This study was to examine whether the Manitoba Provincial Health Contact program for congestive heart failure is cost-effective and/or cost-benefit intervention relative to the standard treatment. The benefit-cost ratio was calculated in terms of the program cost and the cost savings from averted healthcare visits in order to determine whether the program would pay for itself. Then I conducted a cost-effectiveness study in which outcomes were measured in terms of QALYs derived from the SF-36. Bootstrap-resampled incremental cost-effectiveness ratios were computed to allow us to take into account the uncertainty related to small sample size. This intervention program generated a net saving of $28,307. The cost-effectiveness analysis suggests that the Health Lines intervention can generate an additional QALY for $26,486 and Health Line plus Monitoring for $70,266. The findings demonstrate that the Health Lines strategy for congestive heart failure holds great promise.

Worldwide, the numbers of people living with chronic conditions are rapidly on the rise. Chronic illnesses are enduring and often cannot be cured, requiring a strategy for long term management and intervention to prevent further exacerbation. Globally, there has been an increase in interventions using telecommunications technologies to aid patients in their home setting to manage chronic illnesses. Such interventions have often been delivered by nurses. The purpose of this research was to assess whether a particular intervention that had been successfully implemented in the United Kingdom could also be implemented in Canterbury. In particular, this research assessed the perspectives of Canterbury based practice nurses and district nurses. The findings suggest that a majority of both district and practice nurses did not view the service as compatible with their current work situation. Existing workload and concerns over funding of the proposed service were identified as potential barriers. However, the service was perceived as potentially beneficial for some, with the elderly based in rural areas, or patients with chronic mental health needs identified as more likely to benefit than others. Practice nurses expressed strong views on who should deliver such services. Given that it was identified that practice nurses already have in-depth knowledge of their patients’ health, while valuing the strong relationships established with their communities, it was suggested that patients would most benefit from locally based nurses to deliver any community based health services in the future. It was also found that teletriaging is currently widely used by practice nurses across Canterbury to meet a range of health needs, including chronic mental health needs. This suggests that the scope of teletriaging in community health and its potential and full implications are currently not well understood in New Zealand. Significant events, such as the Christchurch earthquakes indicate the potential role of teletriaging in addressing mental health issues, thereby reducing the chronic health burden in the community.

This study was to examine whether the Manitoba Provincial Health Contact program for congestive heart failure is cost-effective and/or cost-benefit intervention relative to the standard treatment. The benefit-cost ratio was calculated in terms of the program cost and the cost savings from averted healthcare visits in order to determine whether the program would pay for itself. Then I conducted a cost-effectiveness study in which outcomes were measured in terms of QALYs derived from the SF-36. Bootstrap-resampled incremental cost-effectiveness ratios were computed to allow us to take into account the uncertainty related to small sample size. This intervention program generated a net saving of $28,307. The cost-effectiveness analysis suggests that the Health Lines intervention can generate an additional QALY for $26,486 and Health Line plus Monitoring for $70,266. The findings demonstrate that the Health Lines strategy for congestive heart failure holds great promise.

No description available.

Telehealth services can address many barriers to traditional office-based mental health services. Few studies have assessed youth and caregiver perceptions of and satisfaction with trauma-focused interventions delivered via telemental health. The present study reports data collected using the Telehealth Satisfaction Questionnaire (TSQ), which was developed to measure child and caregiver satisfaction with services, comfort with the telehealth equipment, and barriers to traditional office-based services. Thirteen clinicians delivered home- and school-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) via videoconferencing on tablets and computers to 60 child patients (71.7% Latinx, 18.3% Black, and 10.0% non-Hispanic White). Patients and caregivers completed the TSQ at treatment discharge via telephone, videoconferencing, or in-person interviews. There was a high level of satisfaction among patients and caregivers receiving TF-CBT via telemental health. Furthermore, most youth and caregivers felt comfortable using the telehealth equipment from the outset of therapy, and all participants who were not initially comfortable using the equipment reported feeling more comfortable over time. The most common barriers to traditional office-based services were caregiver work schedule (57.7%), distance to mental health clinic (55.8%), and lack of transportation (44.2%). Patients and caregivers expressed a preference for telemental health services if given the option between receiving therapy via videoconferencing versus going to an office-based clinic. Findings indicated telemental health treatment addressed barriers that would have otherwise prevented families from accessing office-based services. The TSQ can be used to help clinics and providers assess patient and caregiver satisfaction with telehealth services in various settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The COVID-19 pandemic elicited an abrupt uptake of virtual mental health care delivery to attend to an increased demand for mental health services in an efficient way, amid pandemic restrictions. This research study explores the experience of telemental health care delivery among resident and practicing psychiatrists to examine how their care is impacted by virtual delivery and their approaches to assessing the effectiveness of their virtual care. This qualitative study used semi-structured interviewing and thematic analysis to identify significant concepts. It included eight post-graduate year four (PGY4) resident psychiatrists and two practicing psychiatrists. The research findings indicate that elements of mental health care relating to patient information, safety, privacy, and therapeutic alliance are impacted when delivered virtually, and that patient suitability is an important factor for the success of virtual care. Findings also suggest that there exists a gap in both practice and in theory for methods or tools used to assess the effectiveness of telemental health care. Future research will be necessary to 1) adapt existing mental health care assessment tools to account for the nuances of virtual delivery, and 2) to implement in practice policies that ensure virtual care is used only with patients for whom it is suitable.

Neurorehabilitation, a relatively new domain of clinical intervention has, from its outset, been a rapidly evolving practice, with ongoing advancements in neuroimaging and neuroscience leading to new insights into how the brain grows and recovers from insult. The field of neurorehabilitation is tasked with translating this research into maximally effective treatments. This document addresses how digitally augmented neurorehabilitation, has, and can help meet, these translational needs and clinical imperatives. The first chapter is a review of the literature on the use of avatars in neurorehabilitation and their potential to promote neurological repair and plasticity. The second explores the use of a wearable remote control device for the promotion of enjoyability and intensity in the pediatric neurorehabilitation context. The third chapter pilot tests a video-based assessment methodology and explores the telehealth potential of such an assessment methodology and the final chapter demonstrates how such an assessment methodology can be implemented in pediatric neurorehabilitation in a case study on the treatment of Kernicterus. Collectively these works provide an overview of a selection of digitally augmented neurorehabilitation techniques and tools and preliminary data on how these approaches might be implemented in the field of pediatric neurorehabilitation. / Doctor of Philosophy / Neurorehabilitation, is the clinical effort to repair brain injuries. Telehealth, or telemedicine, is the use of digital technologies to assist in the delivery of healthcare. Telehealth can take many forms- you can do a teleconference with your doctor, you can access your medical records online, you can use a fitbit to promote preventative healthcare. One form is telerehabilitation, examples include video conferencing with your physical therapist, using video game based rehabilitation systems, or the use of digital cameras and programs to capture and analyze your movements. This document explores some of the ways neurorehabilitation can use these digital technologies to help promote neurological repair and recovery. The first chapter is a review of the literature on the use of avatars, or digital placeholders such as animated characters or virtual representations of the patient, in neurorehabilitation and how their use has the potential to promote neurological repair. The second chapter explores the use of a wearable remote control device for the promotion of enjoyability and intensity (high repetitions of desired movements) in the pediatric neurorehabilitation context. The third chapter pilot tests a video-based assessment methodology and explores the telehealth potential of such an assessment methodology and the final chapter demonstrates how this assessment methodology can be used in pediatric neurorehabilitation in a case study on the treatment of Kernicterus, a pediatric disorder that results from bilirubin toxicity. Collectively these works provide a review of the potential for digitally augmented neurorehabilitation and preliminary data on how these approaches might be implemented in the field of pediatric neurorehabilitation.

Podium presentation on health literacy and interprofessional telehealth considerations.

Telehealth offers an innovative strategy to provide access effectively and efficiently to mental health services for underserved youth, creating a service model that leverages most of the available resources without compromising the quality of care. This presentation will discuss the development of a telehealth program to deliver evidence-based trauma-focused care to children and adolescents in community-based locations. As a part of our ongoing program evaluation, we collected data regarding the feasibility and clinical outcomes of trauma-focused CBT delivered via a telehealth service delivery model. Presentation in J. Cohen's Successful Strategies for Treating Traumatized Children in Challenging Circumstances.

No description available.