High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

No description available.

High quality health services are often difficult to access in rural and remote areas of Australia. This is due to a shortage of health care professionals and specialists, inadequate and poorly distributed resources, and the tyranny of distance. The result is a reduced level of health and a higher mortality rate than seen in urban communities. Telemedicine, which is the use of various technologies to deliver a range of health care services over a distance, has the potential to increase equity and access to health care in rural and remote areas. To date there has been a poor uptake of telemedicine technology within the profession of physiotherapy. This undoubtedly stems from the perceived, and indeed, real difficulty of performing what is traditionally ‘hands on’ therapy, via an electronic medium. Added to this is a paucity of rigorous clinical outcome studies to demonstrate the efficacy of performing successful treatment via this delivery method. The aim of this thesis was to establish the efficacy of telemedicine as a clinical tool for physiotherapists. To achieve this, the first major undertaking was the development of a telemedicine system to meet the unique needs of clinical physiotherapists and their patients. A series of studies was then performed to calibrate the system and establish its validity and reliability as a clinical assessment tool. Finally, a randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The telemedicine system was constructed using a human systems development approach, with close consultation with senior clinical physiotherapists and potential users of the system. The personal computer-based system was designed to connect patients in their home with physiotherapists in the hospital, via low-speed and low-cost communications. The system incorporated real-time videoconferencing and physical measurement tools to enable the remote assessment of patients. The validity and reliability of the telemedicine physical measurement tools were established through a series of five studies. The results demonstrated these measurements to be accurate and reliable, under various measurement conditions, when compared to reference instruments. A prospective randomised controlled trial was conducted to assess the treatment efficacy of the telemedicine system. The research model chosen for this study was the rehabilitation of subjects who had undergone total knee replacement surgery. Block randomisation was used to assign 65 participants to either a traditional face-to-face therapy group or a telemedicine rehabilitation group. Participants in both groups received treatment over a six week period. Data analysis focussed on comparing physical and functional rehabilitation outcomes achieved in each treatment group. The results of this study demonstrated that the rehabilitation outcomes produced via the telemedicine system were similar to those achieved in the traditional manner. Additionally, the telemedicine therapy was found to produce greater improvements in a number of functional outcome measurements. A high level of satisfaction was expressed by participants who received treatment via the telemedicine method. This thesis provides evidence of the efficacy of telemedicine as a clinical tool for physiotherapists. Furthermore, the work detailed in this thesis represents one of the first randomised control trials in telerehabilitation and makes a significant contribution towards the knowledge of low-bandwidth telemedicine in general. This thesis provides a framework upon which further research and telemedicine applications may be developed, with the ultimate goal of improving equity and access to high quality health services in rural and remote areas.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Η ύπαρξη Διαδικτύου παρέχει την δυνατότητα μεταφοράς δομημένης πληροφορίας, μέσω πολλών διαφορετικών εφαρμογών. Μια από τις πλέον χρησιμοποιούμενες εφαρμογές αποτελεί το ηλεκτρονικό ταχυδρομείο, το οποίο υπάρχει από την αρχή κιόλας του Διαδικτύου. Τα τελευταία χρόνια έχει κάνει την εμφάνιση της μια νέα σημαντική εφαρμογή η τηλεϊατρική, η οποία περιλαμβάνει μηχανισμούς παρόμοιους με το ηλεκτρονικό ταχυδρομείο. Στην παρούσα διπλωματική εργασία παρουσιάζονται τα πρωτόκολλα μορφοποίησης μηνυμάτων Διαδικτύου RFC 822, RFC 2822, RFC 2045 της κατηγορίας MIME καθώς και το RFC 2231. Αποτελούν κάποια από τα βασικότερα πρωτόκολλα ηλεκτρονικού ταχυδρομείου και κατ’επέκταση την βάση για την ανάπτυξη της τηλειατρικής. Ταυτόχρονα γίνεται μια εκτενής αναφορά στα βασικότερα πρωτόκολλα καθορισμού δομής μορφότυπων που χρησιμοποιούνται στην ιατρική πληροφορική. Πιο συγκεκριμένα στο κεφάλαιο 1 παρουσιάζεται το πρωτόκολλο RFC 822 το οποίο καθορίζει το μορφότυπο και τη σημασιολογία των περιεχόμενων του μηνύματος ηλεκτρονικού ταχυδρομείου. Το συγκεκριμένο πρότυπο ενώ είναι ικανοποιητικό για αποστολή μηνυμάτων κειμένου ASCII δεν είναι επαρκές για μεταφορά μορφών κειμένου μη –ASCII. Στο κεφάλαιο 2 γίνεται εκτενής αναφορά στο πρωτόκολλο RFC 2822, το οποίο αποτελεί μια πιο ενημερωμένη έκδοση του RFC 822 ώστε να απεικονίζει την τρέχουσα πρακτική. Καθορίζει αυστηρά την δομή περιεχομένων μηνυμάτων κειμένου ASCII, ενώ ταυτόχρονα δεν λαμβάνει κανένα μέτρο για αποστολή μηνυμάτων πολυμέσων. Στο κεφάλαιο 3 παρουσιάζεται το RFC 2045 της κατηγορίας MIME, το οποίο είναι μια ανεξάρτητη προδιαγραφή που απλά συμπληρώνει το RFC 822. Το πρωτόκολλο αυτό ορίζει τις απαραίτητες πρόσθετες κεφαλίδες στο μήνυμα, ώστε να μπορέσει να σταλεί περιεχόμενο διαφορετικό από κείμενο ASCII. Χρησιμοποιώντας πεδία ετικέτας "MIME- Version", "Content-Type" και "Content-Transfer-Encoding", είναι δυνατό να περιλαμβάνονται με έναν τυποποιημένο τρόπο, αυθαίρετοι τύποι δεδομένων με συμμορφούμενα RFC 822 μηνύματα ταχυδρομείου. Έτσι κανένας περιορισμός που επιβάλλεται από το RFC 822 δεν παραβιάζεται. Στο κεφάλαιο 4 περιγράφεται το πρότυπο RFC 2231, το οποίο καθορίζει τις επεκτάσεις που εξετάζουν διαφόρους περιορισμούς που προκύπτουν από την χρήση παραμέτρων MIME σε πεδία ετικέτας τύπου περιεχομένου και διάθεσης στο Internet. Όλες αυτές οι επεκτάσεις εφαρμόζονται σε ένα μοντέλο που είναι απόλυτα συμβατό σε συντακτικό επίπεδο με υπαρκτές MIME εφαρμογές. Τέλος στο πέμπτο κεφάλαιο παρουσιάζονται τα βασικά πρωτόκολλα καθορισμού δομής μορφοτύπων που χρησιμοποιούνται στον τομέα της τηλειατρικής. Αναλύονται οι λειτουργικές προδιαγραφές της υπηρεσίας WADO. Παρουσιάζεται το IHE XDS σχεδιάγραμμα ολοκλήρωσης, που επιλαμβάνεται του προβλήματος της διαλειτουργικότητας του ΗΑΥΠ. (Hλεκτρονικό Aρχείο Yγειονομικής Περίθαλψης - ΗΑΥΠ -Electronic Healthcare Record – EHR). Το ΗΑΥΠ αποτελεί έναν βασικό ερευνητικό τομέα στην ιατρική πληροφορική. / The existence of the Internet provides the possibility to transfer structured information through many different applications.One of the most used applications is the e-mail, which exists from the very beginning of the Internet. Recently a new important application, the telemedicine, appears which includes operations similar to e-mail.In this diploma thesis the protocols for the format of Internet messages RFC 822, RFC 2822, the RFC 2045 of the category of MIME and also the RFC 2231 are presented. These are some of the most basic e-mail protocols and thus the basis for the development of telemedicine. Simultaneously there is a comprehensive reference to the basic protocols that establish a structure format and are used in Medical Informatics.Specifically, Chapter 1presents the protocol RFC 822, which defines the format and semantics of the contents of the e-mail. Atlhough this protocol is sufficient for ASCII text messages sending, it’s not for non-ASCII text messages.In Chapter 2 there is reference to protocol RFC 2822, which is a more updated version of RFC 822, in order to reflect current practice. It strictly defines the structure of contents of text messages while it makes no provision for the transmission of multimedia messages. In Chapter 3 we present the RFC 2045 of the category MIME which is an independent specification that complements RFC 822.This protocol provides the necessary additional header in the mail in order to sent content of non-ASCII text. By using header fields "MIME- Version","Content-Type"and"Content-Transfer-Encoding ", it’s possible arbitrary data types with compliant mail messages to be included in a standard way. Because of this any restriction imposed by RFC 822, is being violated. In Chapter 4 , we describe the standard RFC 2231 which defines the extensions considering different restrictions that arise from the use of MIME parameters in content type and content-disposition header fields in Internet e-mail.All these extensions are applicable to a model which is completely compatible in syntax level with already existing applications. Finally in Chapter 5 we present the basic protocols that determine structure formats and are used in telemedicine. Also the functional specifications of the WADO are analyzed here.The IHE XDS layout integration is presented that address the problem of interoperability of HER. The HER is a key research field in medical informatics.

Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The various applications of Information and Communication Technologies (ICTs) in healthcare are increasingly effective to improve the cost-effectiveness and quality of healthcare service delivery. Telemedicine is such an application, using ICTs to provide health services over a distance. Since 1997, the South African Department of Health has invested large amounts of capital to implement telemedicine systems in South Africa. Unfortunately, telemedicine programs have had little success since, leading to many workstations standing dormant. Telemedicine implementation decision making that is based on insufficient evidence is identified as one of the underlying problems that cause telemedicine programs to fail. It is proposed that implementation decisions should be based on quantifiable evidence regarding the potential benefits of telemedicine. A decision support system is developed that can be used to quantify potential benefits and plan telemedicine implementation programs accordingly. The decision support system is modelled and demonstrated using data from the Eastern Cape public health sector. The first phase of the system guides decision makers to identify potential telemedicine benefits as well as data sources that can be used to measure these benefits. The system is scoped to focus on the application of telemedicine to support patient referrals between hospitals. Data sources are considered accordingly, with electronic health record (EHR) data proving to be a feasible primary source for needs assessments, however limiting the benefits that can be quantified. The analysis of the needs assessment is included in the second phase of the decision support system. Data are extracted, transformed and loaded into a data warehouse from where it can be analysed. The system includes three analysis steps to: map referral patterns, analyse potential benefits of telemedicine programs and determine cost-effective telemedicine solutions by allocating equipment at different hospitals. Analysis techniques used in the system include Pareto analysis, economic analysis, linear programming and the use of a genetic algorithm. It is proposed that the potential benefit results and equipment allocation algorithm be used to plan telemedicine programs for continuous evaluation. The final phase of the system therefore guides decision makers to use the results for implementation planning as well as evaluability assessments, for future management and evaluation of telemedicine programs. The decision support system is validated using patient referral data from the Western Cape public health sector. The case study proved that the system is applicable to the real-world and could be a valuable tool for decision makers to base telemedicine implementation planning on quantifiable evidence. The limitation on size and quality of both the Eastern Cape and Western Cape data sets, caused that the full potential of the system could not be demonstrated and validated. It is recommended that the quality standards of EHR referral reports be improved, to ensure more accurate benefit results. Future work is recommended to include qualitative needs assessments in the scope of the decision support system, hereby increasing the amount of benefits to be assessed. Although it is expected that the developed system is capable to support even better resolution decisions with more detailed data sets, the system developed in this study proved already adequate for improved implementation decision making. This could lead to higher success rates of telemedicine programs and ultimately better quality healthcare for all. / AFRIKAANSE OPSOMMING: Die verskillende toepassings van Informasie en Kommunikasie Tegnologie (IKT) in gesondheidsorg, speel ʼn rol in toenemende doeltreffendheid om die koste-effektiwiteit en kwaliteit van gesondheidsorg dienslewering te verbeter. Tele-geneeskunde is een van hierdie toepassings, wat IKT gebruik om gesondheidsdienste oor ʼn afstand te kan voorsien. Die Suid-Afrikaanse Departement van Gesondheid belê sedert 1997, groot bedrae kapitaal in die implementering van tele-geneeskunde stelsels, in Suid-Afrika. Ongelukkig het tele-geneeskunde programme min sukses behaal sedertdien, wat veroorsaak dat vele werkstasies dormant is. Die basering van implementeringsbesluite op onvoldoende getuienis, is geïdentifiseer as een van die onderliggende probleme wat veroorsaak dat tele-geneeskunde programme misluk. Daar word voorgestel dat implementeringsbesluite gebaseer moet word op kwantifiseerbare getuienis ten opsigte van die potensiële voordele van telemedisyne. ʼn Besluitnemingsondersteuning stelsel is ontwikkel wat gebruik kan word om die potensiële voordele te kwantifiseer en dienooreenkomstig implementering van tele-geneeskunde programme te beplan. Die stelsel is gemodelleer en gedemonstreer aan die hand van data uit die Oos-Kaap publieke gesondheidsektor. Die eerste fase van die stelsel begelei besluitnemers om potensiële voordele van telegeneeskunde, sowel as data-bronne wat gebruik kan word om hierdie voordele te meet, te identifiseer. Die stelsel is beperk tot ʼn fokus op die ondersteuning wat tele-geneeskunde aan hospitaal pasiënt verwysingstelsels, kan bied. Data bronne is dienooreenkomstig oorweeg: elektroniese mediese rekords (EMR) word erken as ʼn gunstige primêre databron, maar veroorsaak egter beperkings op die aantal voordele wat gekwantifiseer kan word. Die behoeftebepaling word uitgevoer in die tweede fase van die besluitnemingsondersteuning stelsel. Data is onttrek, getransformeer is en gelaai in 'n data stoor, vanwaar dit ontleed kan word. Die stelsel sluit drie analisestappe in: verwysingspatroon analise, berekening van potensiële voordele vir tele-geneeskunde programme en die bepaling van koste-effektiewe oplossings deur toekenning van toerusting by verskillende hospitale. Die analise tegnieke wat in die stelsel gebruik word, sluit die volgende in: Pareto analise, ekonomiese analise, lineêre programmering en 'n genetiese algoritme. Die gebruik van potensiële voordeel resultate en die toerusting toekenning algoritme word voorgestel vir die beplanning vir deurlopende evaluering in tele-geneeskunde programme. Die finale fase van die stelsel is gestruktureer, om besluitnemers te begelei in die gebruik van analise resultate, vir implementering beplanning sowel as evalueerbaarheid studies, wat sodoende deurlopende evaluering en bestuur van tele-geneeskunde programme sal verbeter.Die besluitnemingsondersteuning stelsel is gevalideer deur pasiënt verwysings data van die Wes-Kaap publieke gesondheidsektor, te gebruik. Die gevallestudie het bewys dat die stelsel toepaslik is in die werklike wêreld en kan as ʼn waardevolle hulpmiddel vir besluitnemers dien om tele-geneeskunde implementering beplanning op kwantifiseerbare bewyse te baseer. Die beperkings op die grootte en gehalte van beide die Oos-Kaap en Wes-Kaap datastelle het veroorsaak dat die stelsel nie tot sy volle reg gedemonstreer en gevalideer kon word nie. Verbeterings in kwaliteit standaarde van EMR verwysing data word aanbeveel om meer akkurate resultate te bekom. Verdere studies wat die byvoeg van kwalitatiewe meetings in die stelsel ondersoek, sal die omvang van potensiële voordele verbeter en dus die algehele waarde van die stelsel verbeter. Alhoewel die ontwikkelde stelsel in staat is om beter resolusie besluite te kan ondersteun met meer gedetailleerde data, is dit bewys dat die huidige stelsel reeds voldoende is om besluitneming te verbeter. Beter besluitneming gevolglik lei tot hoër sukseskoerse van tele-geneeskunde programme en uiteindelik verbeterde gehalte gesondheidsorg vir almal.

Asma é uma doença crônica, de alta prevalência, importante causa de morbidade, responsável por gastos diretos e indiretos significativos. Apesar do cuidado padrão para esta doença estar bem consolidado em diretrizes clínicas baseadas em evidências, frequentemente seus portadores não recebem os cuidados indicados. A qualidade da assistência dispensada pelos profissionais da atenção primária é tanto problema quanto solução. Modelos de cuidados adaptados a doenças crônicas e iniciativas de educação em saúde correspondem a estratégias utilizadas para incremento de qualidade assistencial. As novas tecnologias de informação e comunicação têm encurtado progressivamente as distâncias entre as pessoas. Em saúde, têm sido utilizadas como ferramentas valiosas na disseminação de conhecimentos. Apesar da ampla disponibilidade e utilização, os recursos educativos mediados por tecnologias de informação e comunicação – teleducação – ainda carecem de evidências de maior rigor científico. Objetivo: avaliar a efetividade clínica de uma intervenção multifacetada educativa a distância sobre asma para profissionais da atenção primária à saúde. Método: ensaio clínico randomizado em cluster com 71 equipes de saúde do interior do Rio Grande do Sul. Foram indicados pela totalidade das equipes 443 pessoas com diagnóstico de asma elegíveis para acompanhamento no estudo. As equipes do grupo intervenção (n = 34) participaram de um programa de 3 sessões interativas online e receberam materiais educativos. As equipes do grupo controle (n = 37) não sofreram intervenção. Sobrecarga de sintomas nos últimos 14 dias, controle da asma no último mês, necessidade de consulta não programada nos últimos 6 meses e uso de corticosteroide inalatório preventivo nos últimos 6 meses foram avaliados nas pessoas indicadas pelas equipes na linha de base e 6 meses após a intervenção. Resultados: a assiduidade geral das equipes de saúde às sessões interativas online foi de 50%. Ambos grupos apresentaram melhora dos desfechos clínicos e menor uso de corticosteroide inalatório no seguimento. Exposição a intervenção educacional esteve associada a razões de chances com melhores desfechos clínicos, entretanto com significância estatística limítrofe. Não foram observadas diferenças no uso de corticosteroides inalatórios preventivos entre os grupos. Conclusão: a intervenção em educação a distância demonstrou potencial apesar da baixa assiduidade das equipes sob intervenção. O modelo proposto é factível e reprodutível. Integração com o sistema de registro clínico pode potencializar os resultados. A implementação de estratégias de aperfeiçoamento profissional em caráter institucional deve ser orientada pelas melhores evidências. / Asthma is a high prevalence chronic disease and an important cause of morbidity, responsible for significant direct and indirect health expenses. Although the standard care for this condition is well established in evidence-based clinical guidelines, often patients do not receive the indicated treatment. The quality of care delivered by primary care professionals is both a problem and a solution. Models of care adapted to chronic diseases and health education initiatives are strategies used to increase care quality. New information and communication technologies have progressively shortened distances between people. In healthcare, they have been used as a valuable tool for knowledge dissemination. Despite widespread availability and use, educational resources mediated by information and communication technologies still lack evidence of greater scientific rigor. Objective: to evaluate the clinical effectiveness of a multifaceted distance educational intervention on asthma for primary health care professionals. Methods: cluster randomized clinical trial with 71 health teams from country towns of Rio Grande do Sul. The teams identified a total of 443 persons diagnosed with asthma who were eligible for follow-up in the study The teams in the intervention group (n = 34) participated in a program of 3 interactive online sessions and received educational materials. There was no intervention in the control group teams (n = 37). Symptoms overload in the last 14 days, control of asthma in the last month, need for unplanned consultation in the last 6 months and use of preventive inhaled corticosteroids in the last 6 months were evaluated in the individuals indicated by the teams at the baseline and 6 months after the intervention. Results: The general assiduity of health teams to online interactive sessions was 50%. Both groups showed improved clinical outcomes and used less inhaled corticosteroids at follow-up. Exposure to educational intervention was associated with better clinical outcomes odds ratios, however, with borderline statistical significance. No differences were observed in the use of preventive inhaled corticosteroids between groups. Conclusion: The distance education intervention showed potential despite the low attendance of the intervention teams. The proposed model is feasible and reproducible. Integration with the clinical record system can boost results. The implementation of professional development strategies should be guided by the best evidence in an institutional setting. / Telemedicina