Transcript Slide 1

What Evidence Supports the Use
of Technologies in Home and
Community-based Caregiving of
Older Adults?
Patient and Provider
Satisfaction/Quality
Pamela Whitten, Ph.D.
Associate Professor
Michigan State University
[email protected]
Agenda
• Types of Activity
• Brief Overview of Research Findings
Categories of Technology-Delivered
Care
• Data Only
– E.g., Telemonitoring for blood pressure (Artinian,
Washington, & Templin, 2001)
• Video/Audio Only
– E.g., Telepodiatry in 200-bed home for the
elderly (Corcoran , Hui & Woo, 2003)
• Video/Audio and Data
– E.g., Telehome health in CA (Johnston, Wheeler,
Deuser, & Sousa, 2000)
What We Know from Evaluation
Satisfaction/Perceptions
1. Patient Satisfaction
•
•
Positive responses from geriatric patients
living in retirement community who had
telemedicine service 1xweek for 8 weeks
(Bratton & Short, 2001)
VA Home and Community Care Project
in GA, FL, and Puerto Rico reported a
90% satisfaction rate (Meyer, 2002)
1. Patient Satisfaction
• Study in Korea (Chae et al., 2001) found
that predictors of satisfaction with lowbandwidth telemedicine included:
– Location (patients at home more satisfied
than patients in nursing homes)
– Patient’s perspective on the quality of the
communication encounter between the
provider and patient (instead of quality of
transmission)
1. Patient Satisfaction
• Qualitative and quantitative data point to
positive patient perceptions
– E.g., Home-based TelePsychiatry project
(Whitten, 2003)
– E.g., Telehome Health in the UP for diabetes
and COPD/CHF (Whitten, 2003)
Patients Really Like this Service
• “a few of the more timid patients tell me
that they like having visits via the
equipment better than seeing the provider
in person because they feel they can say
things that the doctor may not like…they
feel like they are safe and can say it
because they’re not in person” (Whitten, in
press)
Some patients REALLY like
telemed
• one woman enjoyed using the
telemedicine system because she felt that
it would make her appear thinner to her
doctor, therefore avoiding a lecture from
her doctor about her compulsive eating
disorder (Whitten, in press)
Telehome health in the UP (Whitten, 2003)
Questions
Mean
Diab/C&C
It was easy to communicate with the
other person during the tele-home
health consult.
4.69/4.57
Tele-home health should only be
used when a health care professional
cannot be physically present.
2.92/3.45
The care that I received via the tele-home
health equipment was as good as a regular
in-person visit.
4.10/3.59
Overall, I am satisfied with the tele-home
health service that I received.
4.77/4.52
2. Provider Satisfaction
• Nurses’ responses varied
– significant learning curve among nurses and
comfort and ease with technology will come
with time (Dansky and Bowles, 2002)
2. Provider Perception
• A telehome health study in Minnesota
concluded that telehome health providers
felt that for 92% of the visits, the televisit
would not have been significantly better if
performed in person (Demiris et al., 2000).
2. Provider Perceptions
• Yet, mounting evidence suggests that
providers may actually be the most
significant barrier to diffusion of telehome
health
Provider Perceptions
• EX: Telehospice in Michigan
• Providers are the main barrier to
telehospice
– Pre and post surveys found that providers
who saw benefit for telehospice from day one
were primary users and this never changed.
How can we explain this?
• Ran series of crosstabs and found no
relationships (experience, demographic)
• Providers felt they received adequate
training and org support
• Providers acknowledged benefits and
recited office success stories
• Preferred to see patients in person
• Did not like things they lost with telemed
(e.g., mileage, unaccountability)
Quality Indicators
Clinical Outcomes
• Many articles purport to demonstrate
clinical effectiveness of telemedicine
• Almost all make positive claims
• Home health study reported improved
mean arterial pressure in hypertension
patients (Rogers et al., 2001)
• The MyCareTeam Website helps people
with diabetes manage their disease. A
feasibility study of the site showed a
statistically significant reduction in HbA1c
(glucose control indicator) over a sixmonth period (Levine et al, 2002).
• In CHF patients over 65 years of age, telehome
health patients demonstrated a 31% decrease in
hospital admissions and a 36% decrease in ER
visits and a 52% improvement in quality of life
scores (Chetney et al., 2002).
• In the Kaiser Permanente telehome health
project, researchers documented no difference
in quality indicators between the telemedicine
group and the control group (Johnson et al.,
2000)
Review Articles
Hailey et al., 2002
• Looked at 1300 papers and found only 46
assessed some type of clinical outcome
In general
• Limited evidence of detrimental effects,
unequivocal benefits, or evidence of safety
Social Support
• Both caregivers and patients perceive
enhanced social support.
Patient support
• Patients credit the telehome health
equipment in a Visiting Nurses Association
telehome health project with increasing
their sense of connection to the staff
(Cardoza & Glaskell, 2002).
Support
• Videotelephony for telehome
care…technology addresses several of the
special needs and expectations of the
elderly in relation to their autonomy,
specifically the need to feel a sense of
belonging that is often countered by social
isolation (Arnaert & Delesie, 2001)
Caregiver support
• A videophone put in a home of an actively
dying patient allowed the patient’s wife to
call into the telehospice unit for support on
the patient’s last night (Whitten & Doolittle,
2002).
Summary of what we know from
research to date
• Patients often embrace technologies when
there is a real need being met
• Providers probably hold the key to its use
• More outcomes research is needed for
definitive answers, but the outlook is
positive
For further information...
• ATA
– http://www.atmeda.org
• Telemedicine Information Exchange
– http://tie.telemed.org
• Journal of Telemedicine and eHealth
– http://www.liebertpub.com/tmj/default1.asp
• Journal of Telemedicine and Telecare
– http://www.coh.uq.edu.au/jtt/
Telemedicine Books
• Ehealth, Telemedicine, and Telehealth: A
guide to Startup and Success (2001)
Maheu, Whitten & Allen
• Telemedicine and Telehealth: Principles,
Policies, Performance and Pitfalls (2000)
Darkins & Carey
• Home Healthcare: Wired and Ready for
Telehealth, the Nurses' and Nursing
Students' Edition (2003) Kinsella