Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 4 Articles
Background: In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help\nsmokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with\nlocal health care resources.\nObjective: The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering\nexpert tobacco treatment at a distance: telemedicine counseling that was integrated into smokersââ?¬â?¢ primary care clinics (Integrated\nTelemedicineââ?¬â?ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes\n(Phone).\nMethods: Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly\nassigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling,\nsimilar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered\nthe counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both\ngroups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome\nwas verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis.\nResults: There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months.\nVerified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406).\nPhone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837);\nhowever, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%,\n128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were significantly more likely to recommend\nthe program to a family member or friend (P=.0075). From the combined provider plus participant (societal) perspective, Phone\nwas significantly less costly than ITM. Participants in ITM had to incur time and mileage costs to travel to clinics for ITM sessions.\nFrom the provider perspective, counseling costs were similar between ITM (US $45.46, SD 31.50) and Phone (US $49.58, SD\n33.35); however, total provider costs varied widely depending on how the clinic space for delivering ITM was valued.\nConclusions: Findings did not support the superiority of ITM over telephone counseling for helping rural patients quit smoking.\nITM increased utilization of cessation pharmacotherapy and produced higher participant satisfaction, but Phone counseling was significantly less expensive. Future interventions could combine elements of both approaches to optimize pharmacotherapy\nutilization, counseling adherence, and satisfaction. Such an approach could commence with a telemedicine-delivered clinic office\nvisit for pharmacotherapy guidance, and continue with telephone or real-time video counseling delivered via mobile phones to\nflexibly deliver behavioral support to patients where they most need itââ?¬â?in their homes and communities....
Background: An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD)\nis rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD\ncan participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the\ntraining venues and transportation difficulties. The aim of the study was to assess the feasibility of an individualized\nhome-based training and counselling programme via video conference to patients with severe COPD after\nhospitalization including assessment of safety, clinical outcomes, patients� perceptions, organisational aspects and\neconomic aspects.\nMethods: The design was a pre- and post-test intervention study. Fifty patients with severe COPD were included.\nThe telemedicine training and counselling included three weekly supervised exercise sessions by a physiotherapist\nand up to two supervised counselling and training sessions in energy conservation techniques by an occupational\ntherapist. The telemedicine videoconferencing equipment was a computer containing a screen, a microphone, an\non/off switch and a volume control.\nResults: Thirty seven (74%) participants completed the programme, with improvements in health status assessed\nby the Clinical COPD Questionnaire and physical performance assessed by a sit-to-stand test and a timed-up-and-go\ntest. There were no cases of patient fall or emergency contact with a general practitioner during the telemedicine\ntraining sessions. The study participants believed the telemedicine training and counselling was essential for getting\nstarted with being physically active in a secure manner. The business case showed that under the current financing\nsystem, the reimbursement to the hospital was slightly higher than the hospital expenditures. Thus, the business case\nfor the hospital was positive. The organizational analysis indicated that the perceptions of the staff were that the\ntelemedicine service had improved the continuity of the rehabilitation programme for the patients and enabled\nthe patients� everyday lives to be included in the treatment.\nConclusions: This study showed that home-based supervised training and counselling via video conference is safe\nand feasible and that telemedicine can help to ensure more equitable access to supervised training in patients\nwith severe COPD....
Background: The majority of studies on quality of oral anticoagulation (OAC) therapy with vitamin K-antagonists\nare performed with short-acting warfarin. Data on long-acting phenprocoumon, which is frequently used in Europe\nfor OAC therapy and is considered to enable more stable therapy adjustment, are scarce. In this study, we aimed to\nassess quality of OAC therapy with phenprocoumon in regular medical care and to evaluate its potential for\noptimization in a telemedicine-based coagulation service.\nMethods: In the prospective observational cohort study program thrombEVAL we investigated 2,011 patients from\nregular medical care in a multi-center cohort study and 760 patients from a telemedicine-based coagulation service\nin a single-center cohort study. Data were obtained from self-reported data, computer-assisted personal interviews,\nand laboratory measurements according to standard operating procedures with detailed quality control. Time in\ntherapeutic range (TTR) was calculated by linear interpolation method to assess quality of OAC therapy. Study\nmonitoring was carried out by an independent institution.\nResults: Overall, 15,377 treatment years and 48,955 international normalized ratio (INR) measurements were\nanalyzed. Quality of anticoagulation, as measured by median TTR, was 66.3% (inte rquartile range (IQR) 47.8/81.9) in\nregular medical care and 75.5% (IQR 64.2/84.4) in the coagulation service (P <0.001). Stable anticoagulation control\nwithin therapeutic range was achieved in 63.8% of patients in regular medical care with TTR at 72.1% (IQR 58.3/\n84.7) as compared to 96.4% of patients in the coagulation service with TTR at 76.2% [(IQR 65.6/84.7); P = 0.001)].\nProspective follow-up of coagulation service patients with pretreatment in regular medical care showed an\nimprovement of the TTR from 66.2% (IQR 49.0/83.6) to 74.5% (IQR 62.9/84.2; P <0.0001) in the coagulation service.\nTreatment in the coagulation service contributed to an optimization of the profile of time outside therapeutic\nrange, a 2.2-fold increase of stabile INR adjustment and a significant decrease in TTR variability by 36% (P <0.001).\n(Continued on next page)...
Introduction: Telemedicine use in addiction treatment and recovery services is limited. Yet, because it removes\nbarriers of time and distance, telemedicine offers great potential for enhancing treatment and recovery for people\nwith substance use disorders (SUDs). Telemedicine also offers clinicians ways to increase contact with SUD patients\nduring and after treatment.\nCase description: A project conducted from February 2013 to June 2014 investigated the adoption of telemedicine\nservices among purchasers of addiction treatment in five states and one county. The project assessed purchasers�\ninterest in and perceived facilitators and barriers to implementing one or more of the following telemedicine modalities:\ntelephone-based care, web-based screening, web-based treatment, videoconferencing, smartphone mobile applications\n(apps), and virtual worlds.\nDiscussion and evaluation: Purchasers expressed the most interest in implementing videoconferencing and smartphone\nmobile devices. The anticipated facilitators for implementing a telemedicine app included funding available to pay for\nthe telemedicine service, local examples of success, influential champions at the payer and treatment agencies, and\nmeeting a pressing need. The greatest barriers identified were: costs associated with implementation, lack of reimbursement\nfor telemedicine services, providers� unfamiliarity with technology, lack of implementation models, and confidentiality\nregulations. This paper discusses why the project participants selected or rejected different telemedicine modalities and\nthe policy implications that purchasers and regulators of addiction treatment services should consider for expanding\ntheir use of telemedicine.\nConclusions: This analysis provides initial observations into how telemedicine is being implemented in addiction services\nin five states and one county. The project demonstrated that despite the considerable interest in telemedicine,\nimplementation challenges exist. Future studies should broaden the sample analyzed and track technology\nimplementation longitudinally to help the research and practitioner communities develop a greater understanding of\ntechnology implementation trends and practices....
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