Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

Abstract

ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

The Virtual Shoulder and Knee Physical Examination

“…In fact, in a randomized controlled trial of orthopaedic visits performed via telehealth compared with in-person consultations, physicians rated their ability to examine patients as good or very good in 98% of telehealth visits, with no significant differences between groups and no adverse safety events. 11 By expanding our menu of exam maneuvers to include alternatives such as the lever test for the ACL, 9,37 as well as minor modifications to classic maneuvers to be self-performed such as the Jobe test, [26][27][28]31,39,46,66 we can still obtain useful data, albeit imperfect, via the The bounce test with a soup can placed beneath the heel. The patient is asked to slightly bend the knee and then allow it to bounce down so that it is completely straight, repeating this several times quickly.…”

“…Several studies across an array of medical disciplines have reported that, compared with in-person visits, telehealth visits have similar patient satisfaction levels while concomitantly reducing travel costs, visit times, wait times, and overall health care costs. 3,46,50,71,72 Despite its increasing utilization in other health care disciplines, telehealth was not widely adopted by sports medicine practitioners before the COVID-19 crisis. 38 However, we now recognize that telehealth is an effective option for musculoskeletal care and will likely endure even after the pandemic, driven by physician and patient demand for efficiency and convenience.…”

Los retos del cuidado de las personas con diabetes durante el estado de emergencia nacional por la COVID-19 en Lima, Perú: recomendaciones para la atención primaria

“…Esta ruta expone a los pacientes a la COVID-19 y carga innecesariamente el área de emergencia. Estudios en otros países evidencian que la telemedicina es efectiva para promover un mejor autocuidado entre los adultos mayores con ECNT (22) , sin embargo, una revisión sistemática encontró que los niveles de health literacy (23) , que implica tener las competencias para acceder, comprender, evaluar y aplicar la información en salud, influyen en los beneficios de la telemedicina para el tratamiento de las ECNT. En el caso peruano habría que considerar, además, el limitado acceso a Internet de estos pacientes.…”

Digital health support – a good thing, but not for me: experiences of family caregivers and healthcare staff

“…A study in Iran of hospitalised patients' use of ICT found that the most important sources of information were patient education, searching health information, and physician contact, and that the factors that affected the use of ICT were the patient's IT skills, access to communication technology tools, and perceived usefulness of the tool (Zare & Jebraeily, 2018). ICT as a way of supporting vulnerable patients' self-care was explored in a review of the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease (Parker et al, 2018). It was found that most studies sought to persuade vulnerable patients to believe that they could self-manage their conditions, but there were none or limited interaction with the patients.…”