346 CHAPTER 19 Telenursing and Remote Access Telehealth expressed reservations

346 chapter 19 telenursing and remote access

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346 | CHAPTER 19 Telenursing and Remote Access Telehealth expressed reservations about using telehealth for the treatment of depression be- cause they felt that technology mediated communication would not lend itself to establishing and maintaining the type of provider-patient relationship that would allow treatment to be effective”(p. 178). However, given the access issues associated with rural communities, telehealth provided an opportunity for intervention in cases where traditional care was challenging. Telehealth was also shown to be an ef- fective alternative to usual care in conducting hearing screenings for rural elemen- tary schools, extending the reach and controlling costs of conducting hearing screenings (Lancaster, Krumm, Ribera, & Klich 2008). Julie Polisena et al. (2009) conducted a meta-analysis of 22 studies that compared telehealth to usual care in patients with chronic diseases and included a cost-effectiveness analysis. They con- cluded that in general telehealth can be cost-saving for the health system and in- surance providers, but caution that because the overall methodologic quality of the studies was low, the societal impact of telehealth is uncertain. It is clear that research in telehealth interventions demonstrates that telehealth is at least as effective as usual care in managing chronic conditions in the home, and in many cases is more cost-effective than home visits. Demiris et al. (2009) suggest that more studies are needed to focus on the patient–provider relationship changes, especially the loss of human touch associated with telehealth interven- tions. They also caution that researchers who are studying telehealth in remote populations must consider long-term sustainability of telehealth support beyond the study period to ensure that the “research does not exacerbate existing dispar- ities” in access to technologies (p. 132). To follow progress in telehealth research, bookmark the sites provided in Box 19-1. BOX 19-1 Telehealth Research and Information Centers Center for Telehealth and E-Health Law: Global Telehealth Resource Center at Global Health Council: .org/sources/view.php3?id=188 Telehealth Research Institute at University of Hawaii: .edu/cms/ Telehealth Resource Centers: Telemedicine Information Exchange: UTMB Center for Center for Telehealth Research and Policy at University of Texas Medical Branch: Virginia Telehealth Network:
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The Foundation of Knowledge Model and Home Telehealth | 347 THE FOUNDATION OF KNOWLEDGE MODEL AND HOME TELEHEALTH There is much to learn about usual home telehealthcare service delivery, particu- larly to the elderly and chronically ill, and for this important purpose using the Foundation of Knowledge model is key to learning how to use telehealthcare tools with typical patients (elderly, needing pointed care) and operate effectively as te- lenurses. To understand the mechanics and effectiveness of home telehealth deliv-
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