iseasea

thighris

kof

hospita

lreadm

issionto

improve

theirself-carea

bilities.

26 International Journal of Telemedicine and Applications

Table6:Con

tinued.

Stud

ies

Interventio

nMainresults

Walivaara

etal.[131]

Distric

tnurses(DNs)fro

mfour

healthcare

centresh

adaccessto

different

kind

sofd

istance-spann

ingtechno

logy

with

mob

iledevices

andused

itin

theirh

ealth

care

atho

me.

Ther

esultsfallinto

2categorie

s:thew

ell-k

nowntechno

logy

atho

spita

lsis

newatho

me;then

ewtechno

logy

opensu

ppo

ssibilities,bu

titalso

has

limitatio

ns.Th

epartic

ipantsview

edthetechn

olog

yatho

mea

ssom

ething

good

andas

something

thatcouldop

enup

possibilitie

s.At

thes

ametim

e,they

placed

theu

seof

thetechn

ologyin

theh

ands

ofthes

taff,

which

indicates

somed

egreeo

fdiss

ociatio

nfro

mthetechn

olog

y.Th

eimpo

rtance

ofperson

almeetin

gsbetweenpatie

ntandcaregiverw

asvery

clearlystressed

even

when

distance

meetin

gscouldbe

perfo

rmed

andaccepted.Th

epartic

ipants

expressedim

mense

trustinthen

ursin

gsta

ffandconsidered

them

respon

sible

forthe

newtechno

logy

atho

me.

Youn

getal.[132]

Thee

ffectivenesso

ftele

phon

eand

video-ph

onefollowup

forc

hildren

andfamilies

after

achild’sscoliosis

surgerywas

evaluated.At

discharge,thoseintheinterventiongrou

pwerep

rovidedwith

avideo-ph

oneo

peratin

gon

theo

rdinaryteleph

onen

etwork(PST

N).

Video-ph

onea

ndteleph

oneu

seprovided

care

continuityforp

atientsa

ndtheirfam

ilies

follo

wingac

hild’sback

surgery.Th

erela

tivee

ffectof

the

video-ph

onea

ndteleph

onetechn

olog

ydepend

edon

thefi

tbetweenthe

characteris

ticso

fthe

patie

ntsa

ndfamilies

andthec

apacities

ofthe

techno

logy.W

henim

plem

entin

gtelehealth

forfollow-upcare,a

participatory

processisrecom

mendedto

ensure

aproperfi

tbetweenuser

characteris

tics

andtechno

logy.

International Journal of Telemedicine and Applications 27

the use of ICT applications, despite that ICT cannot replacea face-to-face encounter but can be used as a complement.Across the literature, outcomes for telehealth-based servicesare generally comparable to outcomes for services deliveredface to face [21]. According to Charlton et al. [133], the styleand type of communication the healthcare professional usesinfluence care outcomes. A literature review [134] shows thatpatientswith possibilities of being cared for and using telecareat home preferred a combination of telecare and traditionalhealthcare delivery.Therefore, ICT applications must be usedas an adjunct and not as replacements for standard care;otherwise, the positive results might not be replicated [135].Many patients prefer being involved and participating indecision making regarding the care they will receive. Despitethis, caring programs will be developed without caregiver’sparticipation [136].

5.1. Methodological Considerations. The strength of thisreview is the broad literature search that finally resulted in 107studies. The literature search was systematically conductedusing selected databases based on relevant search terms. Eventhough the database search was done with assistance froma librarian expert in that field, it is possible that some studymight have been missed. To get the latest published studies,a search alert was created. A limitation of this review maybe that relevant studies might have been missed because ofthe selection of the English language. During the selectionprocess, a quality appraisal was conducted; thereby, thescientific quality of the included studies could be ensured.The studies included have a great variation in study designs.Therefore, it is not possible to integrate the results and givea more specific summary in this review. However, this wasnot the intention as the aim was broad; we wanted to findnumerous studies for being able to present the state of the artin this field of research.

6. Conclusion

The use of ICT applications in home care is an expandingresearch area, with a variety of ICT applications used toincrease access to home care. The result shows that ICTin home care is mostly used as a tool for communicationbetween healthcare professionals and patients or familymembers. Healthcare professionals can, based on this result,advantageously use ICT applications in home care as a tool tosupport people livingwith chronic illnesses gaining control oftheir illness that promotes self-care. However, a great numberof the included studies were performed as pilot studies. Forbeing able to evaluate the effects of ICT applications inhome care, more extensive longitudinal studies are needed.To understand more about how ICT can be adjusted to homecare, multidisciplinary and qualitative studies are neededfrom the perspective of the patient and their close relatives.

Conflict of Interests

Theauthors claim that there are no competing financial inter-ests.

Acknowledgment

The authors are grateful to Lotta Frank, librarian at LuleaUniversity Library LRC, Lulea University of Technology, forvaluable help with the systematic literature search.

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30 International Journal of Telemedicine and Applications

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