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Accuracy of routine echocardiographic measurements made by an inexperienced examiner through tele-instruction.

https://arctichealth.org/en/permalink/ahliterature68989
Source
J Telemed Telecare. 1996;2(3):148-54
Publication Type
Article
Date
1996
Author
J E Afset
P. Lunde
K. Rasmussen
Author Affiliation
Department of Medicine, Kirkenes Hospital, Norway.
Source
J Telemed Telecare. 1996;2(3):148-54
Date
1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost-Benefit Analysis
Echocardiography - economics - methods
Female
Humans
Male
Medically underserved area
Middle Aged
Norway
Reproducibility of Results
Research Support, Non-U.S. Gov't
Telemedicine - economics - methods
Video Recording
Abstract
The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
PubMed ID
9375049 View in PubMed
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The application of teleophthalmology in examining patients with glaucoma: a pilot study.

https://arctichealth.org/en/permalink/ahliterature50906
Source
J Glaucoma. 1999 Dec;8(6):367-73
Publication Type
Article
Date
Dec-1999
Author
A. Tuulonen
T. Ohinmaa
H I Alanko
P. Hyytinen
A. Juutinen
E. Toppinen
Author Affiliation
Department of Ophthalmology, University of Oulu, Finland.
Source
J Glaucoma. 1999 Dec;8(6):367-73
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Female
Glaucoma - diagnosis - economics
Humans
Internship and Residency
Male
Middle Aged
Nerve Fibers - pathology
Ophthalmology - economics - education - methods
Optic Disk - pathology
Optic Nerve - pathology
Patient satisfaction
Pilot Projects
Primary Health Care - economics - methods
Remote Consultation - economics - methods
Retina - pathology
Rural Population
Teaching - methods
Telemedicine - economics - methods
Visual Fields
Abstract
PURPOSE: To test the feasibility of teleophthalmology applications in examining patients with glaucoma, test its use for training purposes in an ophthalmology residency program and as a consultation link between primary healthcare unit and university eye clinic, and to introduce a preliminary model for economic assessment of telemedicine application in ophthalmology. METHODS: A video slit-lamp, an automated perimeter, a nonmydriatic fundus camera and a videoconferencing system were installed in a healthcare center in a rural area. Twenty-nine patients with glaucoma were examined in the rural healthcare center instead of the university eye clinic. A control group consisted of 41 glaucoma patients examined at the eye clinic one year earlier. An ophthalmic resident examined the patients together with the local general practitioner. An interactive video consultation was created with the university glaucoma clinic using ISDN connections and special application software. RESULTS: Both patient groups were equally satisfied with the ophthalmic service. Nearly all patients in the telemedicine group (96%) wanted to have their next visit in their own healthcare center instead of the university clinic. The most important reasons were reduction in traveling (97%), costs (92%), and time (92%). The costs of the telemedicine and conventional visits were equal, but decreased traveling saved $55 per visit. However, the quality of the images obtained in the remote center was poorer than that of the images obtained at the university clinic. CONCLUSION: The results of this pilot study indicate that further research with a larger number of patients is warranted to evaluate both methods, technology, and economics of teleophthalmology.
PubMed ID
10604295 View in PubMed
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Collaborative efforts are needed to ensure proper knowledge dissemination of telemedicine projects.

https://arctichealth.org/en/permalink/ahliterature262976
Source
Dan Med J. 2014 Sep;61(9):A4896
Publication Type
Article
Date
Sep-2014
Author
Neel Kolthoff Jakobsen
Lena Sundby Jensen
Lars Kayser
Source
Dan Med J. 2014 Sep;61(9):A4896
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Denmark
Documentation
Health Communication
Health Services Research - economics - methods - organization & administration
Humans
Information Dissemination
Periodicals as Topic - statistics & numerical data
Research Design
Research Support as Topic - organization & administration
Telemedicine - economics - methods - organization & administration
Abstract
Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were documented and disseminated.
Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted and information about project results and dissemination were obtained.
More than half of all projects were disseminated to professionals as well as to the public and used two-way communication. However, it was generally difficult to obtain an overview of the projects due to dynamic changes in names and scopes.
We propose that the funding authorities require designs comprising proper evaluation models that will subsequently allow the investigators to publish their findings. Furthermore, a dissemination plan comprising both peers and other professions should be made mandatory. The investigators should ensure proper documentation and dissemination of changes both during and after the projects in order to ensure transparency, and national or international organisations should establish a database with relevant data fields.
not relevant.
PubMed ID
25186538 View in PubMed
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Economic evaluation of Manitoba Health Lines in the management of congestive heart failure.

https://arctichealth.org/en/permalink/ahliterature256895
Source
Healthc Policy. 2013 Nov;9(2):36-50
Publication Type
Article
Date
Nov-2013
Author
Yang Cui
Malcolm Doupe
Alan Katz
Paul Nyhof
Evelyn L Forget
Author Affiliation
PhD Student, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB.
Source
Healthc Policy. 2013 Nov;9(2):36-50
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis
Delivery of Health Care - economics - utilization
Female
Health Care Costs - statistics & numerical data
Heart Failure - economics - therapy
Humans
Male
Manitoba
Middle Aged
Models, Economic
Quality-Adjusted Life Years
Telemedicine - economics - methods
Abstract
This one-year study investigated whether the Manitoba Provincial Health Contact program for congestive heart failure (CHF) is a cost-effective intervention relative to the standard treatment.
Individual patient-level, randomized clinical trial of cost-effective model using data from the Health Research Data Repository at the Manitoba Centre for Health Policy, University of Manitoba.
A total of 179 patients aged 40 and over with a diagnosis of CHF levels II to IV were recruited from Winnipeg and Central Manitoba and randomized into three treatment groups: one receiving standard care, a second receiving Health Lines (HL) intervention and a third receiving Health Lines intervention plus in-house monitoring (HLM). A cost-effectiveness study was conducted in which outcomes were measured in terms of QALYs derived from the SF-36 and costs using 2005 Canadian dollars. Costs included intervention and healthcare utilization. Bootstrap-resampled incremental cost-effectiveness ratios were computed to take into account the uncertainty related to small sample size.
The total per-patient mean costs (including intervention cost) were not significantly different between study groups. Both interventions (HL and HLM) cost less and are more effective than standard care, with HL able to produce an additional QALY relative to HLM for $2,975. The sensitivity analysis revealed that there is an 85.8% probability that HL is cost-effective if decision-makers are willing to pay $50,000.
Findings demonstrate that the HL intervention from the Manitoba Provincial Health Contact program for CHF is an optimal intervention strategy for CHF management compared to standard care and HLM.
PubMed ID
24359716 View in PubMed
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The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature113981
Source
BMC Pediatr. 2013;13:73
Publication Type
Article
Date
2013
Author
Jenny Ericson
Mats Eriksson
Lena Hellström-Westas
Lars Hagberg
Pat Hoddinott
Renée Flacking
Author Affiliation
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. jenny.ericson@ltdalarna.se
Source
BMC Pediatr. 2013;13:73
Date
2013
Language
English
Publication Type
Article
Keywords
Breast Feeding - psychology
Clinical Protocols
Cost-Benefit Analysis
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Mothers - psychology
Outcome and Process Assessment (Health Care)
Patient satisfaction
Postnatal Care - economics - methods
Research Design
Sweden
Telemedicine - economics - methods
Abstract
Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at
Notes
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PubMed ID
23663521 View in PubMed
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E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach.

https://arctichealth.org/en/permalink/ahliterature139361
Source
Gut. 2010 Dec;59(12):1652-61
Publication Type
Article
Date
Dec-2010
Author
Margarita Elkjaer
Mary Shuhaibar
Johan Burisch
Yvonne Bailey
Hanne Scherfig
Birgit Laugesen
Søren Avnstrøm
Ebbe Langholz
Colm O'Morain
Elsebeth Lynge
Pia Munkholm
Author Affiliation
Digestive Disease Center Herlev Hospital, Medical Section, University of Copenhagen, Denmark.
Source
Gut. 2010 Dec;59(12):1652-61
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Colitis, Ulcerative - economics - metabolism - psychology - therapy
Denmark
Feasibility Studies
Feces - chemistry
Female
Health Care Costs - statistics & numerical data
Health Knowledge, Attitudes, Practice
Humans
Internet
Ireland
Leukocyte L1 Antigen Complex - metabolism
Male
Mesalamine - therapeutic use
Middle Aged
Patient compliance
Patient Education as Topic - methods
Quality of Life
Self Administration
Telemedicine - economics - methods
Treatment Outcome
Young Adult
Abstract
The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities' focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients' education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial 'Constant-care' was undertaken in Denmark and Ireland.
333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www.constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients' compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs.
88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group.
The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term.
PubMed ID
21071584 View in PubMed
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Evaluating the translation process of an Internet-based self-help intervention for prevention of depression: a cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature116973
Source
J Med Internet Res. 2013;15(1):e18
Publication Type
Article
Date
2013
Author
Ove K Lintvedt
Kathleen M Griffiths
Martin Eisemann
Knut Waterloo
Author Affiliation
Faculty of Health Sciences, Department of Psychology, University of Tromsø, Huginbakken 32, Tromsø, Norway.
Source
J Med Internet Res. 2013;15(1):e18
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Cost-Benefit Analysis
Depression - economics - prevention & control
Great Britain
Humans
Internet - economics
Norway
Quality-Adjusted Life Years
Self Care
Telemedicine - economics - methods
Translating
Abstract
Depression is common and treatable with cognitive behavior therapy (CBT), for example. However, access to this therapy is limited. Internet-based interventions have been found to be effective in reducing symptoms of depression. The International Society for Research on Internet Interventions has highlighted the importance of translating effective Internet programs into multiple languages to enable worldwide dissemination.
The aim of the current study was to determine if it would be cost effective to translate an existing English-language Internet-based intervention for use in a non-English-speaking country.
This paper reports an evaluation of a trial in which a research group in Norway translated two English-language Internet-based interventions into Norwegian (MoodGYM and BluePages) that had previously been shown to reduce symptoms of depression. The translation process and estimates of the cost-effectiveness of such a translation process is described. Estimated health effect was found by using quality-adjusted life years (QALY).
Conservative estimates indicate that for every 1000 persons treated, 16 QALYs are gained. The investment is returned 9 times and the cost-effectiveness ratio (CER) is 3432. The costs of the translation project totaled to approximately 27% of the estimated original English-language version development costs.
The economic analysis shows that the cost-effectiveness of the translation project was substantial. Hopefully, these results will encourage others to do similar analyses and report cost-effectiveness data in their research reports.
Notes
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PubMed ID
23343481 View in PubMed
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Evaluation of a telepsychiatry pilot project.

https://arctichealth.org/en/permalink/ahliterature200719
Source
J Telemed Telecare. 1999;5(1):38-46
Publication Type
Article
Date
1999
Author
S. Doze
J. Simpson
D. Hailey
P. Jacobs
Author Affiliation
Crossroads Regional Health Authority, Wetaskiwin, Canada.
Source
J Telemed Telecare. 1999;5(1):38-46
Date
1999
Language
English
Publication Type
Article
Keywords
Canada
Community Mental Health Services - economics - organization & administration
Costs and Cost Analysis
Evaluation Studies as Topic
Hospitals, General
Hospitals, Psychiatric
Humans
Pilot Projects
Psychiatry - economics - methods
Telemedicine - economics - methods
Abstract
We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist (C$610 per consultation); with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.
PubMed ID
10505368 View in PubMed
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Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient's perspective.

https://arctichealth.org/en/permalink/ahliterature159843
Source
Epilepsia. 2008 Apr;49(4):573-85
Publication Type
Article
Date
Apr-2008
Author
Syed Nizamuddin Ahmed
Carly Mann
D Barry Sinclair
Angela Heino
Blayne Iskiw
Daphne Quigley
Arto Ohinmaa
Author Affiliation
Department of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada. snahmed@ualberta.ca
Source
Epilepsia. 2008 Apr;49(4):573-85
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Adult
Aftercare - methods - standards
Aged
Attitude to Health
Canada
Cost of Illness
Costs and Cost Analysis
Epilepsy - psychology - therapy
Feasibility Studies
Female
Follow-Up Studies
Health Care Costs
Housing - economics
Humans
Male
Middle Aged
Patient satisfaction
Pilot Projects
Questionnaires
Telemedicine - economics - methods
Travel - economics
Treatment Outcome
Videoconferencing - economics
Abstract
Cost analysis and patient satisfaction with telemedicine in epilepsy care.
This controlled study included out-of-town epilepsy patients coming to follow-up at the University of Alberta hospital epilepsy clinic. After an informed consent, patients were randomized to either conventional (n = 18) or telemedicine (n = 23) clinics. Patients or caregivers filled patient satisfaction and travel cost questionnaires in both alternatives. Cost per visit analysis included costs of traveling, lodging, and lost productivity.
Average age of the population was 41 years (range 19-73; 45% women). Eighty-three percent of patients preferred their next visit through telemedicine. About 90% of patients indicated a need for companion travel (mainly by car) to conventional clinic. For the conventional group patients the value of lost productivity was CAD $201, hotel cost CAD $8.50, and the value of car mileage CAD $256.50, totaling about CAD $466.00. Patient costs for telemedicine were CAD $35.85. Telemedicine production costs are similar to the patients' savings in traveling and lost productivity. About 90% of patients in both groups were satisfied with the quality of the service.
Telemedicine can play a role in follow-up care of epilepsy patients, reduce patient costs, and improve patient satisfaction. This is the first full-time epilepsy telemedicine clinic in Western Canada.
PubMed ID
18076644 View in PubMed
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Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial: methods of a randomized effectiveness trial.

https://arctichealth.org/en/permalink/ahliterature261450
Source
Trials. 2013;14:280
Publication Type
Article
Date
2013
Author
Anna Svarre Jakobsen
Lars C Laursen
Birte Østergaard
Susan Rydahl-Hansen
Klaus V Phanareth
Source
Trials. 2013;14:280
Date
2013
Language
English
Publication Type
Article
Keywords
Clinical Protocols
Cost-Benefit Analysis
Denmark
Diagnosis, Computer-Assisted
Disease Progression
Health Care Costs
Hospitals, University
Humans
Patient Discharge
Patient Readmission - economics
Pulmonary Disease, Chronic Obstructive - diagnosis - economics - mortality - physiopathology - therapy
Research Design
Respiratory Therapy
Telemedicine - economics - methods
Telemetry
Therapy, Computer-Assisted
Time Factors
Treatment Outcome
Videoconferencing
Abstract
Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge.
COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university hospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of four to receive either standard treatment at the hospital or the same standard treatment at home using telemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring equipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed up by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen, nebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients in both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria. Follow-up was performed at 1, 3 and 6 months after discharge.
Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012. Results were analyzed in 2013.
The results may have implications on future hospital treatment modalities for patients with severe exacerbations in COPD where telemedicine may be used as an alternative to conventional admission.
Clinical Trials NCT01155856.
Notes
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PubMed ID
24139548 View in PubMed
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