The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.
Background: Demands on long-term-care facilities are predicted to increase at an unprecedented rate as the baby boomer generation reaches retirement age. Aging-in-place (i.e. aging at home) is the desire of most seniors and is also a good option to reduce the burden on an over-stretched long-term-care system. Personal Emergency Response Systems (PERSs) help enable older adults to age-in-place by providing them with immediate access to emergency assistance. Traditionally they operate with push-button activators that connect the occupant via speaker-phone to a live emergency call-centre operator. If occupants do not wear the push button or cannot access the button, then the system is useless in the event of a fall or emergency. Additionally, a false alarm or failure to check-in at a regular interval will trigger a connection to a live operator, which can be unwanted and intrusive to the occupant. This paper describes the development and testing of an automated, hands-free, dialogue-based PERS prototype.
Failure to communicate important patient information between physicians causes medical errors and adverse patient events. On-call neurosurgery physicians at the Toronto Western Hospital do not know the medical details of all the patients that they are covering at night because they do not care for the entire service of patients during the day. Because there is no formal handover system to transfer patient information to the on-call physician, a nurse practitioner-based sign-out system was recently introduced. Its effectiveness for communication was evaluated with preinterventionYpostintervention questionnaires and by recording daily logins. There was a statistically significant decrease in number of logins after 8 weeks of use (p = .05, Fisher's exact test), and the tool was abandoned after 16 weeks. Modifications identified to improve the system include the ability to sort by attending physician and to automatically populate the list with new patients. Effective communication is important for reducing medical errors, and perhaps these modifications will facilitate this important endeavor.
This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness.
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