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346|CHAPTER 19Telenursing and Remote Access Telehealthexpressed reservations about using telehealth for the treatment of depression be-cause they felt that technology mediated communication would not lend itself toestablishing and maintaining the type of provider-patient relationship that wouldallow treatment to be effective”(p. 178). However, given the access issues associatedwith rural communities, telehealth provided an opportunity for intervention incases 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 hearingscreenings (Lancaster, Krumm, Ribera, & Klich 2008). Julie Polisena et al. (2009)conducted a meta-analysis of 22 studies that compared telehealth to usual care inpatients 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 thestudies was low, the societal impact of telehealth is uncertain.It is clear that research in telehealth interventions demonstrates that telehealthis 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 relationshipchanges, especially the loss of human touch associated with telehealth interven-tions. They also caution that researchers who are studying telehealth in remotepopulations must consider long-term sustainability of telehealth support beyondthe 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.BOX19-1Telehealth 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 TexasMedical Branch: •Virginia Telehealth Network:
The Foundation of Knowledge Model and Home Telehealth|347THE FOUNDATION OF KNOWLEDGE MODEL AND HOME TELEHEALTHThere is much to learn about usual home telehealthcare service delivery, particu-larly to the elderly and chronically ill, and for this important purpose using theFoundation of Knowledge model is key to learning how to use telehealthcare toolswith typical patients (elderly, needing pointed care) and operate effectively as te-lenurses. To understand the mechanics and effectiveness of home telehealth deliv-