IntroductionDefinitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues.MethodsTwo search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis.ResultsNone of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0–4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5.ConclusionsFactors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.

Information and communication technologies are widely used in healthcare. However, there is not still a unified taxonomy for them. The lack of understanding of this phenomenon implies theoretical and ethical issues. This paper attempts to find out the basis for a classification, starting from a new perspective: the structural elements are obtained from the etymologies of the lexicon commonly used, that is words like telemedicine, telehealth, telecare and telecure. This will promote a better understanding of communication technologies; at the same time, it will allow to draw some reflection about health, medicine and care, and their semantic and relational nature.

This article attempts to define functions and applications of telemedicine and telehealth in order to achieve a simplified and comprehensive taxonomy. This may be used as a tool to evaluate their efficacy and to address health policies from the perspective of the centrality of information in the healthcare. Starting from a lexical frame, telemedicine or telehealth is conceived as a communication means and their action as a communication process. As a performance, the communication is related to the health outcome. Three functions ( telemetry, telephasis, and telepraxis) and nine applications are identified. Understanding the mechanisms of telemedicine and telehealth effectiveness is crucial for a value-driven healthcare system. This new classification-focusing on the end effect of telemedicine and telehealth and on the type of interactions between involved actors-moves toward a new and simplified methodology to compare different studies and practices, design future researches, classify new technologies and guide their development, and finally address health policies and the healthcare provision.

A causa del maggior sviluppo della bioetica negli ambiti della clinica e della sperimentazione biomedica, e per la difficoltà di definire la stessa sanità pubblica, quest’ultima manca ancora di un quadro etico di riferimento. Dopo un breve profilo storico e semantico, si esamina perciò l’antitesi, in letteratura, tra bioetica ed etica di sanità pubblica. Quindi si rileggono e sfatano le tre principali dicotomie su cui viene costruita tale antitesi – pazienti vs. assistiti, individuo vs. popolazione, paternalismo vs. autonomia. Si può affermare che la salute individuale e la salute collettiva sono fini simultanei e inseparabili degli interventi di sanità pubblica. Inoltre, l’autonomia relazionale è l’unica alternativa all’autonomia d’impronta liberale. L’autonomia individuale, infatti, si sviluppa attraverso l’influenza di legami umani e la giustizia sociale. La relazione – come capacità di promuovere la partecipazione e di mantenere la fiducia – è la sostanza della sanità pubblica, e fonte assiologica della sua etica. È cioé il primo valore e il principale criterio per indirizzare gli interventi di sanità pubblica, che saranno tanto più etici quanto più saranno in grado di massimizzare la relazione nel contesto in cui vengono attuati. ---------- Owing to a greater development of bioethics in the fields of clinical medicine and biomedical research, and because of the difficulty to define the public health itself, the latter still lacks an ethical framework. Therefore, after a brief historical and semantic outline, we examine the antithesis, as proposed in the literature, between bioethics and public health ethics. Then, we reread and debunk the three main dichotomies on which such an antithesis is built – patients vs. healthcare users, individual vs. population, paternalism vs. autonomy. We may state that the individual health and the collective health are simultaneous and inseparable purposes of public health interventions. Moreover, the relational autonomy it is the only alternative to the liberal-shaped autonomy. Indeed, the individual autonomy develops through the influence of human bonds and the social justice. The relationship – as the capability to promote the engagement and to maintain trust – is the substance of public health, and the axiological source of its ethics. In other words, it is the first value and the main criterion to address public health interventions; these will be ethical as much as they will be able to maximize the relationship in the context of their fulfilment.

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