A national survey of telehealth activity in Australian hospitals

Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations

Background

Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients’ lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients’ voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment.

Objective

There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment.

Methods

We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault’s concepts of power and power technology.

Results

Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients’ lives related to the disease being ignored; thus, inadvertently, patients’ voices may be silenced.

Conclusions

Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients’ voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations.

Evaluation of the Western Australian Department of Health telehealth project

In 1999, the Department of Health in Western Australia began a telehealth project, which finished in 2004. The 75 videoconferencing sites funded by the project were part of a total state-wide videoconference network of 104 sites. During the period from January 2002 to December 2003, a total of 3,266 consultations, case reviews and patient education sessions took place. Clinical use grew to 30% of all telehealth activity. Educational use was approximately 40% (1,416 sessions) and management use was about 30% (1,031 sessions). The average overhead cost per telehealth session across all regions and usage types was 192 Australian dollars. Meaningful comparisons of the results of the present study with other public health providers were difficult, because many of the available Websites on telehealth were out of date. Despite the successful use of telehealth to deliver clinical services in Western Australia, sustaining the effort in the post-project phase will present significant challenges.

Evaluating Telemedicine: Lessons and Challenges

Telemedicine applications have been rapidly implemented since the early 1990s and are now in use in a wide range of healthcare settings. There is, however, limited evidence of clinical benefits resulting from their use. This paper describes the design and implementation of a multi-method evaluation of an emergency telemedicine application's clinical impact. In particular, the challenges faced and lessons learnt regarding the development of a suitable methodology and collection of health information from a variety of sources are discussed. In order to understand the application's clinical impact it was necessary to use different types of data from multiple sources, and to interpret the results from each enquiry in relation to results from the others.

The use of technology and perceptions of its effectiveness in training physicians

BACKGROUND

Technology has been incorporated into the classrooms of future healthcare professionals for decades and vast research has investigated its effectiveness. Much less attention, however, has examined how medical schools are actually using technology and telemedicine to aid teaching.

AIMS

It is unclear how medical schools use technology as pedagogical aids. This study investigates technology and telemedicine use in physician training in the United States.

METHODS

We distributed an online survey on technology and telemedicine use through the American Association of Colleges of Osteopathic Medicine and the Association of American Medical Colleges.

RESULTS

Both allopathic and osteopathic institutions train students with various forms of technology, but appear to be doing so differently. Few schools use telemedicine in the classroom and even fewer require it.

CONCLUSION

Osteopathic institutions report more positive attitudes toward e-learning and technology, but allopathic schools on an average have more technology available and longer years of use.

A survey of the state of telemedicine in Western Australia

To provide a baseline for future planning we conducted a survey of the use of telemedicine in the state of Western Australia. A questionnaire was designed, validated and posted to all public and private health-care facilities in Western Australia (metropolitan hospitals, country hospitals and nursing posts). Of the 132 questionnaires sent out, 102 were returned (77% response rate). Seven of the responding hospitals (all public) were classified as mainly providers of telehealth services and 95 (both public and private) were mainly receivers. Of these 95 receivers of services, 58 facilities (61%) reported that they had access to videoconferencing for telehealth purposes. The most common purposes for which videoconferencing was used were reported to be education (76% of those using videoconferencing), wound care (55%) and psychiatry (53%). The most common store-and-forward application was tele-ECG, which was reported by more than half (54%) of respondents. Eighty-five percent of public health-care facilities reported the use of telehealth (either videoconferencing or store-and-forward) in comparison with 24% of those in the private sector. There was a tendency for facilities further away from Perth to be users of more telehealth services: the correlation between distance and the number of telehealth services received was significant (Spearman's rho = 0.54, P < 0.001). The survey showed that about 73% of responding health-care facilities in Western Australia were using telemedicine.

Ambiguous and arbitrary: the role of telephone interactions in rural health service delivery

Anecdotal evidence and a limited body of research suggests that telephone interactions between health care consumers and health professionals form an important part of unscheduled health care provision. However, very little is known about these interactions, particularly in the rural context. In rural Australia, there is a need to explore a range of models of service delivery. Telephone-based unscheduled care is one area that demands consideration. By defining unscheduled health care and delineating telephone-based unscheduled health care from other telehealth services, the concepts of formal and informal telephone-based unscheduled health care provision are explored. This article raises previously unasked questions about the role of telephone-based unscheduled health care in the rural context. As a dimension of health care that is poorly understood, the need for further conceptualisation, research and policy development in this area is highlighted.

The role of home-based information and communications technology interventions in chronic disease management: a systematic literature review

This article presents a systematic literature review done to evaluate the feasibility and benefits of home-based information and communications technology enabled interventions for chronic disease management, with emphasis on their impact on health outcomes and costs. Relevant articles were retrieved from PubMed and evaluated using quality worksheets with pre-identified inclusion and exclusion criteria. Of the 256 articles retrieved, 27 were found to concord with the study criteria. Evaluation of the identified articles was conducted irrespective of study design, type of home-based intervention or chronic disease involved. The review demonstrates that HBIs applied to chronic disease management improve functional and cognitive patient outcomes and reduce healthcare spending. However, further research is needed to assess benefit in terms of evidence-based outcome indicators (that can provide a basis for meta-analysis), to confirm sustainable cost benefits, and to systematically collect data on physician satisfaction with patient management.