Search

We systematically reviewed the evidence for the effectiveness of tele-neurorehabilitation (TNR) applications. The review included recent reports on rehabilitation for any disability associated with a neurological deficit or condition. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each application had been successful, and whether further data were needed to establish the application as suitable for routine use. Nineteen credible studies that reported patient outcomes or administrative changes were identified. These studies related to 13 conditions. The focus of rehabilitation included Internet-supported treatments for management of fatigue, pain and depression; promotion of physical activity; and speech therapy. Sixteen studies were of high or good quality and three were fair to good, with some limitations. In 13 of the 19 studies the TNR application was successful in providing at least equivalent outcomes to conventional approaches. Additional work would be needed on eight applications to establish suitability for routine use, and would be desirable in five. Thus the recent literature provides further support for TNR applications, showing the promise of this field in a number of areas. However, the database of credible studies remains small. [ABSTRACT FROM PUBLISHER]

We systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications. The review included reports on rehabilitation for any disability, other than mental health conditions, and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of study design were considered. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each TR application had been successful, whether reported outcomes were clinically significant, and whether further data were needed to establish the application as suitable for routine use. Sixty-one scientifically credible studies that reported patient outcomes or administrative changes were identified through computerized literature searches on five databases. Twelve clinical categories were covered by the studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one of the studies (51%) were of high or good quality. Study results showed that 71% of the TR applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies tended to have worse outcomes than those from high- or good-quality studies. We judged that further study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many fields, but compelling evidence of benefit and of impact on routine rehabilitation programmes is still limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in routine care. [ABSTRACT FROM AUTHOR]

An evaluation was undertaken on the effectiveness and efficiency of care coordination in delivering health services to Australian veterans with chronic or complex medical conditions requiring multidisciplinary care and who had moderate to high care needs. The veterans participated in a randomized controlled trial (RCT) supported by the Department of Veterans' Affairs. For evaluation of the RCT, information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Of 525 veterans who were recruited, 481 were surveyed at baseline (243 in the intervention group and 238 controls). At follow-up, 421 were surveyed (213 intervention and 208 controls). There were no significant differences between the coordinated care and control groups of veterans in costs of care or in QOL measurements using the SF-12 Health Survey and the EuroQol Group EQ-5D. These findings are consistent with those reported in earlier studies which suggest that benefits from care coordination programmes may take some time to emerge. [ABSTRACT FROM AUTHOR]

An evaluation was undertaken on the effectiveness and efficiency of care coordination as a means of delivering health services to Australian veterans with a diagnosis of congestive heart failure. The veterans participated in a randomized controlled trial of care coordination that was supported by the Department of Veterans' Affairs (DVA). Of 490 veterans who were recruited, 409 were surveyed at baseline (214 in the intervention group and 195 controls). At follow-up, 288 were surveyed (155 intervention and 133 controls). Information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Cost of care data were obtained from DVA records. Information on QOL was obtained from telephone interviews, using the Short Form (SF-12) Health Survey and the EuroQol Group EQ-5D survey. There were no significant differences in costs of care between the intervention (coordinated care) and control groups of veterans. Nor were there significant differences between the intervention and control groups in QOL measurements with either of the evaluation tools that were used. Because evidence of benefit from coordinated care may be slow to emerge in patients with chronic disease, it would be desirable for future work in this area to include long term, good quality comparative studies on selected veteran populations. Such studies should measure QOL and economic outcomes in addition to clinical indicators. [ABSTRACT FROM AUTHOR]

Telepsychiatry is well established in many countries, but there is still little information about its use in routine health care. We reviewed the literature for information on the use of telepsychiatry in mental health services. From 1033 publications identifiedin the literature search and through references froma separate project, 16 studies or descriptions of the routine use of telepsychiatry services were selected for further review. Eleven of these articles dealt primarily with video conferencing and five with telephone-based services. Clinical use of video conferencing in the programmes described by the reviewed papers was modest, with an average of 16 consultations per month. Three of the telephone-based services had large numbers of clients. The papers we reviewed gave limited consideration to the healthcare systems in which telepsychiatry was provided and to the use of conventional mental health services. Telepsychiatry appears to still be a niche technology in many health systems. A lack of champions for the technology and reimbursement problems may contribute to the limited use of this area of telemedicine. [ABSTRACT FROM AUTHOR]

A comparative study was conducted in two Australian nursing homes operated by the same organization. One home had implemented an electronic documentation system and the other remained paper-based. Survey questionnaires were answered by 14 of the 17 caregivers at the electronic documentation site (82%) and 10 of the 23 caregivers at the paper documentation site (43%). They provided opinions about satisfaction with their home's documentation system, and the training and support provided. Information was also obtained on the caregivers' attitudes towards using electronic documentation. The caregivers at the electronic documentation site quickly adapted to the use of the new technology after receiving effective training and support. Caregivers at both homes were satisfied with their homes' documentation system, and had positive attitudes towards using electronic documentation systems. As an important communication tool, electronic nursing documentation may lead to improved efficacy of telemedicine in nursing home settings. [ABSTRACT FROM AUTHOR]

The utilization of telemental health (TMH) services in Finland was surveyed in 2006. In total, 135 health-care units provided responses. Eighty-four responses were received from primary care units (health-care centres and clinics) and eight from other clinics, in all hospital districts. The overall rate of TMH consultations was 4 per 100,000 population. The highest TMH consultation per population ratio, 22 per 100,000, was in northern Finland. Most of the sites used telepsychiatry services for less than 10% of clinical outpatient services. The sites with over 20% utilization of clinical TMH services from all psychiatric consultations were all rural health centres. Compared with Finland, the utilization rates of TMH were higher in Canada; that might be due to differences between the countries in the organization of mental health services in primary and specialized care. In Finland TMH consultations made up only a very small proportion of all mental health services. The use of TMH was particularly common in remote areas; however, there were many rural centres that did not utilize clinical TMH. TMH was widely utilized for continuing and medical education. [ABSTRACT FROM AUTHOR]

Each of 130 studies about home telehealth was independently rated by three reviewers in terms of patient selection, specification of interventions, specification of analysis, patient disposal and outcomes reported. The mean ratings of study quality were used to calculate an overall decision-making score. From the decision-making score, a net evidence score was derived for each of the 26 diseases/conditions identified. The mean decision-making score, combining study design and quality ratings, was used for comparison with a preliminary report prepared in 2006. The inclusion of ratings of study quality strengthened and confirmed the original findings. In summary, there are good to high quality studies supporting the use of home telehealth in the areas of diabetes, the general area of mental health, high-risk pregnancy monitoring, heart failure, other cardiac conditions and smoking cessation. Incorporating the rating of study quality in systematic reviews is an important step which provides additional information about the strength of evidence available. [ABSTRACT FROM AUTHOR]

We carried out a systematic review of recent telemedicine assessments to identify scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes or the results of an economic assessment. From 605 publications identified in the literature search, 44 papers met the selection criteria and were included in the review. Four other publications were identified through references cited in one of the retrieved papers and from a separate project to give a total of 48 papers for consideration, which referred to 42 telemedicine programmes and 46 studies. Some kind of economic analysis was included in 25 (52%) of the papers. In considering the studies, we used a quality appraisal approach that took account of both study design and study performance. For those studies that included an economic analysis, a further quality-scoring approach was applied to indicate how well the economic aspects had been addressed. Twenty-four of the studies were judged to be of high or good quality and 11 of fair to good quality but with some limitations. Seven studies were regarded as having limited validity and a further four as being unacceptable for decision makers. New evidence on the efficacy and effectiveness of telemedicine was given by studies on geriatric care, intensive care and some of those on home care. For a number of other applications, reports of clinical or economic benefits essentially confirmed previous findings. Although further useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce. [ABSTRACT FROM AUTHOR]

A survey of Canadian telepsychiatry programmes was undertaken to provide information for future health services. Fourteen programmes were identified. They used a variety of service models and administrative arrangements. The average number of clinical consultations per programme per year was 238, which corresponds to 107 psychiatric teleconsultations per million persons served by the programmes. The rate for children's telepsychiatry services was higher, at 194 per million. Comparison with some telepsychiatry programmes in the USA revealed similar patterns of activity. While the development of telepsychiatry services in Canada is promising, there is nevertheless concern regarding the viability and activity levels of these programmes over the long term. This survey demonstrates that programmes from across a large country can respond to a standardized questionnaire and provide comparable information. [ABSTRACT FROM AUTHOR]

A guideline for assessment of telemedicine applications was used by the Alberta Mental Health Board (AMHB) in its evaluation of a telemedicine mental health (TMH) service. Many attributes referred to in the guideline were well covered in the AMHB evaluation. However, there were limitations on the assessment of outcomes and cost-effectiveness. From the perspective of the AMHB, the guideline was helpful, although more so in the earlier stages of the TMH service than for its appraisal as it reached maturity. The measures of performance suggested by the guideline did not fully match local operational conditions. Constraints on the assessment of the mature TMH service included the complexity of the network, the limited resources available for evaluation and the routine administrative demands of decision makers. This experience points to the usefulness of standardized assessment approaches to telemedicine, but also to their limitations. [ABSTRACT FROM AUTHOR]

A systematic review of telemedicine assessments based on searches of electronic databases between 1966 and December 2000 identified 66 scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes, or results of economic assessment. Thirty-seven of the studies (56%) suggested that telemedicine had advantages over the alternative approach, 24 (36%) also drew attention to some negative aspects or were unclear whether telemedicine had advantages and five (8%) found that the alternative approach had advantages over telemedicine. The most convincing evidence on the efficacy and effectiveness of telemedicine was given by some of the studies on teleradiology (especially neurosurgical applications), telemental health, transmission of echocardiographic images, teledermatology, home telecare and on some medical consultations. However, even in these applications, most of the available literature referred only to pilot projects and to short-term outcomes. Few papers considered the long-term or routine use of telemedicine. For several applications, including teleradiology, savings and sometimes clinical benefit were obtained through avoidance of travel and associated delays. Studies of home care and monitoring applications showed convincing evidence of benefit, while those on teledermatology indicated that there were cost disadvantages to health-care providers, although not to patients. Forty-four of the studies (67%) appeared to have potential to influence future decisions on the telemedicine application under consideration. However, a number of these had methodological limitations. Although useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce and the generalizability of most assessment findings is rather limited. [ABSTRACT FROM AUTHOR]

There is relatively little information on the routine use of telemental health (TMH). As part of a Canadian–Finnish project, we reviewed the use of TMH in Alberta. Using administrative data, numbers and types of TMH consultations in the province's health regions were compared with earlier published data for Alberta, and with data for Finland and other Canadian provinces. Since the first year of routine use (1997) there has been a six-fold increase in the use of TMH, and numbers of consultations per head of population are higher than elsewhere in Canada or in Finland. TMH accounts for 8% of mental health clinic consultations in the seven rural health regions. However, two regions have made negligible use of clinical TMH. TMH provides only a small proportion of all outpatient mental health services. TMH in Alberta is established in rural health regions, although with variable coverage, but remains a niche technique when all mental health services are considered. [ABSTRACT FROM AUTHOR]

We carried out a systematic review of the literature on telecardiology assessment from 1992 to September 2003. We selected articles reporting clinical, economic or administrative outcomes. Quality of evidence was assessed using an approach that considered both study design and study performance. Forty-four studies met the selection criteria. Studies of home care applications, particularly management of congestive heart failure, were of highest quality, giving a high degree of confidence in their findings. Studies on paediatric and non-emergency adult hospital applications were of poorer quality; they were mostly reports of case series and gave relatively little detail. Economic analysis was limited to cost studies and in most cases was judged to be of poor to fair quality. While telecardiology has been widely applied, there is still limited good-quality evidence of its benefits to health-care. Success in establishing the feasibility of telecardiology applications is offset by a failure to obtain convincing data on their influence on health outcomes and on their cost-effectiveness. [ABSTRACT FROM AUTHOR]

Papers presented at the three Successes and Failures in Telehealth conferences have made a helpful contribution to what is known about the practicalities of implementing and using telehealth. Ten of the 89 papers covered general concepts, 40 described primary studies and 26 discussed telehealth programmes or networks. Common themes that emerged on determinants of success and failure included the reliability of equipment, the reliability of vendors, political and budgetary issues, the perceived need for telehealth, the involvement of stakeholders, health professionals' opinions, the stability of management structures, the turnover of personnel and cooperation between organizations. Limitations in some papers included an absence of data, weak study designs, short-term perspectives and lack of information on health outcomes. Despite these limitations, the papers have made a valuable contribution to our knowledge of what has worked and what has failed in the field of telehealth. [ABSTRACT FROM AUTHOR]

Development of telemedicine mental health services in Alberta evolved via a pilot project, the delivery of routine services to a small group of centres and subsequent expansion to a province-wide programme. Success of the service was linked to support for telehealth by the provincial government and consultation between the Alberta Mental Health Board (AMHB) and local stakeholders. Assessments by the AMHB have shown that telepsychiatry is acceptable and sustainable at a realistic cost. However, there are few measures of clinical effectiveness available and none of cost-effectiveness. A detailed economic evaluation of the telemedicine mental health network would now be a major task. The expansion of telemedicine mental health services has increased the expectations of health-care decision makers. In addition, the complexity of the network has increased and new initiatives, such as the use of telepsychology, have been introduced. Management of this successful telehealth programme continues to be time consuming and challenging. [ABSTRACT FROM AUTHOR]

Diagnostic and therapeutic procedures associated with cardiology are heavily supported by diagnostic imaging technology. The management of such images, including radiographs, echocardiography examinations and cardiac angiography studies, requires a suitable means of handling the data. A number of manufacturers are now offering picture archiving and communication systems (PACS) and telecardiology options. These could greatly improve the efficiency of data management for cardiac examinations, including linkage to radiology and hospital information systems and electronic patient records. A barrier to the implementation of cardiac PACS has been the relatively high capital cost. There have also been technical difficulties in implementing a suitable interface. Historical problems have included 'turf wars' between different specialist groups and a reluctance to shift from well established practice patterns. Early cooperative work between radiologists and cardiologists in the development of coronary arteriography has been replaced by contention between cardiologists, radiologists and vascular surgeons, often driven by economic considerations rather than the needs of the patient. At this stage, cardiac PACS and telecardiology have great potential for improving the coordinated care of cardiac patients in Australia. [ABSTRACT FROM AUTHOR]

Canada has taken important steps towards establishing telehealth within its health-care system. However, in many areas telehealth in Canada has yet to progress beyond the stage of testing feasibility. A recent survey of eight Canadian telehealth programmes that are using videoconferencing indicated that there is little evidence of either clinical or economic benefits compared with conventional care. There are examples of sustainable, routine telehealth services in Canada. However, overall, the number of patients seen by telehealth is still very small in comparison with the number of face-to-face visits. 'People-related' factors seem dominant in determining the degree of success of telehealth applications. [ABSTRACT FROM AUTHOR]

The European Federation for Medical Informatics is developing a detailed guideline for preparing evaluation reports. By doing this, it is hoped that the quality of evaluation studies in health informatics will improve and thus the evidence base. While much of the necessary information for preparing good quality evaluation publications is available in other documents, the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) is valuable in bringing together many points into a single document. The current version is comprehensive and includes valuable information on a number of areas. A list of recommended items for inclusion in an evaluation report is given. There is perhaps a danger that some authors might be intimidated by the suggested detail to be provided. Nonetheless, the Federation is to be congratulated for putting together a comprehensive guideline which promises to be a useful contribution to improving the quality of evaluation studies in information technology, including telemedicine. [ABSTRACT FROM AUTHOR]

A preface for the February 2, 2002 issue of the "Journal of Telemedicine & Telecare" is presented.