Telemedicine in Cancer Care

2018 ◽  
pp. 540-545 ◽  
Author(s):  
S. Joseph Sirintrapun ◽  
Ana Maria Lopez
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Lifestyle Modification ◽  
Clinical Settings ◽  
Home Based ◽  
Home Based Care ◽  
Care Costs ◽  
Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

Eating Disorders: Identification and Management in General Medical and Psychiatric Settings

2021 ◽  
pp. 107839032199971
Author(s):  
Rebecca A. Owens ◽  
Evelyn Attia ◽  
Joyce J. Fitzpatrick ◽  
Kathryn Phillips ◽  
Stephanie Nolan
Keyword(s):  
Health Care ◽  
Eating Disorders ◽  
Assessment Tool ◽  
Psychiatric Morbidity ◽  
Clinical Settings ◽  
Life Saving ◽  
Treatment Plans ◽  
Receive Treatment ◽  
Health Features ◽  
Care Costs

OBJECTIVE Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.

scholarly journals “You get three different hats on and try to figure it out:” home based care provision during a disaster

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sue Anne Bell ◽  
Sarah Dickey ◽  
Marie-Anne Rosemberg
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Focus Groups ◽  
Home Health ◽  
Care Provision ◽  
Care Providers ◽  
Home Based ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Home Based Care

Abstract Background Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities. Methods Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach. Results Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients. Conclusions This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster.

Home-Based Pediatric Cancer Care: Perspectives and Improvement Suggestions From Children, Family Caregivers, and Clinicians

2021 ◽  
pp. OP.20.00958
Author(s):  
Lindsay A. Jibb ◽  
Julie Chartrand ◽  
Tatenda Masama ◽  
Donna L. Johnston
Keyword(s):  
Family Caregivers ◽  
Pediatric Cancer ◽  
Cancer Care ◽  
Care Center ◽  
System Level ◽  
Pediatric Care ◽  
Children With Cancer ◽  
Key Informants ◽  
Home Based ◽  
Home Based Care

PURPOSE: Although the hospital remains the dominant site for delivering most pediatric cancer care, home-based care is increasingly provided. To effectively deliver comprehensive, relevant, and acceptable care in children's homes, the voices of these key informants must be considered. We examined the views of children with cancer, their family caregivers, and clinicians on home-based cancer care to identify necessary strategies to improve the delivery of care. METHODS: Children with cancer, their family caregivers, and multiprofessional clinicians who provide care at a tertiary pediatric care center or in the community participated in audio-recorded, semistructured interviews in French and English. Interviews were conducted until data saturation in each participant group was achieved. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS: Thirteen children, 20 family caregivers, and 22 clinicians participated. Home-based care was endorsed as a means to improve child health-, family social- and financial-, and system-level outcomes. The success of a home-based model is built on care that addresses child and family informational, treatment and care, material, and psychosocial needs. Mechanisms to improve care include enhanced homecare agency-hospital-family communication, training for homecare nurses in pediatric cancer care, virtual solutions, and an expanded breadth of services provided in-home. Child-, family-, and system-related factors affect the delivery of optimal home-based care. CONCLUSION: Children, families, and clinicians value a model of pediatric cancer care that incorporates home-based services. The insights of these key informants should be reflected in the principles that become the basis of home-based cancer care best practices.

scholarly journals Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review

Sensors ◽  
2020 ◽  
Vol 20 (17) ◽  
pp. 5006
Author(s):  
Pau Redón ◽  
Atif Shahzad ◽  
Talha Iqbal ◽  
William Wijns
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Acute Coronary Syndromes ◽  
Clinical Evidence ◽  
Home Based ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
Care Costs

Diagnosing and treating acute coronary syndromes consumes a significant fraction of the healthcare budget worldwide. The pressure on resources is expected to increase with the continuing rise of cardiovascular disease, other chronic diseases and extended life expectancy, while expenditure is constrained. The objective of this review is to assess if home-based solutions for measuring chemical cardiac biomarkers can mitigate or reduce the continued rise in the costs of ACS treatment. A systematic review was performed considering published literature in several relevant public databases (i.e., PUBMED, Cochrane, Embase and Scopus) focusing on current biomarker practices in high-risk patients, their cost-effectiveness and the clinical evidence and feasibility of implementation. Out of 26,000 references screened, 86 met the inclusion criteria after independent full-text review. Current clinical evidence highlights that home-based solutions implemented in primary and secondary prevention reduce health care costs by earlier diagnosis, improved patient outcomes and quality of life, as well as by avoidance of unnecessary use of resources. Economical evidence suggests their potential to reduce health care costs if the incremental cost-effectiveness ratio or the willingness-to-pay does not surpass £20,000/QALY or €50,000 limit per 20,000 patients, respectively. The cost-effectiveness of these solutions increases when applied to high-risk patients.

scholarly journals Impact of Travel Time on Health Care Costs and Resource Use by Phase of Care for Older Patients With Cancer

2019 ◽  
Vol 37 (22) ◽  
pp. 1935-1945 ◽  
Author(s):  
Gabrielle B. Rocque ◽  
Courtney P. Williams ◽  
Harold D. Miller ◽  
Andres Azuero ◽  
Stephanie B. Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Travel Time ◽  
Health Care Costs ◽  
Resource Use ◽  
Cancer Care ◽  
Medicare Beneficiaries ◽  
Patient Cost ◽  
Hospitalization Rates ◽  
Care Costs ◽  
Medicare Spending

PURPOSEMany community cancer clinics closed between 2008 and 2016, with additional closings potentially expected. Limited data exist on the impact of travel time on health care costs and resource use.METHODSThis retrospective cohort study (2012 to 2015) evaluated travel time to cancer care site for Medicare beneficiaries age 65 years or older in the southeastern United States. The primary outcome was Medicare spending by phase of care (ie, initial, survivorship, end of life). Secondary outcomes included patient cost responsibility and resource use measured by hospitalization rates, intensive care unit admissions, and chemotherapy-related hospitalization rates. Hierarchical linear models with patients clustered within cancer care site (CCS) were used to determine the effects of travel time on average monthly phase-specific Medicare spending and patient cost responsibility.RESULTSMedian travel time was 32 (interquartile range, 18-59) minutes for the 23,382 included Medicare beneficiaries, with 24% of patients traveling longer than 1 hour to their CCS. During the initial phase of care, Medicare spending was 14% higher and patient cost responsibility was 10% higher for patients traveling longer than 1 hour than those traveling 30 minutes or less. Hospitalization rates were 4% to 13% higher for patients traveling longer than 1 hour versus 30 minutes or less in the initial (61 v 54), survivorship (27 v 26), and end-of-life (310 v 286) phases of care (all P < .05). Most patients traveling longer than 1 hour were hospitalized at a local hospital rather than at their CCS, whereas the converse was true for patients traveling 30 minutes or less.CONCLUSIONAs health care locations close, patients living farther from treatment sites may experience more limited access to care, and health care spending could increase for patients and Medicare.

Core Elements of the Patient Protection and Affordable Care Act and Their Relevance to the Delivery of High-Quality Cancer Care

2012 ◽  
pp. e4-e8 ◽  
Author(s):  
Beverly Moy ◽  
Amy P. Abernethy ◽  
Jeffrey M. Peppercorn
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Affordable Care Act ◽  
Cancer Care ◽  
Ethical Implications ◽  
Quality Cancer Care ◽  
Patient Protection ◽  
Challenges And Opportunities ◽  
Core Elements ◽  
Improve Access

Overview: The Affordable Care Act (ACA) contains many provisions that affect cancer care. The provisions of health care reform aim to improve access to quality cancer care, particularly among the most vulnerable Americans. However, health care reform also offers many challenges and opportunities that affect every stakeholder in oncology. This article summarizes the ACA provisions relevant to oncology, discusses the ethical implications for the oncology caregiver, and describes the effects on specific oncology stakeholders.

Prevalence of Chronic Illness in Pregnancy, Access to Care, and Health Care Costs

2008 ◽  
Vol 18 (6) ◽  
pp. S107-S116 ◽  
Author(s):  
Sharmila Chatterjee ◽  
Milton Kotelchuck ◽  
Usha Sambamoorthi
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Access To Care ◽  
Health Care Costs ◽  
Care Costs ◽  
In Pregnancy

Untapped Potential of Home Health Care Innovations to Improve Outcomes With Bundled Payment Initiatives

2016 ◽  
Vol 29 (1) ◽  
pp. 53-55
Author(s):  
Teresa Lee ◽  
Jennifer Schiller
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Home Health ◽  
Bundled Payment ◽  
Home Based ◽  
Medicare Program ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Home Based Care ◽  
Payment Models

A rapidly changing health care payment system creates opportunities for optimizing home health and home-based care for patients needing cardiac rehabilitation (CR). Home health agencies are poised to play a significant role in episode payment models in the context of post–acute care for patients with cardiovascular conditions. As the Medicare program expands its episode payment models to include patients with cardiovascular conditions, hospitals and other health care stakeholders that will be engaged in these bundled payment arrangements should consider use of home health care in the delivery of CR as a bridge to outpatient therapy and patient self-management.

scholarly journals Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

2016 ◽  
Vol 34 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Eduardo Cazap ◽  
Ian Magrath ◽  
T. Peter Kingham ◽  
Ahmed Elzawawy
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Cancer Care ◽  
Health Care Systems ◽  
Diagnosis And Treatment ◽  
Middle Income ◽  
Health Crisis ◽  
Middle Income Countries ◽  
Care Systems ◽  
Low And Middle Income

Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis.

scholarly journals Impact of Home Care Services on Patient and Economic Outcomes: A Targeted Review

2021 ◽  
pp. 108482232110383
Author(s):  
Irene Lizano-Díez ◽  
Sonia Amaral-Rohter ◽  
Lucía Pérez-Carbonell ◽  
Susana Aceituno
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Positive Impact ◽  
Patient Empowerment ◽  
Home Care Services ◽  
Care Services ◽  
Adherence To Medication ◽  
Home Based ◽  
Patient Reported ◽  
Home Based Care

Patient Support Programs (PSPs) reinforce patients’ care provided by health care professionals with the aim to improve adherence and patient empowerment. PSPs may include interventions such as home-based care, individualized medication counseling, support, training, and home delivery of medicines and/or devices. This study described these services and its impact on patient-reported outcomes and health care savings. We conducted an integrative literature review which was limited to publications from the last 10 years (2009-2019) and focused on diseases that require special support and/or parenteral administration. From 7040 total citations, we identified 64 home-based care services performed worldwide. Among the home-based care services, most were provided by nurses (n = 47/64; 73.4%) and addressed to cancer patients (n = 22/64; 34.4%); 23 out of 64 services (35.9%) incorporated telepharmacy. In general, home-based services and PSPs showed a positive impact on patients’ adherence to medication, patient satisfaction, and health-related quality of life. In addition, 14 (21.9%) services reported economic results, most of which showed that home therapy led to substantial cost savings.

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