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Telemedicine is being used in an increasing number of countries as an alternative to face-to-face traditional healthcare, to reduce the chances of spreading COVID-19. Although the use and benefits of telemedicine have been increasingly demonstrated for a long time, we do not know much about its adoption and use during the COVID-19 pandemic, when the community is confined by the social distancing restrictions. The main aim of this research is to study the factors affecting the adoption and use of telemedicine in patients during the period of COVID-19 restrictions. We also want to investigate the benefits of telemedicine for patients. We used a qualitative approach in this study. We interviewed six patients who used telemedicine during the COVID-19 restrictions. We find that telemedicine applications offered an overall positive experience for patients as a viable alternative way of medical care when physical attendance was restricted.

Aims and Objectives: To explore the effects of introducing a telemonitoring and care planning system for urinary continence assessment in a nursing home and adherence by care staff to urinary continence care plans., Background: Only a few studies have explored the effect of introducing telemonitoring system on urinary continence care, none for older people in nursing homes., Design: Pre- and postintervention repeated measures design., Methods: Data for the study were collected from August-October 2011. Care staff were trained in the use of a telemonitoring system for continence assessment. Voiding events for each older person were recorded using the system during a 72-hour urinary continence assessment, and the data were used to prepare an individualised care plan. After two weeks of using the new care plan, a second assessment was carried out for each older person, using the telemonitoring system., Results: The participants were on average 81 years old and assessed as having high care needs. The statistically significant outcomes were as follows: reduced volume of urine voided into continence aids, reduced number of prescribed toileting visits, increased number of actual toilet visits, increased number of successful toileting events and increased adherence to urinary continence care plans by staff., Conclusions: During a 12-week trial, urinary continence assessment and management of older people were improved. This suggests that the introduction of a suitably designed telemonitoring system combined with staff training can improve urinary continence care., Relevance to Clinical Practice: The results suggest that nursing homes can improve continence assessment and management practices by adopting an appropriately designed mobile, wireless telemonitoring system for continence assessment and providing the associated staff training programmes., (© 2014 John Wiley & Sons Ltd.)

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.

Telehealth has the potential to improve the management of chronic health conditions but there are still limited data on its effectiveness and cost-effectiveness in routine practice. A questionnaire study nested within a pragmatic randomized controlled trial estimated costs and outcomes for management of patients in England who had heart failure, chronic obstructive pulmonary disease, or diabetes. Patients received telehealth support and usual care or usual care only. The study perspective was that of the health system. Incremental cost per quality-adjusted life year of telehealth when added to usual care was £79,000. In this setting, telehealth had a low probability of being a cost-effective addition to standard care for patients with the chronic conditions.

Background: A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine., Method: The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant., Discussion: Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.

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.

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 identified in the literature search and through references from a 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 videoconferencing and five with telephone- based services. Clinical use of videoconferencing 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.

Objective: To review the evidence of benefit from use of telemental health (TMH) in studies that reported clinical or administrative outcomes., Method: Relevant publications were identified through computerized literature searches using several electronic databases. Included for review were scientifically valid articles that described controlled studies, comparing TMH with a non-TMH alternative, and uncontrolled studies that had no fewer than 20 participants. Quality of the evidence was assessed with an approach that considers both study performance and study design. Judgments were made on whether further data were needed to establish each TMH application as suitable for routine clinical use., Results: Included in the review were 72 papers that described 65 clinical studies; 32 (49%) studies were of high or good quality. Quality of evidence was higher for Internet- and telephone-based interventions than for video conferencing approaches. There was evidence of success with TMH in the areas of child psychiatry, depression, dementia, schizophrenia, suicide prevention, posttraumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention. Evidence of success for general TMH programs and in the management of obsessive-compulsive disorder were less convincing. Further study was judged to be necessary or desirable in 53 (82%) of the studies., Conclusion: Evidence of benefit from TMH applications is encouraging, though still limited. There is a need for more good-quality studies on the use of TMH in routine care. The emerging use of Internet-based applications is an important development that deserves further evaluation.

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.

Telemedicine has the potential substantially to improve the delivery of health care. However, cost-effectiveness studies are needed to help define the appropriate scope and application of telemedicine in different settings. Reports on the evaluation of telemedicine are dominated by technical and feasibility studies. Such studies may be very helpful for initial decision making. However, any cost information at this level tends to be very preliminary and often concerned with making a case to proceed further. Decision makers will wish for further information as the telemedicine application is introduced, to consider its effectiveness - its performance under routine conditions. Without information on the costs and effectiveness of telemedicine services, decision makers run the risk of supporting telemedicine systems that are not responsive to health-care needs or which do not provide cost-effective services. The most immediate needs seem to be improvements in the conduct and reporting of studies, and additional information on the performance of telemedicine in routine practice. Investigators need to provide transparent accounts of their studies, describing in detail the approaches taken, sources of data and assumptions made, and indicating the reliability of their results. Decisions may have to be made on the basis of limited studies, but sufficient detail must be made available to decision makers.

Economic evaluation of telemedicine applications is required to provide decision makers in health care with appropriate information on costs and benefits of this information and communications technology. The level of economic evaluation should evolve as telemedicine applications mature. At the basic level, economic evaluation may include basic cost analysis and primarily observational data on nonmonetary benefits. The focus will change as telemedicine programs develop. At this intermediate level, practice patterns and workforce issues are addressed as they affect utilization and costs of telemedicine services. Longer-term economic evaluation, thus far not achieved in telemedicine assessment, should focus on assessment of health outcomes and economic impact. Alberta, Canada has made progress assessing telemedicine applications in psychiatry, radiology, rheumatology, and rehabilitation. Data availability and analytic resources continue to present challenges to economic assessment of telemedicine.

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.

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.

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.

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.

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.

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.

Telemedicine is being used in an increasing number of countries as an alternative to face-to-face traditional healthcare, to reduce the chances of spreading COVID-19. Although the use and benefits of telemedicine have been increasingly demonstrated for a long time, we do not know much about its adoption and use during the COVID-19 pandemic, when the community is confined by the social distancing restrictions. The main aim of this research is to study the factors affecting the adoption and use of telemedicine in patients during the period of COVID-19 restrictions. We also want to investigate the benefits of telemedicine for patients. We used a qualitative approach in this study. We interviewed six patients who used telemedicine during the COVID-19 restrictions. We find that telemedicine applications offered an overall positive experience for patients as a viable alternative way of medical care when physical attendance was restricted. [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]

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 conducted a systematic review of the literature to identify studies in home telehealth that compared a home telehealth intervention with a non-telehealth standard/usual care alternative in terms of administrative changes, patient management decisions, patient outcomes, caregiver outcomes, economic impact or social impact on patients. A search of various databases produced 6643 references. Of these 769 papers were selected for more detailed investigation. These papers, combined with hand searching of relevant telehealth journals and cross-referencing of citations in identified publications, resulted in 138 papers referring to 130 projects for review. In this preliminary analysis we used a quality appraisal approach that took into account the study design. An additional analysis of patient numbers was then used to calculate a net evidence score. A large proportion of studies (80%) were randomised controlled trials. Only 22 projects (17%) reported economic data deemed to be sufficient for appraisal. Evidence exists for the clinical effectiveness of home telehealth in diabetes, the general area of mental health, high risk pregnancy monitoring, heart failure and cardiac disease. [ABSTRACT FROM AUTHOR]

We conducted a systematic review of evidence on the ability of tele-oncology applications to improve access to care closer to home for adult rural patients affected by cancer. From 269 publications identified in the literature search, 54 studies met our inclusion criteria. Forty two were clinical studies (32 quantitative, eight qualitative and two that included both quantitative and qualitative methodology). Strength of evidence from quantitative clinical studies was assessed using an approach that takes account of both study design and study quality. Qualitative studies were appraised by giving scores for six areas of interest. In terms of the continuum of cancer care, the most common study area was psychosocial and supportive care. While there were a number of high quality studies, overall the evidence of benefit from tele-oncology was limited and few investigations had proceeded beyond the stage of establishing feasibility. The literature suggests some useful possibilities for new services to cancer patients in rural areas but it seems likely that these would need validation with suitable local studies. [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]

Background: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature.Methods: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles.Results: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving.Interpretation: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use. [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 compared conventional palliative homecare visits and a combination of conventional and home telehealth 'video-visits' with respect to symptom management and quality of life. Participants were recruited from 11 rural communities in Alberta and randomized to the treatment or control groups, remaining in the study for 8 weeks. Although we planned to recruit 200 clients over two years, only 44 clients participated. Factors contributing to low recruitment included the introduction of new service delivery models and changes in the home care environment. No significant differences were found between the groups in measures of symptom management and quality of life. Compared to the home care nurses, clients generally indicated a higher level of readiness to use the technology. The study suggested that videophone technology would probably not be adopted for palliative home care in the population that was studied although it might be considered for other applications in the management of chronic illnesses. [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]

The author reflects on the feasibility of home telehealth system in terms of the quality and cost effectiveness from the available evidence. The difficulty in assessing the contribution of the telehealth system to the total medical care is discussed. The author mentions that less data and improper funding are insufficient evidence. The author suggests a stronger assessment process with clear presentation of data and longterm evaluation for the success of telehealth system survey.

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