EFFECTIVENESS OF VIDEO-VISITS IN PALLIATIVE HOME CARE: PRELIMINARY FINDINGS OF AN RCT IN THE COMMUNITY

摘要

Background Studies have demonstrated effectiveness of home telehealth technology to deliver health care services, however challenges remain in understanding integration of the technology into routine care. Evidence of clinical effectiveness and cost-effectiveness on a population level, as well as the readiness of both clients and health care professionals is still required. Method A 36-month multi-method study (2003-2006) is currently underway in 4 health regions and 11 home care offices serving rural communities in the province of Alberta, Canada. Two study questions address the need for evidence on the effectiveness of home telehealth in terms of quality of life and symptom management, as well as on cost effectiveness. The third question addresses clients' and nurses' readiness to use the technology. Two hundred clients are being recruited and randomly assigned to routine home care or routine care plus video-visits. Preliminary Results As of March 2005, 30 clients have completed an average of 5.6 weeks of the proposed 8-week study period. Client recruitment has proven more challenging than expected due to factors such as regional variability in the definition of palliative, difficulty meeting eligibility criteria and factors in the work environment. Clients with high care requirements have not been represented in the sample, which may reflect a disease severity not suitable for video care. Nurses determined approximately 30% of their visits could have been conducted via videophone, with most clients very positive about the experience. Conclusion Implementing home telehealth technology on a population level introduces new challenges. Economic benefits may not be evident; however, a demonstrated improvement in quality of life may provide the incentive to proceed.