review article using information and communication technology...
TRANSCRIPT
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; [email protected]
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
10
5
0
3
11
5
810
4
1214
16
1
23
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
25
30
35
40
20
15
10
5
0
38
9 7 6 5
12 13
2 2 2
Chro
nic
wou
nds
Dia
bete
s
Canc
er
Stro
ke
Infe
ctio
usdi
seas
es
Spin
al co
rdin
jurie
s
End-
of-li
feca
re
Non
spec
ified
diag
nosis
Hea
rt an
dlu
ng
Chro
nic
illne
ss
Disease diagnosis
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
ble6:Overviewof
studies
(𝑛=107)included,interventio
ns,and
mainresults.
Stud
ies
Interventio
nMainresults
Agrelletal.[28]
Chronically
illpatie
ntsc
ould
usem
edicalequipm
entintheirh
omes
guided
bynu
rses
viav
ideo-based
hometelecares
ervices.
Participantsweree
ither
very
satisfiedor
somew
hatsatisfi
edwith
services
they
hadreceived.A
llexcept
onew
erew
illingto
receiveh
ometele
care
services
inthefuture.Th
epresenceo
ftele
care
equipm
entintheh
omeimplied
24-hou
r-a-dayaccessto
anurse.Som
eofthe
participantsfeltun
comfortable
disclosin
gintim
ateinformationdu
ringtelevisitsa
ndotherslamentedthe
redu
cedam
ount
oftim
enursesspent
“socializing”
ascomparedto
in-person
visits.
Ameenetal.[29]
Patie
ntsinan
experim
entaland
controlgroup
hadtheiru
lcers
photograph
edbefore
andaft
ertheintervention.
Duringthe
interventio
nperio
d,an
experie
nced
clinicaln
urse
specialistintissue
viabilitygave
expertteleadvice
tothec
ommun
itynu
rse.
Statisticallysig
nificantimprovem
entswereo
bservedforthe
experim
ental
grou
pin
thea
reas
ofdressin
gsandmanagem
ent.Teleadvice
canbe
ofgreat
benefit
tocommun
itynu
rses
inenhancingtheirk
nowledgeinthep
racticeo
flegulcerc
are.Provision
ofteleadvice
cansig
nificantly
improven
urses’
know
ledgeinthec
areo
fleg
ulcers.Tele
advice
hasimplications
form
ore
efficientu
seof
human
resourcesa
ndcosteffectiv
enessinwou
ndcare.
ArnaertandDele
sie[30]
Real-timeinterperson
alcommun
icationwas
used
betweeneld
erly
patie
ntsa
ndnu
rses.Tele
-nursesd
eliveredpsycho
socialsupp
ortand
educationalinterventions
basedon
threep
rinciples:con
tactand
commun
ication,
safetyandprotectio
n,andcare
mediatio
n.
Telecare
isan
alternativec
arem
odelthatcouldbe
integrated
into
existing
homecares
ervicestoprovideo
lder
peop
lewith
integrated
health
services.
Arnaertetal.[31]
Videoteleph
ones
(videoph
ones)w
ereu
sedfore
xplorin
gattitud
esof
oldera
dults
with
depressiv
esym
ptom
sintheirh
omes.
Participants’
preattitudesw
ered
ependent
ontheira
ctiveo
rpassiv
eroleinthe
learning
processo
fthe
newtechno
logy.Th
eirp
ostattitudesw
erec
lassified
asam
bivalent
orpo
sitive.Tw
oparticipantswho
hadap
ositive
attitud
etow
ard
thev
ideoph
ones
expressedap
ositive
behavior
use.
Artinianetal.[32]
Patie
ntsp
articipated
innu
rse-managed
hometele-mon
itorin
gplus
usualcareo
rinnu
rse-managed,com
mun
ity-based
mon
itorin
gplus
usualcare.Ea
chweekdu
ringthes
tudy
perio
d,patie
ntsreceived
teleph
onec
ounselingabou
tlifesty
lemod
ificatio
ns.A
specially
trained
registe
rednu
rsed
elivered
theinterventions.E
achparticipant
received
anele
ctronich
omeB
PLinkmon
itora
ndBP
mon
itorin
gservices.Th
eBPL
inkmon
itorisa
syste
mthatenables
person
sto
mon
itorb
lood
pressure
andheartratea
thom
eand
send
readings
totheinvestig
ator
andto
theirp
rimarycare
provider
byteleph
one
with
outthe
useo
facompu
ter
Participantsin
theh
ometele-mon
itorin
gandcommun
ity-based
mon
itorin
ggrou
pshadclinically
andsta
tistic
allysig
nificantreductio
nsin
both
systo
licbloo
dpressure
anddiastolic
bloo
dpressure
durin
ga3
-mon
thmon
itorin
gperio
das
comparedwith
thep
artic
ipantsin
theu
sualcare
grou
p.
Baer
etal.[33]
Wou
ndsw
erep
hotographedby
ahom
ecaren
urse
usingad
igita
lcamera,andtheimages
weretransmitted
toas
erverfrom
then
urse’s
office,togetherw
ithpatient
details.Th
ehom
ecaren
urse
graded
the
wou
ndsa
ndsuggestedatreatmentp
lan.
Subsequently,
aspecialist
wou
ndcare
nursea
lsograded
them
andsuggestedatreatmentp
lan,
usingthed
atas
toredon
thew
ebserver,H
omeT
elehealth
Con
sultatio
nSyste
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.
References
[1] A. Haahr, M. Kirkevold, E. Hall, and K. Østergaard, “Livingwith advanced Parkinson’s disease: a constant struggle withunpredictability,” Journal of Advanced Nursing, vol. 67, no. 2, pp.408–411, 2011.
[2] K. Roback and A. Herzog, “Home informatics in healthcare:assessment guidelines to keep up quality of care and avoidadverse effects,” Technology and Health Care, vol. 11, no. 3, pp.195–206, 2003.
[3] M. Ohman, S. Soderberg, and B. Lundman, “Hovering betweensuffering and enduring: the meaning of living with chronicillness,” Qualitative Health Research, vol. 13, no. 4, pp. 528–524,2003.
[4] G. Demiris, “The diffusion of virtual communities in healthcare: concepts and challenges,” Patient Education and Counsel-ing, vol. 62, no. 2, pp. 178–188, 2006.
[5] S. Koch andM. Hagglund, “Health informatics and the deliveryof care to older people,” Maturitas, vol. 63, no. 3, pp. 195–199,2009.
[6] European Commision, “What is eHealth? ICT for health,”Europe’s Information Society, 2012, http://ec.europa.eu/infor-mation society/activities/health/whatis ehealth/index en.htm.
[7] S. Koch, “Home telehealth: current state and future trends,”International Journal of Medical Informatics, vol. 75, no. 8, pp.565–576, 2006.
[8] WHO, “eHealth for health-care delivery,” 2005, http://www.who.int/eht/eHealthHCD/en/index.html.
[9] S. M. Finkelstein, S. M. Speedie, G. Demiris, M. Veen, J. M.Lundgren, and S. Potthoff, “Telehomecare: quality, perception,satisfaction,” Telemedicine and e-Health, vol. 10, no. 2, pp. 122–128, 2004.
[10] C. Nilsson, M. Ohman, and S. Soderberg, “Information andcommunication technology in supporting people with seriouschronic illness living at home—an intervention study,” Journalof Telemedicine and Telecare, vol. 12, no. 4, pp. 198–202, 2006.
[11] A. DiCenso, G. Guyatt, and D. Ciliska, Evidence-Based Nursing:AGuide to Clinical Practice, ElsevierMosby, St. Louis,Mo, USA,2005.
[12] SBU (Swedish Council on Technology Assessment in HealthCare), “Literature searching and evidence interpretation forassessing health care practices,” SBU Report no. 119E, Author,Stockholm, Sweden, 1993.
[13] SBU (Swedish Council on Technology Assessment in HealthCare), “Treatment with neuroleptics,” SBU Report no. 113,Author, Stockholm, Sweden, 1997.
[14] SBU (Swedish Council on Technology Assessment in HealthCare), “Treating asthma and COPD. A systematic review,” SBUReport vol. 151, Author, Stockholm, Sweden, 2000.
[15] A. Willman, P. Stoltz, and C. Bahtsevani, Evidence BesedNursing—A Bridge between Research and Clinical Work, Stu-dentlitteratur, Lund, Sweden, 2006.
[16] C. Bahtsevani, G. Uden, and A. Willman, “Outcomes ofevidence-based clinical practice guidelines: a systematic
28 International Journal of Telemedicine and Applications
review,” International Journal of Technology Assessment inHealth Care, vol. 20, no. 4, pp. 427–433, 2004.
[17] M. Annersten and A. Willman, “Performing subcutaneousinjections: a literature review,” Worldviews on Evidence-BasedNursing, vol. 2, no. 3, pp. 122–130, 2005.
[18] M. Tarnhuvud, C. Wandel, and A. Willman, “Nursing inter-ventions to improve the health of men with prostate cancerundergoing radiotherapy: a review,” European Journal of Oncol-ogy Nursing, vol. 11, no. 4, pp. 328–339, 2007.
[19] Kairos future, “The data explosion and the future of health.What every decision-maker in the health and healthcare indus-tries need to know about the coming revolution,” Tech. Rep.,Stockholm, Sweden, 2012.
[20] H. J. Liss, R. L. Glueckauf, and E. P. Ecklund-Johnson, “Researchon telehealth and chronic medical conditions: critical review,key issues, and future directions,”Rehabilitation Psychology, vol.47, no. 1, pp. 8–30, 2002.
[21] A. F. Sato, L. M. Clifford, A. H. Silverman, and W. H. Davies,“Cognitive-behavioral interventions via telehealth: applicationsto pediatric functional abdominal pain,” Children’s Health Care,vol. 38, no. 1, pp. 1–22, 2009.
[22] J. Mitchell, “From telehealth to ehealth: the unstoppable rise ofehealth,” Tech. Rep., John Mitchell & Associates for the FederalAustralianDepartment of Communications, InformationTech-nology and the Arts (DOCITA), Canberra, Australia, 1999.
[23] J. E. Bardram, C. Bossen, and A. Thomsen, “Designing fortransformations in collaboration: a study of the deployment ofhomecare technology,” in Proceedings of the International ACMSIGGROUP Conference on Supporting Group Work (GROUP’05), pp. 294–303, November 2005.
[24] S. Koch, “Healthy ageing supported by technology—a cross-disciplinary research challenge,” Informatics for Health andSocial Care, vol. 35, no. 3-4, pp. 81–91, 2010.
[25] S. Koch, M. Marschollek, K. H.Wolf, M. Plischke, and R. Haux,“On health-enabling and ambient-assistive technologies—whathas been achieved and where do we have to go?” Methods ofInformation in Medicine, vol. 48, no. 1, pp. 29–37, 2009.
[26] A. Venter, R. Burns, M. Hefford, and N. Ehrenberg, “Resultsof a telehealth-enabled chronic care management service tosupport people with long-term conditions at home,” Journal ofTelemedicine and Telecare, vol. 18, pp. 172–175, 2012.
[27] J. A. DePalma, “Telehealth in the community: a researchupdate,” Home Health Care Management and Practice, vol. 21,no. 3, pp. 205–207, 2009.
[28] H. Agrell, S. Dahlberg, and A. F. Jerant, “Patients’ perceptionsregarding home telecare,” Telemedicine Journal and e-Health,vol. 6, no. 4, pp. 409–415, 2000.
[29] J. Ameen, A. M. Coll, and M. Peters, “Impact of tele-advice oncommunity nurses’ knowledge of venous leg ulcer care,” Journalof Advanced Nursing, vol. 50, no. 6, pp. 583–594, 2005.
[30] A. Arnaert and L. Delesie, “Effectiveness of video-telephonenursing care for the homebound elderly,” Canadian Journal ofNursing Research, vol. 39, no. 1, pp. 20–36, 2007.
[31] A. Arnaert, J. Klooster, and V. Chow, “Attitudes towardsvideotelephones: an exploratory study of older adults withdepression,” Journal of Gerontological Nursing, vol. 33, no. 9, pp.5–13, 2007.
[32] N. T. Artinian,O.G.M.Washington, andT.N. Templin, “Effectsof home telemonitoring and community-based monitoring onblood pressure control in urban African Americans: a pilotstudy,” Heart and Lung, vol. 30, no. 3, pp. 191–199, 2001.
[33] C. A. Baer, C. M. Williams, L. Vickers, and J. C. Kvedar, “Apilot study of specialized nursing care for home health patients,”Journal of Telemedicine and Telecare, vol. 10, no. 6, pp. 342–345,2004.
[34] S. Barnason, L. Zimmerman, J. Nieveen, and M. Hertzog,“Impact of a telehealth intervention to augment home healthcare on functional and recovery outcomes of elderly patientsundergoing coronary artery bypass grafting,” Heart and Lung,vol. 35, no. 4, pp. 225–233, 2006.
[35] S. Barnason, L. Zimmerman, J. Nieveen, M. Schmaderer, B.Carranza, and S. Reilly, “Impact of a home communicationintervention for coronary artery bypass graft patients withischemic heart failure on self-efficacy, coronary disease riskfactor modification, and functioning,” Heart and Lung, vol. 32,no. 3, pp. 147–158, 2003.
[36] D. Benatar, M. Bondmass, J. Ghitelman, and B. Avitall, “Out-comes of chronic heart failure,” Archives of Internal Medicine,vol. 163, no. 3, pp. 347–352, 2003.
[37] R. M. Bendixen, C. E. Levy, E. S. Olive, R. F. Kobb, and W.C. Mann, “Cost effectiveness of a telerehabilitation programto support chronically ill and disabled elders in their homes,”Telemedicine and e-Health, vol. 15, no. 1, pp. 31–38, 2009.
[38] S. K. Bohnenkamp, P. McDonald, A. M. Lopez, E. Krupinski,andA. Blackett, “Traditional versus telenursing outpatientman-agement of patients with cancer with new ostomies,” OncologyNursing Forum, vol. 31, no. 5, pp. 1005–1010, 2004.
[39] K. H. Bowles and K. H. Dansky, “Teaching self-management ofdiabetes via telehomecare,” Home Healthcare Nurse, vol. 20, no.1, pp. 36–42, 2002.
[40] K.H. Bowles, D. E.Holland, andD.A.Horowitz, “A comparisonof in-person home care, home care with telephone contactand home care with telemonitoring for disease management,”Journal of Telemedicine and Telecare, vol. 15, no. 7, pp. 344–350,2009.
[41] P. F. Brennan, G. Casper, S. Kossman, and L. Burke, “Heart-CareII: home care support for patients with chronic cardiacdisease,” Studies in Health Technology and Informatics, vol. 129,part 2, pp. 988–992, 2007.
[42] K. Buckley, B. Tran, J. Agazio, and E. Wuertz, “A community-based telehealth programme for elderly low-income AfricanAmericans,” Journal on Information Technology in Healthcare,vol. 6, no. 6, pp. 400–412, 2008.
[43] K. M. Buckley, L. K. Adelson, and J. G. Agazio, “Reducing therisks of wound consultation: adding digital images to verbalreports,” Journal ofWound,Ostomy andContinenceNursing, vol.36, no. 2, pp. 163–170, 2009.
[44] K. M. Buckley, B. Q. Tran, and C. M. Prandoni, “Receptiveness,use and acceptance of telehealth by caregivers of stroke patientsin the home,” Online Journal of Issues in Nursing, vol. 9, no. 3, p.9, 2004.
[45] L. Cardozo and J. Steinberg, “Telemedicine for recently dis-charged older patients,” Telemedicine and e-Health, vol. 16, no.1, pp. 49–55, 2010.
[46] Y. M. Chae, J. H. Lee, S. H. Ho, H. J. Kim, K. H. Jun, andJ. K. Won, “Patient satisfaction with telemedicine in homehealth services for the elderly,” International Journal of MedicalInformatics, vol. 61, no. 2-3, pp. 167–173, 2001.
[47] M. Chambers and S. Connor, “Technology as an aid to copingwith caring: a usability evaluation of a telematics intervention,”Studies in Health Technology and Informatics, vol. 84, part 2, pp.1130–1134, 2001.
International Journal of Telemedicine and Applications 29
[48] M. Chambers and S. L. Connor, “User-friendly technology tohelp family carers cope,” Journal of Advanced Nursing, vol. 40,no. 5, pp. 568–577, 2002.
[49] K. Chang, R. Davis, J. Birt, P. Castelluccio, P. Woodbridge,and D. Marrero, “Nurse practitioner-based diabetes care man-agement: impact of telehealth or telephone intervention onglycemic control,” Disease Management and Health Outcomes,vol. 15, no. 6, pp. 377–385, 2007.
[50] J. G. F. Cleland, A. A. Louis, A. S. Rigby, U. Janssens, and A.H. M. M. Balk, “Noninvasive home telemonitoring for patientswith heart failure at high risk of recurrent admission anddeath: the Trans-European Network-Home-Care ManagementSystem (TEN-HMS) study,” Journal of the American College ofCardiology, vol. 45, no. 10, pp. 1654–1664, 2005.
[51] J. Clemensen, S. B. Larsen, M. Kirkevold, and N. Ejskjaer,“Telemedical teamwork between home and hospital: a syn-ergetic triangle emerges,” Studies in Health Technology andInformatics, vol. 130, pp. 81–89, 2007.
[52] S. Dang, N. Remon, J. Harris et al., “Care coordination assistedby technology for multiethnic caregivers of persons withdementia: a pilot clinical demonstration project on caregiverburden and depression,” Journal of Telemedicine and Telecare,vol. 14, no. 8, pp. 443–447, 2008.
[53] K. Dansky and J. Vasey, “Managing heart failure patients afterformal homecare,” Telemedicine and e-Health, vol. 15, no. 10, pp.983–991, 2009.
[54] K. H. Dansky, J. Vasey, and K. Bowles, “Impact of telehealth onclinical outcomes in patients with heart failure,”Clinical NursingResearch, vol. 17, no. 3, pp. 182–199, 2008.
[55] K. H. Dansky, J. Vasey, and K. Bowles, “Use of telehealth byolder adults to manage heart failure,” Research in GerontologicalNursing, vol. 1, no. 1, pp. 25–32, 2008.
[56] K. H. Dansky, B. Yant, D. Jenkins, and C. Dellasega, “Qualitativeanalysis of telehomecare nursing activities,” Journal of NursingAdministration, vol. 33, no. 7-8, pp. 372–375, 2003.
[57] A. Darkins, P. Ryan, R. Kobb et al., “Care coordination/hometelehealth: the systematic implementation of health informatics,home telehealth, and disease management to support the careof veteran patients with chronic conditions,” Telemedicine ande-Health, vol. 14, no. 10, pp. 1118–1126, 2008.
[58] S. de Lusignan, S. Wells, P. Johnson, K. Meredith, and E.Leatham, “Compliance and effectiveness of 1 year’s hometelemonitoring. The report of a pilot study of patients withchronic heart failure,” European Journal of Heart Failure, vol. 3,no. 6, pp. 723–730, 2001.
[59] J. L. DelliFraine, K. H. Dansky, and J. S. Rumberger, “The use ofknowledge management in telemedicine and perceived effectson patient care activities,” International Journal of HealthcareTechnology and Management, vol. 10, no. 3, pp. 196–209, 2009.
[60] G. Demiris, S. M. Speedie, and S. Finkelstein, “Change ofpatients’ perceptions of TeleHomeCare,” Telemedicine Journaland e-Health, vol. 7, no. 3, pp. 241–248, 2001.
[61] T. R. Elliott, D. Brossart, J. W. Berry, and P. R. Fine, “Problem-solving training via videoconferencing for family caregiversof persons with spinal cord injuries: a randomized controlledtrial,” Behaviour Research andTherapy, vol. 46, no. 11, pp. 1220–1229, 2008.
[62] S. M. Finkelstein, S. M. Speedie, and S. Potthoff, “Hometelehealth improves clinical outcomes at lower cost for homehealthcare,” Telemedicine Journal and e-Health, vol. 12, no. 2, pp.128–136, 2006.
[63] L. Forbat, R. Maguire, L. McCann, N. Illingworth, and N.Kearney, “The use of technology in cancer care: applyingFoucault’s ideas to explore the changing dynamics of power inhealth care,” Journal of AdvancedNursing, vol. 65, no. 2, pp. 306–315, 2009.
[64] J. E. Gray, C. Safran, R. B. Davis et al., “Baby CareLink: using theinternet and telemedicine to improve care for high-risk infants,”Pediatrics, vol. 106, no. 6, pp. 1318–1324, 2000.
[65] C. Guilfoyle, L. Perry, B. Lord, K. Buckle, J. Mathews, and R.Wootton, “Developing a protocol for the use of telenursing incommunity health in Australia,” Journal of Telemedicine andTelecare, vol. 8, supplement 2, pp. 33–36, 2002.
[66] R. P. Hauber and M. L. Jones, “Telerehabilitation support forfamilies at home caring for individuals in prolonged states ofreduced consciousness,” Journal of Head Trauma Rehabilitation,vol. 17, no. 6, pp. 535–541, 2002.
[67] Y. Hirakawa, Y. Masuda, K. Uemura, M. Kuzuya, and A.Iguchi, “Effect of long-term care insurance on communi-cation/recording tasks for in-home nursing care services,”Archives of Gerontology and Geriatrics, vol. 38, no. 2, pp. 101–113,2004.
[68] R. Hofmann-Wellenhof, W. Salmhofer, B. Binder, A. Okcu,H. Kerl, and H. P. Soyer, “Feasibility and acceptance oftelemedicine for wound care in patients with chronic leg ulcers,”Journal of Telemedicine and Telecare, vol. 12, supplement 1, pp.15–17, 2006.
[69] K. Horton, “The use of telecare for people with chronicobstructive pulmonary disease: implications for management,”Journal of NursingManagement, vol. 16, no. 2, pp. 173–180, 2008.
[70] M. Huddleston and R. Kobb, “Emerging technology for at-riskchronically ill veterans,” Journal for Healthcare Quality, vol. 26,no. 6, pp. 12–24, 2004.
[71] R. L. Jenkins and M. McSweeney, “Assessing elderly patientswith congestive heart failure via in-home interactive telecom-munication,” Journal of Gerontological Nursing, vol. 27, no. 1, pp.21–27, 2001.
[72] A. F. Jerant, R. Azari, C. Martinez, and T. S. Nesbitt, “Arandomized trial of telenursing to reduce hospitalization forheart failure: patient-centered outcomes and nursing indica-tors,” Home Health Care Services Quarterly, vol. 22, no. 1, pp.1–20, 2003.
[73] A. F. Jerant, R. Azari, and T. S. Nesbitt, “Reducing the costof frequent hospital admissions for congestive heart failure: arandomized trial of a home telecare intervention,”Medical Care,vol. 39, no. 11, pp. 1234–1245, 2001.
[74] T. Kawaguchi, M. Azuma, and K. Ohta, “Development ofa telenursing system for patients with chronic conditions,”Journal of Telemedicine and Telecare, vol. 10, no. 4, pp. 239–244,2004.
[75] N. Kearney, L. Kidd, M. Miller et al., “Utilising handheld com-puters to monitor and support patients receiving chemother-apy: results of a UK-based feasibility study,” Supportive Care inCancer, vol. 14, no. 7, pp. 742–752, 2006.
[76] L. Keaton, L. Pierce, V. Steiner et al., “An E-rehabilitation teamhelps caregivers deal with stroke,”The Internet Journal of AlliedHealth Sciences and Practice, vol. 2, no. 4, p. 17, 2004.
[77] R. M. Kleinpell and B. Avitall, “Integrating telehealth as astrategy for patient management after discharge for cardiacsurgery: results of a pilot study,” Journal of CardiovascularNursing, vol. 22, no. 1, pp. 38–42, 2007.
30 International Journal of Telemedicine and Applications
[78] L. Kobza and A. Scheurich, “The impact of telemedicineon outcomes of chronic wounds in the home care setting,”Ostomy/Wound Management, vol. 46, no. 10, pp. 48–53, 2000.
[79] L. M. LaFramboise, C. M. Todero, L. Zimmerman, andS. Agrawal, “Comparison of Health Buddy with traditionalapproaches to heart failuremanagement,” Family &CommunityHealth, vol. 26, no. 4, pp. 275–288, 2003.
[80] L. M. LaFramboise, J. Woster, A. Yager, and B. C. Yates,“A technological life buoy: patient perceptions of the HealthBuddy,” Journal of Cardiovascular Nursing, vol. 24, no. 3, pp.216–224, 2009.
[81] S. B. Larsen, J. Clemensen, andN. Ejskjaer, “A feasibility study ofUMTS mobile phones for supporting nurses doing home visitsto patients with diabetic foot ulcers,” Journal of Telemedicine andTelecare, vol. 12, no. 7, pp. 358–362, 2006.
[82] J. Lillibridge and B. Hanna, “Using telehealth to deliver nursingcasemanagement services toHIV/AIDS clients,”Online Journalof Issues in Nursing, vol. 14, no. 1, p. 9, 2009.
[83] S. P. Lin andH.Y. Yang, “Exploring key factors in the choice of e-health using an asthma caremobile servicemodel,”Telemedicineand e-Health, vol. 15, no. 9, pp. 884–890, 2009.
[84] B. Lindberg, K. Axelsson, and K. Ohrling, “Experience withvideoconferencing between a neonatal unit and the families’home from the perspective of certified paediatric nurses,”Journal of Telemedicine and Telecare, vol. 15, no. 6, pp. 275–280,2009.
[85] B. Lindberg, K. Axelsson, and K. Ohrling, “Taking care of theirbaby at home but with nursing staff as support: the use ofvideoconferencing in providing neonatal support to parents ofpreterm infants,” Journal of Neonatal Nursing, vol. 15, no. 2, pp.47–55, 2009.
[86] I. Lindberg, K. Ohrling, and K. Christensson, “Midwives’experience of using videoconferencing to support parents whowere discharged early after childbirth,” Journal of Telemedicineand Telecare, vol. 13, no. 4, pp. 202–205, 2007.
[87] B. J. Lutz, N. R. Chumbler, T. Lyles, N. Hoffman, and R.Kobb, “Testing a home-telehealth programme for US veteransrecovering from stroke and their family caregivers,” Disabilityand Rehabilitation, vol. 31, no. 5, pp. 402–409, 2009.
[88] B. J. Lutz, N. R. Chumbler, and K. Roland, “Carecoordination/home-telehealth for veterans with stroke andtheir caregivers: addressing an unmet need,” Topics in StrokeRehabilitation, vol. 14, no. 2, pp. 32–42, 2007.
[89] F. S. Mair, J. Hiscock, and S. C. Beaton, “Understanding factorsthat inhibit or promote the utilization of telecare in chronic lungdisease,” Chronic Illness, vol. 4, no. 2, pp. 110–117, 2008.
[90] M. L. Marineau, “Special populations: telehealth advance prac-tice nursing: the lived experiences of individuals with acuteinfections transitioning in the home,” Nursing Forum, vol. 42,no. 4, pp. 196–208, 2007.
[91] K. McCall, J. Keen, K. Farrer et al., “Perceptions of the use of aremote monitoring system in patients receiving palliative careat home,” International Journal of Palliative Nursing, vol. 14, no.9, pp. 426–431, 2008.
[92] L. McCann, R. Maguire, M. Miller, and N. Kearney, “Patients’perceptions and experiences of using a mobile phone-basedadvanced symptom management system (ASyMS) to monitorand manage chemotherapy related toxicity,” European Journalof Cancer Care, vol. 18, no. 2, pp. 156–164, 2009.
[93] M. R.McGee and P. Gray, “A handheld chemotherapy symptommanagement system: results from a preliminary outpatient field
trial,” Health Informatics Journal, vol. 11, no. 4, pp. 243–258,2005.
[94] C. Miller, L. Zimmerman, S. Barnason, and J. Nieveen, “Impactof an early recovery management intervention on functioningin postoperative coronary artery bypass patients with diabetes,”Heart and Lung, vol. 36, no. 6, pp. 418–430, 2007.
[95] L. Moreno, S. B. Dale, A. Y. Chen, and C. A. Magee, “Coststo Medicare of the Informatics for Diabetes Education andTelemedicine (IDEATel) Home Telemedicine demonstration:findings from an independent evaluation,” Diabetes Care, vol.32, no. 7, pp. 1202–1204, 2009.
[96] B. Mullan, M. Snyder, B. Lindgren, S. M. Finkelstein, and M.I. Hertz, “Home monitoring for lung transplant candidates,”Progress in Transplantation, vol. 13, no. 3, pp. 176–182, 2003.
[97] S. Myers, W. R. Grant, E. N. Lugn, B. Holbert, and C. J. Kvedar,“Impact of home-based monitoring on the care of patients withcongestive heart failure,” Home Health Care Management andPractice, vol. 18, no. 6, pp. 444–451, 2006.
[98] C. Nilsson, L. Skar, and S. Soderberg, “Swedish District Nurses’experiences on the use of information and communicationtechnology for supporting people with serious chronic illnessliving at home—a case study,” Scandinavian Journal of CaringScience, vol. 24, pp. 259–265, 2010.
[99] S. J. Pangarakis, K. Harrington, R. Lindquist, C. Peden-McAlpine, and S. Finkelstein, “Electronic feedbackmessages forhome spirometry lung transplant recipients,” Heart and Lung,vol. 37, no. 4, pp. 299–307, 2008.
[100] V. L. Phillips, S. Vesmarovich, R. Hauber, E. Wiggers, and A.Egner, “Telehealth: reaching out to newly injured spinal cordpatients,” Public Health Reports, vol. 116, supplement 1, pp. 94–102, 2001.
[101] L. L. Pierce, G. L. Rupp, B. Hicks, and V. Steiner, “Meetingthe educational needs for caregivers and survivors of stroke,”Gerontology & Geriatrics Education, vol. 23, no. 4, pp. 75–90,2003.
[102] S. Procter and A. Single, “Home telehealthcare: findings from apilot study in North-east London,” British Journal of HealthcareComputing&Medical Informatics, vol. 23, no. 8, pp. 10–13, 2006.
[103] A. Przybylski, J. Zakrzewska-Koperska, A. Maciag et al.,“Technical and practical aspects of remote monitoring ofimplantable cardioverter-defibrillator patients in Poland—preliminary results,” Kardiologia Polska, vol. 67, no. 5, pp. 505–511, 2009.
[104] C. Quinn, “Low-technology heart failure care in home health:improving patient outcomes,” Home Healthcare Nurse, vol. 24,no. 8, pp. 533–540, 2006.
[105] J. Reis, B. McGinty, and S. Jones, “An e-learning caregivingprogram for prostate cancer patients and family members,”Journal of Medical Systems, vol. 27, no. 1, pp. 1–12, 2003.
[106] C. Safran, G. Pompilio-Weitzner, K. D. Emery, and L. Hampers,“Collaborative approaches to e-health: valuable for users andnon-users,” Studies in Health Technology and Informatics, vol.116, pp. 879–884, 2005.
[107] J. Sandberg, P. M. Trief, R. Izquierdo et al., “A qualitativestudy of the experiences and satisfaction of direct telemedicineproviders in diabetes case management,” Telemedicine Journaland e-Health, vol. 15, no. 8, pp. 742–750, 2009.
[108] S. Scalvini, E. Zanelli, L. Paletta et al., “Chronic heart fail-ure home-based management with a telecardiology system: acomparison between patients followed by general practitionersand by a cardiology department,” Journal of Telemedicine andTelecare, vol. 12, supplement 1, pp. 46–48, 2006.
International Journal of Telemedicine and Applications 31
[109] S. Scalvini, E. Zanelli, M. Volterrani et al., “A pilot study ofnurse-led, home-based telecardiology for patients with chronicheart failure,” Journal of Telemedicine and Telecare, vol. 10, no. 2,pp. 113–117, 2004.
[110] K. A. Schwarz, L. C. Mion, D. Hudock, and G. Litman,“Telemonitoring of heart failure patients and their caregivers:a pilot randomized controlled trial,” Progress in CardiovascularNursing, vol. 23, no. 1, pp. 18–26, 2008.
[111] P. Sevean, S. Dampier,M. Spadoni, S. Strickland, and S. Pilatzke,“Patients and families experiences with video telehealth inrural/remote communities in Northern Canada,” Journal ofClinical Nursing, vol. 18, no. 18, pp. 2573–2579, 2009.
[112] S. Shea, R. S. Weinstock, J. A. Teresi et al., “A randomized trialcomparing telemedicine case management with usual care inolder, ethnically diverse, medically underserved patients withdiabetes mellitus: 5 year results of the IDEATel study,” Journalof the American Medical Informatics Association, vol. 16, no. 4,pp. 446–456, 2009.
[113] C. E. Smith, J. J. Cha, S. V. Kleinbeck, F. A. Clements, D. Cook,and J. Koehler, “Feasibility of in-home telehealth for conductingnursing research,” Clinical Nursing Research, vol. 11, no. 2, pp.220–233, 2002.
[114] C. E. Smith, E. R. Dauz, F. Clements et al., “Telehealth ser-vices to improve nonadherence: a placebo-controlled study,”Telemedicine Journal and e-Health, vol. 12, no. 3, pp. 289–296,2006.
[115] M. L. Stricklin, K. Lowe-Phelps, and R. J. McVey, “Homecare patients’ responses to point-of-care technology,” HomeHealthcare Nurse, vol. 19, no. 12, pp. 774–778, 2001.
[116] W. K. Tang, H. Chiu, J. Woo, M. Hjelm, and E. Hui, “Telepsy-chiatry in psychogeriatric service: a pilot study,” InternationalJournal of Geriatric Psychiatry, vol. 16, no. 1, pp. 88–93, 2001.
[117] M. Terry, L. S. Halstead, P. O’Hare et al., “Feasibility study ofhome care wound management using telemedicine,” Advancesin Skin &Wound Care, vol. 22, no. 8, pp. 358–364, 2009.
[118] S. Torp, E. Hanson, S. Hauge, I. Ulstein, and L. Magnusson, “Apilot study of how information and communication technologymay contribute to health promotion among elderly spousalcarers in Norway,” Health and Social Care in the Community,vol. 16, no. 1, pp. 75–85, 2008.
[119] B. J. Wakefield, C. L. Bylund, J. E. Holman et al., “Nurse andpatient communication profiles in a home-based telehealthintervention for heart failure management,” Patient Educationand Counseling, vol. 71, no. 2, pp. 285–292, 2008.
[120] N. van den Berg, T. Fiß, C. Meinke, R. Heymann, S. Scriba,and W. Hoffmann, “GP-support by means of AGnES-practiceassistants and the use of telecare devices in a sparsely populatedregion in Northern Germany proof of concept,” BMC FamilyPractice, vol. 10, article 44, 2009.
[121] J. Varis, S. Karjalainen, K. Korhonen, M. Viigimaa, K. Port, andI. Kantola, “Experiences of telemedicine-aided hypertensioncontrol in the follow-up of Finnish hypertensive patients,”Telemedicine Journal and e-Health, vol. 15, no. 8, pp. 764–769,2009.
[122] P. Whitten, G. Doolittle, and M. Mackert, “Telehospice inMichigan: use and patient acceptance,” American Journal ofHospice and Palliative Care, vol. 21, no. 3, pp. 191–195, 2004.
[123] P. Whitten and M. Mickus, “Home telecare for COPD/CHFpatients: outcomes and perceptions,” Journal of Telemedicineand Telecare, vol. 13, no. 2, pp. 69–73, 2007.
[124] D. C. M. Willems, M. A. Joore, J. J. E. Hendriks, F. H. M.Nieman, J. L. Severens, and E. F. M.Wouters, “The effectiveness
of nurse-led telemonitoring of asthma: results of a randomizedcontrolled trial,” Journal of Evaluation in Clinical Practice, vol.14, no. 4, pp. 600–609, 2008.
[125] J. M. Winters and J. M. Winters, “Videoconferencing andtelehealth technologies can provide a reliable approach toremote assessment and teaching without compromising qual-ity,” Journal of Cardiovascular Nursing, vol. 22, no. 1, pp. 51–57,2007.
[126] D. C. Visco, T. Shalley, S. J. Wren et al., “Use of telehealth forchronic wound care: a case study,” Journal of Wound, Ostomyand Continence Nursing, vol. 28, no. 2, pp. 89–95, 2001.
[127] M. Vitacca, G. Assoni, P. Pizzocaro et al., “A pilot study of nurse-led, home monitoring for patients with chronic respiratoryfailure and with mechanical ventilation assistance,” Journal ofTelemedicine and Telecare, vol. 12, no. 7, pp. 337–342, 2006.
[128] M. Vitacca, L. Bianchi, A. Guerra et al., “Tele-assistance inchronic respiratory failure patients: a randomised clinical trial,”European Respiratory Journal, vol. 33, no. 2, pp. 411–418, 2009.
[129] M. Vitacca, A. Guerra, G. Assoni et al., “Weaning frommechan-ical ventilation followed at home with the aid of a telemedicineprogram,” Telemedicine Journal and e-Health, vol. 13, no. 4, pp.445–449, 2007.
[130] A. K. Woodend, H. Sherrard, M. Fraser, L. Stuewe, T. Cheung,and C. Struthers, “Telehome monitoring in patients with car-diac disease who are at high risk of readmission,” Heart andLung, vol. 37, no. 1, pp. 36–45, 2008.
[131] B. M. Walivaara, S. Andersson, and K. Axelsson, “Views ontechnology among people in need of health care at home,”International Journal of Circumpolar Health, vol. 68, no. 2, pp.158–169, 2009.
[132] L. Young, H. Siden, and S. Tredwell, “Post-surgical tele-health support for children and family care-givers,” Journal ofTelemedicine and Telecare, vol. 13, no. 1, pp. 15–19, 2007.
[133] C. R. Charlton, K. S. Dearing, J. A. Berry, and M. J. Johnson,“Nurse practitioners’communication styles and their impact onpatient outcomes: an integrated literature review,” Journal of theAmerican Academy of Nurse Practitioners, vol. 20, pp. 382–388,2008.
[134] T. Botsis and G. Hartvigsen, “Current status and future per-spectives in telecare for elderly people suffering from chronicdiseases,” Journal of Telemedicine and Telecare, vol. 14, no. 4, pp.195–203, 2008.
[135] T. L.Williams, C. R. May, and A. Esmail, “Limitations of patientsatisfaction studies in telehealthcare: a systematic review of theliterature,” Telemedicine Journal and e-Health, vol. 7, no. 4, pp.293–316, 2001.
[136] F. Ducharme, L. Beaudet, A. Legault,M.-J. Kergoat, L. Levesque,and C. Caron, “Development of an intervention program forAlzheimer’s family caregivers following diagnostic disclosure,”Clinical Nursing Research, vol. 8, pp. 44–67, 2001.
International Journal of
AerospaceEngineeringHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
RoboticsJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Active and Passive Electronic Components
Control Scienceand Engineering
Journal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
International Journal of
RotatingMachinery
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporation http://www.hindawi.com
Journal ofEngineeringVolume 2014
Submit your manuscripts athttp://www.hindawi.com
VLSI Design
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Shock and Vibration
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Civil EngineeringAdvances in
Acoustics and VibrationAdvances in
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Electrical and Computer Engineering
Journal of
Advances inOptoElectronics
Hindawi Publishing Corporation http://www.hindawi.com
Volume 2014
The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014
SensorsJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Modelling & Simulation in EngineeringHindawi Publishing Corporation http://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Chemical EngineeringInternational Journal of Antennas and
Propagation
International Journal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Navigation and Observation
International Journal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
DistributedSensor Networks
International Journal of