Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making

Abstract

We investigated whether telemedicine (videoconferencing) was feasible in patients with special care needs on home ventilation, whether it affected the confidence of families about the clinical management of their child, and whether it supported clinical decision-making. Videoconferencing software was provided free for 14 families who had a computer and webcam. Families completed questionnaires about clinical management before the addition of telemedicine and 2-3 months after they had used telemedicine. They also completed a questionnaire about their experience with videoconferencing. There were 27 telemedicine encounters during the 9-month study. Families reported higher confidence in clinical care with telemedicine compared to telephone. They also reported that the videoconferencing was high-quality, easy to use, and did not increase their telecommunication costs. The telemedicine encounters supported clinical decision-making, especially in patients with active clinical problems or when the patient was acutely ill. The telemedicine encounters prevented the need for 23 clinic visits, three emergency room visits, and probably one hospital admission. Although the study was small, videoconferencing appears useful in the management of medically fragile patients on home ventilator support, producing high levels of family confidence in clinical management and value to clinicians in their decision-making.

Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits

“…The risk of hospitalisation was also lower in the videoconferencing group . Videoconferencing has also been shown to be feasible in the management of children on home ventilator support as well as for paediatric palliative care at home .…”

Section 4: Home monitoring and follow-up of home-ventilated children

“…74,75 A recent small pilot study from Boston Children's Hospital in the US enrolled 14 patients followed by telemedicine, of whom nine were children on HMV (invasive and noninvasive). 70 The study showed a high degree of acceptance by the families and felt that the use of telemedicine avoided clinic and emergency room visits.…”

“…We could not identify strong evidence on the use of telemedicine for follow-up care of children on HMV. Only three publications reported the telemedicine experience in such children [68][69][70] Even in adults, evidence is scarce. There were two systematic reviews on telemedicine that provided some important conclusions; one was solely on patients with diabetes 71 and the other presented data on four conditions, including pulmonary conditions.…”

Telemedicine Support Groups for Home Parenteral Nutrition Users

“…These patients and their families often experience high levels of isolation, fears about functional decline and death, diminishing quality of life as well as depression, concerns about caregivers, financial worries, and day‐to‐day stressors associated with challenging medical regimens. Furthermore, mobile‐based telemedicine may decrease risks associated with travel (eg, infection control risks, discomfort) in critically ill populations, such as patients with amyotrophic lateral sclerosis (ALS) 28 and children on ventilators 29 . Home‐based telemedicine addresses challenges in driving associated with vision loss, seizures, cognitive difficulties, and other conditions.…”