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      How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews

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          Abstract

          Introduction

          Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues.

          Methods

          Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis.

          Results

          None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0–4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5.

          Conclusions

          Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.

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          Most cited references52

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          Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis.

          Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days.
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            What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings.

            Nearly half a century ago, telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Practitioners from a variety of medical specialties have claimed success in their telemedicine pursuits. Gradually, this new modality of healthcare delivery is finding its way into the mainstream medicine. As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. The meaning of telemedicine encapsulated in these definitions varies with the context in which the term was applied. An analysis of these definitions can play an important role in improving understanding about telemedicine. In this paper we present an extensive literature review that produced 104 peer-reviewed definitions of telemedicine. These definitions have been analyzed to highlight the context in which the term has been defined. The paper also suggests a definition of modern telemedicine. The authors suggest that telemedicine is a branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another. It is deployed to overcome issues like uneven distribution and shortage of infrastructural and human resources. We expect that this study will enhance the level of understanding and meaning of telemedicine among stakeholders, new entrants, and researchers, eventually enabling a better quality of life.
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              A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions.

              We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 November 2018
                2018
                : 13
                : 11
                : e0207332
                Affiliations
                [1 ] Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy
                [2 ] Hospital Direction, San Bortolo Hospital, Vicenza, Italy
                Universita degli Studi di Firenze, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0765-5478
                Article
                PONE-D-17-21654
                10.1371/journal.pone.0207332
                6237381
                30440004
                4adf03bf-d6d9-42ac-8ab1-6da82a3d9004
                © 2018 Bertoncello et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 June 2017
                : 30 October 2018
                Page count
                Figures: 2, Tables: 6, Pages: 24
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Health Care
                Medical Services
                Telemedicine
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Medicine and Health Sciences
                Geriatrics
                Medicine and Health Sciences
                Health Care
                Community Based Intervention
                Medicine and Health Sciences
                Cardiology
                Heart Failure
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

                Uncategorized
                Uncategorized

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