Tele-ICU coverage is associated with lower ICU mortality and LOS but not with lower in-hospital mortality or hospital LOS.

A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced length of stay, 1 only one-third of critically ill patients receive intensivist care, and the shortfall is projected to worsen. 2 As a result, hospitals increasingly rely on tele-ICU coverage. 3 For the purposes of this article, we defi ne tele-ICU coverage as the application of telemedicine 4 to in-hospital critical care units, thereby encompassing an array of technologies of varying complexity 5,6 that allow physical ICUs to access critical care experts in real time.At the present time, it is estimated that 10% of US hospitals use some form of tele-ICU coverage, Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU confi guration, methodology, participants, and fi ndings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by . 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.

A literature review was conducted to identify research into multiple-contact (i.e. extended) telemedicine interventions for substance-use disorder. The goals were: (1) to describe the methodology used to evaluate telemedicine interventions; (2) to identify the range of interventions which have been formally evaluated; and (3) to summarize the findings. Fourteen databases and Google Scholar were searched, as well as bibliographies of relevant papers and online conference abstracts. There were 50 studies which met the inclusion criteria, of which 50% were randomized controlled trials. The studies most frequently reported the effect on substance use and 61% of those findings fully supported telemedicine interventions. Although the studies reported persistent challenges in sustaining participation, 76% of the studies reporting on satisfaction indicated that participants were enthusiastic supporters of telemedicine. Only 30% of reviewed studies addressed the effect on resource utilization. The majority of studies reported evidence of clinical effectiveness, which justifies continued research in the field.

Home telehealth programs can enhance older adults' access to care, but eliciting accurate information regarding program effectiveness is challenging because patients are reluctant to criticize. This study sought accurate patient perspectives about both benefits and challenges of the Veterans Health Administration's rapidly expanding care coordination/home telehealth program. Patients who completed the standard 8-item satisfaction survey were subsequently interviewed, and the transcripts were content analyzed to identify program functions most salient to patients and program components most challenging for patients. Interviews generally supported patients' high survey ratings but also revealed some challenges that the survey did not capture. Program functions most salient to patients were providing access, educating or instructing, and monitoring or tracking. However, patients were frustrated by equipment problems as well as care coordinator inaccessibility and slow response. Gathering detailed information about patient perceptions of health care delivery is important so challenges can be addressed to meet patients' expectations.

This article identifies potential barriers to substance use recovery associated with rural residence. The evidence is discussed and illustrated with examples. Fourteen specific barriers to substance abuse recovery are identified within 4 broad categories: access to treatment services, access to other professionals, access to peer support groups, and barriers to confidentiality. Although telehealth, expansion of mental health care, intensive referral, and other efforts might enhance access to care, the evidence suggests practitioners and researchers should remain aware of community-level barriers to recovery from substance use disorder and work with clients to overcome them.