Telemedicine journal and e-health : the official journal of the American Telemedicine Association
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The aim of this study was to evaluate hospice providers' attitudes and perceptions regarding videophone technology in settings where the technology was introduced but underutilized. Specifically, the project seeks to provide an in-depth understanding of attitudes and perceptions that may lead to failure of a telehealth implementation in the hospice setting in the context of the technology acceptance model. Two hospice agencies were selected as a purposive sample. ⋯ Findings indicate that the Technology Acceptance Model (TAM) provides a good framework for an understanding of telehealth underutilization. Staff perceived that videophones were useful, but they were discouraged by their perception that the videophones were not reliable or easy to use and by their uncertainty about the cases that they were best suited for. Lessons learned are integrated into a randomized clinical trial currently under development.
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The objective of this study was to evaluate willingness-to-pay stated preferences for telemedicine versus in-person clinic visits in patients with a history of psoriasis or melanoma. Face-to-face interviews were conducted with 92 (n = 92) adult participants with a history of psoriasis or melanoma recruited primarily from hospital-based dermatology practices. Data were collected on patient demographics and willingness-to-pay responses. ⋯ The majority of those choosing telemedicine (95%) were also willing to pay a median of 25 dollars(5 dollars-500 dollars) out-of-pocket. When time to see a physician was held constant for telemedicine and in-person visits, 19% of participants preferred telemedicine and about 58% of these participants were willing to pay a median of 25 dollars(10 dollars-125 dollars) out-of-pocket. This preliminary work suggests that dermatology patients prefer telemedicine if this modality provides quicker access to their physician.
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Comparative Study
Triangulation analysis of tele-palliative care implementation in a rural community area in Japan.
We conducted a comprehensive evaluation of tele-palliative care by triangulation method. This consisted of qualitative analyses of 2 patients and then performing quantitative analysis of a simulated model for tele-palliative care based on that experience. Semistructured interviews with 2 patients were conducted for qualitative analysis. ⋯ One-way sensitivity analyses showed that home care was the most cost-saving strategy if the care was continued for more than 4 months or the number of physician visits during tele-palliative care could be reduced to less than 6 physician visits per month. The important issues in reducing the cost of tele-palliative care were (1) having adequate patient numbers, (2) reducing the number of physicians' visits, and (3) offsetting the costs of telemedicine against cost savings to the system to sustain the program. In addition, the qualitative analysis demonstrated patients positive views of tele-palliative care.
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The doctor-patient relationship is one of the most complex interpersonal relationships, in that it involves individuals who are not on the same level, it has not been sought by both individuals, it is emotionally loaded and it requires close mutual co-operation towards a shared goal. A well-managed clinical interview lays the grounds for a good doctor-patient relationship which in turn leads to further advantages. In a classical ambulatory setting the doctor-patient relationship should take into account a number of context variables: physical environment, doctor's clothing and instrumental vs. affective behavior. ⋯ The setting of a videoconferencing interview is completely different as interaction is not direct but occurs via a technological system that enables an unusual form of visual and auditory interaction that may be more or less realistic depending on the technology employed. The growing use of telemedicine and videoconferencing has led to new reflections on the doctor-patient relationship in non-conventional settings and warrants in-depth studies on the dynamics of this form of consultation so as to increase the patients' level of satisfaction in telemedicine. The next step will be to verify experimentally and with adequate tools what the demands of patients are in a videoconferencing setting.