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Residential Aged Care (RAC) and e-Health

These articles highlight some considerations around telehealth and e-health in residential aged care.
 

Barrett M, Larson A, Carville K, Ellis I. Challenges faced in implementation of a telehealth enabled chronic wound care system. Rural Remote Health. 2009 Jul-Sep;9(3):1154. (free full text journal article)
In the rural Midwest region of Western Australia (WA), wound care is a major burden on the healthcare system. Optimal wound care was found to be impeded by issues that included the involvement of multiple healthcare providers, incomplete and inconsistent documentation, and limited access to expert review. A telehealth solution was trailed in 2007. This study trialled the use of a shared electronic wound imaging and reporting system in combination with an expert remote wound consultation service for the management of patients with chronic wounds. The study found that obstacles to telehealth uptake were workforce issues and significant delays in installing the software at some sites. The disease burden of the patient group, funding models and workforce shortages frustrated the successful adoption of an evidence based strategy that was known to improve health outcomes. 

Belardi L. GP video consults in aged care on trial [Internet]. 2014 [cited 2014 Dec 22]. Article published on the Australian Ageing Agenda website. (free full text article)
A pilot program to test the viability of introducing Medicare-funded GP video consultations with aged care residents is currently underway in nine regions across the country. The four-year trial funded by the Department of Social Services involves eight Medicare locals and aged care provider Feros Care. The pilot will evaluate the possible inclusion of new telehealth items on the MBS as well assess the clinical appropriateness and impact of videoconferencing to deliver GP services in aged care.

Celler BG, Basilakis J, Budge M, Lovel NH. A clinical monitoring and management system for residential aged care facilities. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3301-4.
In response to an extended user needs analysis, a home telecare system designed for the management of patients with chronic disease was adapted for use in residential aged care facilities (RACFs). The system architecture and hardware and software components are described for both the client- and server-side. The client-side includes medication dispensing, scheduled clinical measurements and questionnaire delivery. The server-side supports Web-based administrative tools for scheduling and medications management, as well as automated reporting functions. A brief discussion on a trial of the system in five different RACFs focuses on how clinical information technology can support and improve care standards and deliver better health outcomes for residents in Australian aged care homes.

Edirippulige S, Martin-Khan M, Beattie E, Smith AC, Gray LC. A systematic review of telemedicine services for residents in long term care facilities. J Telemed Telecare. 2013 Apr;19(3):127-132. Epub 2013 May 23.
A systematic review of the literature on telemedicine use in long-term care facilities (LTCFs) was conducted and assessed for quality of the published evidence. A database search identified 22 papers which met the inclusion criteria. The quality of the studies was assessed and if they contained economic data, they were rated according to standard criteria. Overall, the quality of evidence for telemedicine in LTCFs was low. There was only one small randomised controlled trial (RCT). Most studies were observational and qualitative, and focused on utilisation. They were mainly based on surveys and interviews of stakeholders. A few studies evaluated the cost associated with implementing telemedicine services in LTCFs. The present review shows that there is evidence for feasibility and stakeholder satisfaction in using telemedicine in LTCFs in a number of clinical specialities.

Gray LC, Edirippulige S, Smith AC, Beattie E, Theodoros D, Russell T, et al. Telehealth for nursing homes: the utilization of specialist services for residential care. J Telemed Telecare. 2012 Apr;18(3):142-6. Epub 2012 Feb 23. 
Specialist care consultations were identified by two research nurses using documentation in patient records, appointment diaries, electronic billing services and on-site observations at a 441-bed long term care facility. Over a six-month period there were 3333 consultations (a rate of 1511 consultations per year per 100 beds). Most consultations were for general practice (n = 2589, 78%); these consultations were mainly on site (99%), with only 27 taking place off site. There were 744 consultations for specialities other than general practice. A total of 146 events related to an emergency or unplanned hospital admission. The remaining medical consultations (n = 598, 18%) related to 23 medical specialities. Many services which are currently being provided on site to metropolitan long-term care facilities could be provided by telehealth in both urban and rural facilities.

Loh PK, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc. 2009 Jul;10(6):408-13. Epub 2009 May 30. 
The aim of this study was to determine why introduction of health consulting services via telehealth video conference consultations failed in residential aged care facilities (RACF). The study involved 2 not-for-profit RACFs and surveyed managers, employed carers, physiotherapist, occupational therapist, registered nurses, and residents. The survey revealed there was awareness of information and communication technology (ICT) in RACF. However, respondents were uncertain of potential benefits provided to their clients. Positive attitudes to ICT included themes of saving time, easier doctor access, cost saving, and improved communications. Negative attitudes included themes of loss of human contact, inadequate training, security barriers, not user friendly, limited ability to comply with suggestions, privacy issues, and capital cost. More training for staff is required to enable them to use ICT efficiently and hardware / software at the user interface must be designed to maintain confidentiality with ease of access. Access to Telehealth services should not impede the routine delivery of personal care and human contact for residents.

Macedon Ranges and North Western Melbourne Medicare Local (MRNWM-ML). Telehealth in residential aged care. (YouTube clip 5:33mins)
The Macedon Ranges and North Western Melbourne Medicare Local (MRNWM-ML) have been working with residential aged care facilities (RACF's), GP's and specialists to prepare for and use telehealth technology to assist with the care of RACF residents.

McDonald K. Trialling telehealth – An aged care view [serial online]. 2014 Apr 10 [cited 2014 Dec 22]; Available from: Pulse+IT online magazine. (free full text article)
Article provides feedback and outcomes on the telehealth program set up last year by the Macedon Ranges and North Western Melbourne Medicare Local (MRNWM-ML) to link the area’s 40-odd residential aged care facilities and 130 general practices with out of area specialists.

Meyer D, Marx T, Ball-Seiter V. Social isolation and telecommunication in the nursing home: A pilot study. Gerontechnology. 2011;10(1):51-8.
Summary: The aim of this study was to determine the degree of isolation and depression levels among rural nursing home residents, their perception of communication with family members who live too far away to visit regularly, and the interest and perception of telecommunication through webcams. In addition, the willingness among friends and family to finance all or part of telecommunication devices used on their end was studied. This study identified a need for better or more contact and willingness on the part of both the residents and their family and friends to try and enhance communication with telecommunication devices.

Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, Carati C. Technology support to a telehealth in the home service: Qualitative observations. J Telemed Telecare. 2016 Jul;22(5):296-303. doi: 10.1177/1357633X15601523. Epub 2015 Sep 11.
The aim of this study was to understand the issues encountered during the provision of technology services that supported the Flinders University Telehealth in the Home (FTH) trial. A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Results found that the use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery.

Tsai HH, Tsai YF. Changes in depressive symptoms, social support, and loneliness over 1 year after a minimum 3-month videoconference program for older nursing home residents. J Med Internet Res. 2011 Nov 15;13(4):e93. (free full text journal article)
The purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents' social support, loneliness, and depressive status over 1 year. The experimental group received at least 5 minutes / week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. The videoconference program was found to have had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents' instrumental social support. However, this intervention had no effect on informational social support.

Wade V, Whittaker F, Hamlyn J. An evaluation of the benefits and challenges of video consulting between general practitioners and residential aged care facilities. J Telemed Telecare. 2015 Dec;21(8):490-3.
This research evaluated a project that provided video consultations between general practitioners (GPs) and residential aged care facilities (RACFs), with the aim of enabling faster access to medical care and avoidance of unnecessary hospital transfers. Evaluation data were gathered by direct observation at the project sites, semi-structured interviews and video call data from the technical network. Process development and change management aspects of the project required substantially more effort than was anticipated due to problems with RACF technical infrastructure, the need for repeated training and awareness raising in RACFs, the challenge of establishing new clinical procedures, the short length of the project and broader difficulties in the relationships between GPs and RACFs. Video consulting between GPs and RACFs was clinically useful and avoided hospital attendance on a small scale, but further focus on process development is needed to embed this as a routine method of service delivery.

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Page updated 04 May 2017