Royaume-Uni – Une analyse de la télésanté en Écosse 28

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Veille documentaire sur la téléréadaptation
Résultats du 17 septembre au 1er octobre 2012
Articles de périodiques
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J Telemed Telecare. 2012;18(4):211-20.
Twenty years of telemedicine in chronic disease management--an evidence synthesis.
Wootton R.
Source
Norwegian Centre for Integrated Care and Telemedicine, Tromsø, Norway. Abstract
A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five
common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled
trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of
37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators
in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a
conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported
positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias.
Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective
(or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months).
It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period.
Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in
managing chronic diseases is on the whole weak and contradictory.
PMCID: PMC3366107 Free PMC Article
PMID: 22674020
3.
J Telemed Telecare. 2012;18(4):221-5. Epub 2012 May 31.
Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth
among chronic obstructive pulmonary disease patients.
Dinesen B, Haesum LK, Soerensen N, Nielsen C, Grann O, Hejlesen O, Toft E, Ehlers L.
Source
Telehomecare Research Group, Medical Informatics, Department of Health Science and Technology, Faculty of
Medicine, Aalborg University, Denmark.
Abstract
We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could
reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health
centre, general practitioner (GP) or the pulmonary hospital ward. They were randomized to usual care or tele-
rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were
suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to
follow-up. In the control group 51 patients were allocated to usual care and three patients were lost to follow-up. In the
tele-rehabilitation group, the mean hospital admission rate was 0.49 per patient per 10 months compared to the control

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group rate of 1.17; this difference was significant (P = 0.041). The mean cost of admissions was €3461 per patient in
the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates
for time to hospital admission were longer for the intervention group than the controls, but the difference was not
significant. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.
PMID: 22653618
4.
Korean J Radiol. 2012 Jan-Feb;13 Suppl 1:S21-30. Epub 2012 Apr 23.
Emerging technologies for telemedicine.
Minh CD, Shimizu S, Antoku Y, Torata N, Kudo K, Okamura K, Nakashima N, Tanaka M.
Source
Vietnam Research and Education Network, National Agency for Science and Technology Information, Hanoi 10000,
Vietnam.
Abstract
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are
introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo.
Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out
technologies that are especially targeted at doctors and technicians, so that those interested in using similar
technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
PMCID: PMC3341457 Free PMC Article
PMID: 22563284
6.
Telemed J E Health. 2012 May;18(4):305-8. Epub 2012 Mar 16.
E-counseling in psychosocial cancer care: a survey of practice, attitudes, and training among providers.
Schnur JB, Montgomery GH.
Source
Department of Oncological Sciences, Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1130, New York, NY
10029, USA
Abstract
OBJECTIVE:
In the cancer setting, e-counseling interventions may be uniquely beneficial as they spare patients the cost and burden
of traveling to a hospital or clinic for psychosocial care. However, the prevalence of e-counseling among psychosocial
cancer care providers is unknown, as are the training needs with regard to e-counseling among this group of
professionals. Thus, our group conducted an online professional training needs assessment with psychosocial cancer
care providers.
SUBJECTS AND METHODS:
Participants (n=120) were recruited from the listservs of the Health Psychology Division of the American Psychological
Association, the Society of Behavioral Medicine-Cancer Special Interest Group, the American Psychosocial Oncology
Society, and the Association of Oncology Social Work. All completed a 14-item online survey.
RESULTS:
Although 84% of participants stated that e-counseling could be important to their clinical work with cancer patients and
survivors, 88% reported that they did not have the skills to effectively conduct e-counseling, and 81% reported that
there were no adequate e-counseling educational opportunities. When asked about future training opportunities,
participants reported a preference for online training versus live training (p<0.001).
CONCLUSIONS:
Overall, the results highlight the need for online training programs in e-counseling for psychosocial cancer care
providers. The training of psychosocial cancer care providers in e-counseling is a critical first step towards increasing
implementation of e-counseling interventions and using the Internet to deliver effective interventions to cancer patients
in need.
PMCID: PMC3343303 [Available on 2013/5/1]
PMID: 22424079
8.
Gerontologist. 2012 Aug;52(4):541-52. Epub 2012 Jan 11.
Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized
controlled trial.
Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Ten Have T.
Source

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Center for Mental Health & Aging, School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk,
Philadelphia, PA 19104, USA.
Abstract
PURPOSE:
Telehealth care is emerging as a viable intervention model to treat complex chronic conditions, such as heart failure
(HF) and chronic obstructive pulmonary disease (COPD), and to engage older adults in self-care disease management.
DESIGN AND METHODS:
We report on a randomized controlled trial examining the impact of a multifaceted telehealth intervention on health,
mental health, and service utilization outcomes among homebound medically ill older adults diagnosed with HF or
COPD. Random effects regression modeling was used, and we hypothesized that older adults in the telehealth
intervention (n = 51) would receive significantly better quality of care resulting in improved scores in health-related
quality of life, mental health, and satisfaction with care at 3 months follow-up as compared with controls (n = 51) and
service utilization outcomes at 12 months follow-up.
RESULTS:
At follow-up, the telehealth intervention group reported greater increases in general health and social functioning, and
improved in depression symptom scores as compared with usual care plus education group. The control group had
significantly more visits to the emergency department than the telehealth group. There was an observed trend toward
fewer hospital days for telehealth participants, but it did not reach significance at 12 months.
IMPLICATIONS:
Telehealth may be an efficient and effective method of systematically delivering integrated care in the home health
sector. The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to
disability, transportation, or isolation.
PMID: 22241810
3.
Telemed J E Health. 2012 May;18(4):271-6. Epub 2012 Mar 16.
Exploring therapeutic alliance with an internet-based self-management program with brief telephone support for youth
with arthritis: a pilot study.
White M, Stinson JN, Lingley-Pottie P, McGrath PJ, Gill N, Vijenthira A.
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
Findings from a pilot study are presented exploring therapeutic alliance between adolescent juvenile idiopathic arthritis
patients and a trained nonprofessional health coach during the feasibility testing of a 12-week self-management
program delivered online with brief telephone support. Therapeutic alliance was measured using the Working Alliance
Inventory Client Scale (WAI-C), and qualitative information about the experience was gathered using the Distance
Experience Questionnaire. WAI-C scores were found to be comparable to previously published pediatric face-to-face
data and pediatric distance treatment data. Therapeutic alliance scores were also found to be correlated with improved
treatment outcomes (decreased reported pain).
PMID: 22424081
7. Calling All Pain Patients: Telehealth Has Arrived. Kroenke, Kurt;
Pain Practice, 2012 Sep; 12 (7): 502-5 (journal article - commentary, editorial) ISSN: 1530-7085 PMID: 22924977
CINAHL AN: 2011672909
McGeary et al. provide an important review on the current state of telehealth for pain management. As the
number and quality of pain telehealth studies is limited, the authors also extrapolate from what is known about
telehealth for other medical disorders and suggest future directions for pain telehealth. Their review covers a
number of practical issues, including a description of telecare delivery options (store-and-forward, hub-and-spoke,
consultation, home-based models), consideration of crucial cost and reimbursement issues, and
recommendations for improving the methodological rigor of pain telehealth research.
8. A Comprehensive Review of Telehealth for Pain Management: Where We
Are and The Way Ahead.(includes abstract); McGeary, Donald D.; McGeary,
Cindy A.; Gatchel, Robert J.; Pain Practice, 2012 Sep; 12 (7): 570-7
(journal article - review) ISSN: 1530-7085 PMID: 22303839 CINAHL AN:
2011672904

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Abstract: Pain is generally undertreated in the United States, owing to a number of barriers including geographic distance
from specialty treatment providers; functional disability that limits mobility; treatment-related stigma; economic limitations;
and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly
erode a pain patient's quality of life, and there is widespread agreement that pain care must evolve to address this
significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for
distance interaction between providers and/or patients) offers a novel opportunity to expand pain assessment,
consultation, and treatment services beyond the walls of the specialty pain clinic, but there is limited availability of
resources describing how to best use this technology to improve access to care. A recent literature review (September
2011) using universally endorsed MeSH search criteria revealed only 32 MEDLINE references focusing on telehealth for
pain. This is surprising in light of the very large number of references covering telehealth (14,164
references) and pain (104,564 references), respectively. Of the studies available, there are very few randomized trials of
telehealth pain care and only one general overview of e-health and chronic pain, which dedicates just a few paragraphs to
telehealth. This manuscript represents one of the first comprehensive reviews of the current state of telehealth and pain
management research and practice. The goals are to provide a rationale for the potential benefit of telehealth-based pain
management services; describe the various applications of telehealth technology for pain management; orient the reader
to cost models for telehealth; present examples of services in place; and offer recommendations for future research based
on the current state of knowledge.
http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011672904&site=ehost-live
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L365618792
Record 1
Economic cost of home-telemonitoring care for BiPAP-assisted ALS individuals
Lopes De Almeida J.P., Pinto A., Pinto S., Ohana B. and De Carvalho M.
Amyotrophic Lateral Sclerosis 2012 13:6 (533-537)
Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home
compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40
consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital,
office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost
encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs
included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs
considered days of wages lost due to absenteeism. G1 included 20 patients aged 60±10 years and G2 included 19
patients aged 62±13 years. Results showed that no differences were found regarding clinical/demographic characteristics
at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in
annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64%
average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from
absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant),
telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year. © 2012
Informa Healthcare.
L52106371
Record 2
A feasibility study to investigate the acceptability and potential effectiveness of a telecare service for older
people with chronic obstructive pulmonary disease
Chau J.P.C., Lee D.T.F., Yu D.S.F., Chow A.Y.M., Yu W.-C., Chair S.-Y., Lai A.S.F. and Chick Y.-L.
International Journal of Medical Informatics 2012 81:10 (674-682)
Aims: To investigate the feasibility, acceptance and potential effectiveness of delivering a telecare service on the health
outcomes and hospital service utilization of community-dwelling patients with chronic obstructive pulmonary disease.
Methods: Eligible participants were older people, with moderate or severe chronic obstructive pulmonary disease, and
who had been admitted to hospital at least once for exacerbation during the previous year. The participants were
randomly assigned to the intervention or control group. Participants in the intervention group received a telecare device kit
and they were asked to monitor their oxygen saturation, pulse rate and respiration rate using the device and to transmit
the data to an online network platform. A medication and purse-lip breathing reminder with a feedback function is also
provided in the device kit. A community nurse monitors changes in the physiological parameters and takes immediate
action to address the patients' needs. Participants in the control group received no other extra care. Study outcomes
include user satisfaction, health-related quality of life, pulmonary function, hospital re-admission and use of emergency
room services. Results: Twenty-two participants in the intervention group and 18 in the control group were included in the
analysis. The mean age of all 40 participants was 72.93. years. Overall, the participants in the intervention group
expressed satisfaction with the telecare service. Some patients reported difficulty in reading the screen of the mobile

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phone and manipulating the tiny key-in buttons. No significant differences were found between the two time points
(baseline and post-test period) with regard to health-related quality of life. No significant differences in pulmonary function
and in the number of emergency department visits and hospital re-admissions between the study groups were found.
Conclusion: The high level of user satisfaction indicated the feasibility of conducting a large-scale randomized control trial
to evaluate the effects of a telecare service on health outcomes of patients with chronic obstructive pulmonary disease. ©
L365630172
Record 3
Web-based specialist support for spinal cord injury person's care: Lessons learned
Della Mea V., Marin D., Rosin C. and Zampa A.
International Journal of Telemedicine and Applications 2012 Article Number 861860
Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular
followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing
online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been
introduced in the regional healthcare network in order to make it compliant with current legal regulations on data
protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI
persons to portal use (up to 50 users), the number of accesses remained very low. Reasons for that have been
investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use
of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still
perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the
users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call. © 2012 Vincenzo
Della Mea et al.
L70878616
Record 5
Acute coronary syndrome: What is the cost-effectiveness of prevention, point-of-care technology and
telemonitoring?
Van Dyck W., Vértes G., Palaniappan M., Gassull D., Jain P., Schulthess D., Tambuyzer E., Hudson R. and Moran N.
Health Policy and Technology 2012 1:3 (173-177)
This study is a cost-analysis that calculates the impact of three interventions for patients identified as 'at risk' for Acute
Coronary Syndrome - a cardio-vascular exercise programme, point-of-care digital diagnostics, and telemonitoring
adherence tools. The methodology utilizes a model of the annualized costs of ACS for the entire treatment value chain,
and measures the impact of the three interventions by the change in treatment cost, incremental net benefit, and QALY.
The results demonstrate that the largest impact is measured when all three interventions are utilized simultaneously
producing a cumulative savings of €4424 and 0.126 QALY per patient. We also find a significant decrease in Emergency
Room visits by 15% and changes in rates of utilization of Catharization (-59%), Angioplasty (-59%), Bypass (-17%),
Medication (-14%) and Rehabilitation (-13%). © 2012 Fellowship of Postgraduate Medicine.
L51814526
Record 6
Telemedicine utilization to support the management of the burns treatment involving patient pathways in both
developed and developing countries: A case study
Syed-Abdul S., Scholl J., Chen C.C., Santos M.D.P.S., Jian W.-S., Liou D.-M. and Li Y.-C.
Journal of Burn Care and Research 2012 33:4 (e207-e212)
This case study reports on the utilization of telemedicine to support the management of the burns treatment in the islands
of Sao Tome and Principe by Taipei Medical University-Affiliated hospital in Taiwan. The authors share experiences about
usage of telemedicine to support treatment of the burn victims in a low-income country that receive reconstructive surgery
in a developed country. Throughout the entire care process, telemedicine has been used not only to provide an expert
advice from distance but also to help establish and maintain the doctor-patient relationship, to keep patients in contact
with their families, and to help educate and consult the medical personal physically present in Sao Tome and Principe.
This case study presents the details of how this process has been conducted to date, on what were learned from this
process, and on issues that should be considered to improve this process in the future. The authors plan to create
instructional videos and post them on YouTube to aid clinical workers providing similar treatment during the acute care
and rehabilitation process and also to support eLearning in many situations where it otherwise is not possible to use
videoconferencing to establish real-time contact between doctors at the local site and remote specialists. (J Burn Care
Res 2012;33:e207-e212). © 2012 by the American Burn Association.
L364984094
Record 8
Approaches to economic evaluation in telemedicine