Patient Autonomy and Quality of Care in Telehealthcare

Rubeis, Giovanni; Schochow, Maximilian; Steger, Florian

doi:10.1007/s11948-017-9885-3

Cited by 50 publications

(37 citation statements)

References 35 publications

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“… 38 They have thus worried that medicine has become depersonalised as a result. 39 In the LYNC study, clinicians were concerned whether assessments could be made accurately without the added cues of tone of voice or body language. Clinicians need, as such, to develop new skills and adapt the way in which they work in order to successfully utilise digital consulting, which will result in changes to the nature of their role.…”

Section: Resultsmentioning

confidence: 99%

“…Telehealthcare is theorised to revolutionise medicine, as it provides patients with opportunities to monitor and manage their own health. 39 Indeed some systematic reviews have highlighted how patients feel 'empowered' as a result of digital communication systems. 42 However, other discussions have criticised this view, since digital consultations and remote healthcare demand patients to participate and take responsibility for their health, in ways in which they are unable or uncomfortable.…”

Section: Resultsmentioning

confidence: 99%

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How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

et al. 2020

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Background While studies have examined the impact of digital communication technology on healthcare, there is little exploration of how new models of digital care change the roles and identities of the health professional and patient. The purpose of the current study is to generate multidisciplinary reflections and questions around the use of digital consulting and the way it changes the meaning of being a patient and/or a health professional. Method We used a large pre-existing qualitative dataset from the Long-term Conditions Young People Networked Communication (LYNC) study which involved interviews with healthcare professionals and a group of 16–24 years patients with long-term physical and mental health conditions. We conducted a three-stage mixed methods analysis. First, using a small sample of interview data from the LYNC study, we identified three key themes to explore in the data and relevant academic literature. Second, in small groups we conducted secondary analysis of samples of patient and health professional LYNC interview data. Third, we ran a series of rapid evidence reviews. Findings We identified three key themes: workload/flow, impact of increased access to healthcare and vulnerabilities. Both health professionals and patients were 'on duty' in their role more often. Increased access to healthcare introduced more responsibilities to both patients and health professionals. Traditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting. Conclusions Our collaboration identified conflicts and constraints in the construction of digital patients and digital clinicians. There is evidence that digital technologies change the nature of a medical consultation and with it the identities and the roles of clinicians and patients which, in turn, calls for a redefinition of traditional concepts of medical ethics. Overall, digital consulting has the potential to significantly reduce costs while maintaining or improving patient care and clinical outcomes. Timely study of digital engagement in the National Health Service is a matter of critical importance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

et al. 2020

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“…On the other end of the spectrum, technology-mediated empowerment has been criticized not only as interfering with autonomy as underlying the protection of privacy, leading to a depersonalization of medicine and care, and a pathologization of daily life (cf. Rubeis et al 2018), but could even be seen as contradictory since it also presupposes demanding forms of autonomous capabilities such as health and technology literacy.…”

Section: Ambivalences and Limitationsmentioning

confidence: 99%

11 Reconfigurations of autonomy in digital health and the ethics of (socially) assistive technologies

2020

Aging Between Participation and Simulation

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In this contribution the ethical impact of socially assistive technologies is analyzed against the background of digitalized healthcare and medicine in a thoroughly "datafied" society in general. Socially assistive technologies such as smart home sensors and carebots raise ethical issues which are continuous with other technologies in this cluster (e. g. health-related apps, telemonitoring) but their application in the context of particularly vulnerable populations such as elderly persons also appears to expose the limitations of established medical ethics and technology assessment tools starkly. While some specified analytic and ethical tools have already been developed, the meaning and scope of the underlying ethical criteria and reference concepts themselves is changing further. This will be illustrated by focusing in on reconceptualizations of (personal) autonomy such as the shift from patient autonomy to user or consumer autonomy, the vision of empowered autonomy in participatory, democratic care and medicine, and the effects of a prospective "autonomy" of the devices themselves. A broader discussion of assistive technologies along these lines may help accommodate the often precarious internal capabilities for self-determination in the elderly and/or vulnerable, and avoid neglect of important contextual and external factors to support and promote autonomy as an ethical cornerstone also in digital health.

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“…Mobile health (mHealth) systems in COPD, designed according to the needs of the patients, aim to improve adherence to maintenance programs by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Health informatics platforms should not replace, at any time, the personal and regular relationship with health care professionals but complement it, as it is very important to maintain continuous and open contact with the multidisciplinary team that provides the necessary support and attention. But, in any case, patients should be responsible for their care, which may lead to an improvement of the therapy’s effectiveness [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Jiménez-Reguera¹,

López²,

Fitch³

et al. 2020

JMIR Mhealth Uhealth

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Background Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease. Objective This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients. Methods COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George’s Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function. Results In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation. Conclusions mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management. Trial Registration ClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930

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Patient Autonomy and Quality of Care in Telehealthcare

Cited by 50 publications

References 35 publications

How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

11 Reconfigurations of autonomy in digital health and the ethics of (socially) assistive technologies

Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

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