Paper
Understanding how the patient interacts with Internet intervention is key to advancing telemedicine.
Published 2008 · W. Santamore, C. Homko
The Journal of cardiovascular nursing
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Abstract
Today’s technology (personal digital assistants, cellular phones, Internet, text messaging, interactive voice response, e-mail) has altered and expanded our daily means of communication. For preventive care and chronic diseases, nurse management is essential. Telemedicine (the use of today’s technology) will inevitably alter the delivery of patient care outside of the hospital setting. Telemedicine has the potential to improve the efficiency of nursing care delivery, as well as healthcare delivery in general, while enhancing patient satisfaction through the flexibility of asynchronous communication and improved access to health information. Already, these technologies are starting to be used clinically and will impact on the patientYhealthcare provider relationship. The patient’s concerns, perceptions, and needs must be addressed to achieve optimal technology utilization and patient benefit. In this issue, Nahm et al starts to examine these questions. Forty-four heart failure patients were recruited from the Medicare Coordinated Care Demonstration project. Overall, confidence for using telemonitoring devices and Web-based health modules was high, whereas confidence for learning health information using Web modules was lower. The 2 most highly rated health information needs were research findings and medication. Most participants would like to have e-mail communication with healthcare providers. The findings showed participants’ high readiness to use e-health programs if access and training were provided. Comparing and contrasting some of our telemedicine studies highlight the need for training. In one study, we tested the hypothesis that training, and not access per se, was the main obstacle to the use of Internet-based telemedicine systems. After obtaining informed consent, we selected 42 participants (average age, 60.4 years) with little or no computer experience from Temple’s (inner city) and Geisinger’s (rural Pennsylvania) medical clinics. A graduate student conducted a 2-hour training protocol that covered 14 skills on how to use a computer and how to access telemedicine sites. Most participants (88%) responded within 10 days from a local Internet access site with a report on their health status. Their responses and comfort with its use were not correlated with age, sex, or ownership of a computer, whereas scores on all computer skills were positively correlated with use of the system. In an earlier heart failure study, where we required all the participants to have a computer with Internet access but did not provide training, only 46% of the participants regularly used the telemedicine system. The observation is similar to Nahm et al study, where, among nonusers, 50% reported availability of Web access; thus, Internet access does not equate to actual Internet use. In a cardiovascular risk reduction, Internet access was not required. However, we trained all individuals on how to use the computer and telemedicine system and had a utilization rate of over 80%. Clearly, training is important, but for individuals with limited mobility or severe chronic diseases, access must also be considered. Future telemedicine systems will probably have multiple means of connectivity (cellular phones, Internet, text messaging, interactive voice response, e-mail) to more comprehensively address access issues. Most telemedicine studies focus on the technology and clinical outcomes, in part because of the technical expertise of the groups. Although these studies are essential, they do not provide the basic information
Telemedicine has the potential to improve healthcare delivery and patient satisfaction, but training and access are crucial for optimal utilization and patient benefit.
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