Telehomecare

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Telehomecare (THC) is a subfield within telehealth. It involves the delivery of healthcare services to patients at home through the use of telecommunications technologies, which enable the interaction of voice, video, and health-related data. [1] The management of care is done from an external site by a healthcare professional.

Contents

Though often used interchangeably with remote patient monitoring, telehomecare encompasses more than just monitoring, as it includes education, emotional and social support, information dissemination, and self-care guidance. THC has been employed to improve the management of chronic health conditions such as heart disease, COPD, and diabetes, potentially reducing the number of visits to primary healthcare services. The aging population's increasing demand for home care emphasizes the need for accessible healthcare services, which THC can address. Furthermore, THC facilitates connections between hospitals and primary care providers, improving patients' access to services and potentially reducing healthcare costs.

THC technology caters to various patient needs, ranging from minimal to sophisticated monitoring. A typical system comprises a central unit connected to one or more peripheral devices, such as blood pressure monitors, weight scales, glucometers, pulse oximeters, peak flow meters, or stethoscopes. Patients input their vital signs and health information into the THC unit either manually or via the peripherals. This data is transmitted through telephone lines to a secure server at the manufacturer's data center before being uploaded to a secure web-based application. Healthcare professionals can then access and review the patient's information from any location with internet connectivity.

Applications

Based on research conducted in the United States by the Capital Area Consortium on Aging and Disability, the bandwidth of 128 kbs was useful in a wide range of medical and nursing applications of THC. This includes: [2]

One of the applications of THC is providing nursing care using telephones, televisions, computers, and videoconferencing. [4] THC can potentially improve patient outcomes, increase healthcare providers' productivity, and reduce healthcare costs. [4] This application may be referred to as telenursing.

Cost-effectiveness

THC has demonstrated a significant impact on hospital admissions and emergency room visits, as well as, walk-in clinic visits. Ontario Telemedicine Network (OTN) conducted a trial program that involved more than 800 patients with one of two chronic diseases - Congestive Heart Failure or COPD. The results were:

THC offers the opportunity to shift the delivery of many healthcare services from hospitals and other healthcare facilities to patients' homes, thus reducing the load on the healthcare system and reserving hospitals for more critical cases. A recent study in The Journal of Telemedicine and Telecare showed that very few studies have evaluated the cost-effectiveness of THC, therefore, more research is needed to assess the value of THC in reducing costs associated with chronic disease management. [6]

Related Research Articles

<span class="mw-page-title-main">Ambulatory care</span> Medical care provided for outpatients

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

<span class="mw-page-title-main">Primary care</span> Day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a chiropractor,a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health.

<span class="mw-page-title-main">Telenursing</span>

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant."

<span class="mw-page-title-main">Self-care</span> Taking care of ones own health

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, reading and dental care. Self-care is not only a solo activity as the community—a group that supports the person performing self-care—overall plays a large role in access to, implementation of, and success of self-care activities.

A nurse-led clinic is any outpatient clinic that is run or managed by registered nurses, usually nurse practitioners or Clinical Nurse Specialists in the UK. Nurse-led clinics have assumed distinct roles over the years, and examples exist within hospital outpatient departments, public health clinics and independent practice environments.

Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.

Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, systemic lupus erythematosus, multiple sclerosis, and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.

Unwarranted variation in health care service delivery refers to medical practice pattern variation that cannot be explained by illness, medical need, or the dictates of evidence-based medicine. It is one of the causes of low value care often ignored by health systems.

mHealth Medicine and public health supported by mobile devices

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and personal digital assistants (PDAs), and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery/sharing of healthcare information for practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care as well as training and collaboration of health workers.

Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information over a distance using audio, visual, and data communication. Applications comprise health care management such as diagnoses, consultation, and treatment as well as (continuous) education.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.

<span class="mw-page-title-main">Remote patient monitoring</span>

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

<span class="mw-page-title-main">Eastern Health Alliance</span> Hospital in Tampines Plaza, Singapore

Eastern Health Alliance was a regional health system in the east of Singapore.

<span class="mw-page-title-main">Glooko</span>

Glooko, Inc provides a Software-as-a-Service (SaaS) application and accompanying mobile app for diabetes patients and their healthcare providers in the United States and internationally.

Model for assessment of telemedicine (MAST) is a framework for assessment of the value of telemedicine.

e-consult is a mechanism developed by the Department of Veterans Affairs that enables primary care providers to obtain specialists' inputs into a patient's care treatment without requiring the patient to go to a face-to-face visit.

References

  1. Bowles, Kathryn H.; Baugh, Amy C. (January 2007). "Applying Research Evidence to Optimize Telehomecare". The Journal of Cardiovascular Nursing. 22 (1): 5–15. doi:10.1097/00005082-200701000-00002. PMC   2874189 . PMID   17224692.
  2. 1 2 Health Canada. (1998). Tele-Homecare: An Overview - Background Paper for Discussion.
  3. Street Jr, R. L.; Gordon, H. S.; Ward, M. M.; Krupat, E.; Kravitz, R. L. (2005). "Patient participation in medical consultations: Why some patients are more involved than others". Medical Care. 43 (10): 960–969. doi:10.1097/01.mlr.0000178172.40344.70. PMID   16166865. S2CID   28640847.
  4. 1 2 Thobaben, Marshelle (2005). "Telehomecare". Home Health Care Management & Practice. 17 (6): 487–488. doi:10.1177/1084822305278125.
  5. Lemelin, Annie; Paré, Guy; Bernard, Sophie; Godbout, Ariane (2020). "Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management". Diabetes Technology & Therapeutics. 22 (3): 195–202. doi:10.1089/dia.2019.0259. ISSN   1520-9156. PMID   31603351. S2CID   204244463.
  6. Wootton, R. (2012). "Twenty years of telemedicine in chronic disease management--an evidence synthesis". Journal of Telemedicine and Telecare. 18 (4): 211–220. doi:10.1258/jtt.2012.120219. PMC   3366107 . PMID   22674020.

External sources