• Geriatrics
  • eHealth's vital for better elderly care

    Populations are aging. Africa’s may be at a slower rate than the rest of the world, but it has an opportunity to use eHealth to transform its healthcare for its elderly patients.

    An article in The Economist says reliance on hospital care can be reduced by equipping people’s homes and rehabilitation services with monitoring equipment. It suggests that health systems have been slow in these types of transformation. This hints at an opportunity for Africa’s health systems to jump ahead and manage demand in a way that sustains the limited hospital resources for very ill patients.

    In the UK’s NHS, a project at Airedale Hospital that’s placed telemedicine services in nursing and care homes has reduced hospital admissions by more than a third. Nurses used it to triage patients. It’s a model for Africa’s eHealth strategies.

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    Image from www.prometheonpharma.com

  • Denmark's identifying and sharing some good eHealth practices

    Evaluating eHealth’s generic impact in Africa’s been a bit like the search for the elusive needle in the conceptual haystack. eHealth may have huge, visible potential, but finding it’s probable generic net benefit over time, the difference between estimated costs and benefits, hasn’t found much traction. Instead, modest efforts have been directed to evaluations of specific types of eHealth in specific settings with limited transferability. 

    In 2014, Denmark planned to break through the barrier. It’s

    Share best practices Learn from one another Increase the use of welfare technology, which is eHealth and eWelfare.

    It’s financed by the government’s Denmark’s Digital Welfare Strategy 2013 to 2020 within a budget between DKK 1.065m ($144m) and 1.5m, (US$217m) for each project. The allocations of the DKK 4.065m budget:

    Evaluation of digitally supported work on early detection, DKK 1.065m Use of return systems for the prevention of pressure ulcers and injuries, DKK 1.5m. Longer home together will test and evaluate of an intelligent sensor based alarm system for home, DKK1.5m.

    Early detection’s led by the municipality of Aalborg. It’ll test solutions for the early detection of health issues in the elderly, including automatic alerts for medical professionals. The municipality of Aabenraa leads on systems that automatically turn bed-ridden patients, so reduces the number of medical staff needed. Using of sensors installed in homes to support home care for peoples with is being evaluated by the city of Aarhus. The next series of applications is expected in mid-2016.

    Low and Middle Income Countries (LMIC) have different eHealth priorities, so the need for evaluation data. In 2011, WHO published findings from a review of evaluations of three types of eHealth in Low and Middle Income Countries (LMIC). It included:

    Systems facilitating clinical practice Institutional systems Systems facilitating care at a distance. 

    It found that large randomised trials provide strong evidence of eHealth’s efficacy and its potential impact on outcomes, but, highly controlled studies fail to answer questions about:

    eHealth’s reach into vulnerable communities Can eHealth systems be adopted, scaled up and maintained outside the environments in which they were originally studied, the conundrum of transferability.

    It proposed new approaches to evaluation that emphasise qualitative and quantitative methods, community-based participatory research, and organizational theory in addition to controlled trials and ensure that eHealth’s relevance and flexibility to adapt to different settings. Evaluations comprising several sites are expensive, so a constraint. Their benefits need weighing against two other approaches. One’s larger numbers of smaller and innovative, less definitive evaluations of eHealth adapted to different cultures and environments. The other’s step-wedge designs where eHealth’s gradually rolled out to new sites. 

    It’s vital that Africa’s health systems adopt this advice to improve their eHealth investment. It seems that eHealth decision-takers may have to keep waiting for facts provided by their eHealth evaluation needles, while their health hay stacks keep steadily expanding. It’s not just time and tide that doesn’t wait.

  • Telemedicine reduces elderly's ER visits

    It’s well known that older people need more healthcare than younger people. This doesn’t mean that their demand can’t be managed. A study by a team from Rochester University in New York and the University of Wisconsin, and published in Telemedicine and e-Health, a Liebert publication, found that people living in Senior Living Communities (SLC) effectively engaged with telemedicine need fewer Emergency Room (ER) visits than people who live in less engaged SLCs or without access to high-intensity telemedicine for acute illnesses.

    It shows that telemedicine alone isn’t enough. Its benefits are maximised by a high degree of health worker engagement. The precise, specific engagement needed isn’t a straightforward matter. The study team identified potential factors, but recommended more research to understand resident and staff engagement, and how to increase it.

    Data came from a secondary analysis of data from a prospective cohort study evaluating the effectiveness of high-intensity telemedicine for SLC residents. Comparisons of engaged SLCs with less engaged SLCs and no telemedicine found that:

    There were 503 telemedicine visits 362, 72%, were for more engaged SLCs 141, 28% were for less engaged SLCs More engaged SLC residents had an annualised ER visit rate of 28% Less engaged SLC residents had an unchanged annualised ER visit rate People without access attended ER’s at the same rate too, which isn’t surprising.

    Stakeholder engagement is easy to identify as a prerequisite for maximising benefits. It can take time to achieve and sustain, but the study shows that without it, benefits may be missed completely. African countries have to ensure that resources needed are provided as part of each eHealth project. Resources aren’t enough. The study shows that achieving effective engagement has some mysteries that are not yet revealed.

  • Telemedicine will grow by 18% a year

    An assessment of the global telemedicine market by Research and Markets says spending will grow at a compound rate of more than 18% a year up to 2020. It says the shortage of physicians in rural and remote areas provides the opportunity for telemedicine to reach millions of patients, leading to a rapid and widespread deployment. The study, Global Telemedicine Market Outlook 2020, reviewed telemedicine technologies, including hardware, software and services. Total spending in 2014 was an estimated US$ 17.8 billion.

    The estimated growth is attributed to the high prevalence of chronic diseases, the increasing number of smartphone users, the need for better quality services and increasing elderly populations.

    But, reimbursement challenges, uneven telecom network distributions in remote areas, and high operating cost hinder implementation. This may tip Africa away below the average growth. It may also be constrained by affordability.

    The dominant suppliers included in the report include McKesson, Philips Healthcare, GE Healthcare, and Cerner. Will they see an average growth in African countries?

  • Japan's elderly can benefit from apps

    In 2014, Apple and IBM began working together to promote access to information on mobile devices. It links IBMs analytics and Big Data capabilities with Apple’s iPhone and iPad skills. Themes include health, banking, insurance and transport.

    Re/code has a report on the latest venture of a link with Japan Post “dramatically improve the lives of millions of people.” In Japan, 25% of the population are elderly. That’s about 32 million people. The numbers forecast to rise to more than 50 million in 2055.

    The postal service reaches every household in Japan. For a small fee, it provides a Watch Over service. Postal workers check on elderly customers and report their well-being to family members. The iPad program enhances the service.

    IBM will create apps to help remind elderly to take their medication and comply with diet and exercise regimes, provide access to social service agencies and help with shopping for groceries. Users will also have access to the usual iPad apps like FaceTime and Messages and Mail.

    IBM will provide Japan Post with software and systems to manage the devices and software for training its employees in using deploying the iPads. The programme has several phases. A small pilot starts later in 2015, with a planned expansion to some five million users by 2020; an average of a million extra users a year. By 2020, some 27 million elderly won’t benefit.

    The concept, and its scale, has potential for other settings. Africa doesn’t have the same elderly challenges as Japan. It has other priorities, some longstanding, like high maternal death rates, and some emerging ones, such as non-communicable diseases. Several communities in African countries can benefit from an equivalent initiative with a focus on mobile phones. Could it be a next step for Apple and IBM?

  • Why use telemonitoring if it makes no cost difference?

    A study in Pub med by a team from Regenstrief Center for Healthcare Engineering at Purdue University, Indiana, USA has found that there are no cost differences between telemonitoring and conventional care for elderly patients. There were some differences, though. The costs of the telemonitoring patients weren’t as variable, and they had lower total 30-day readmission costs too.

    The patients had a range of characteristics. They were high-risk, seriously ill, frail, elderly patients, each with co-morbidities. The research team says that a different cohort with higher readmission risks, such as heart failure patients may provide better outcomes at lower cost.

    The team also pointed out that a weakness of the study is the difficulty in estimating telemonitoring costs because the devices were provided free. They also said that telemonitoring costs will drop as equipment becomes cheaper with technology advances.

    England’s Whole System Demonstrator had a similar finding. It said that its telemonitoring isn’t cost effective.

    With the lack of positive findings, a cautious approach to telemonitoring seems a good idea for African countries contemplating telemonitoring initiatives. It seems important to find the right context first.