title: Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making.
abstract: We investigated whether telemedicine (videoconferencing) was feasible in patients with special care needs on home ventilation, whether it affected the confidence of families about the clinical management of their child, and whether it supported clinical decision-making. Videoconferencing software was provided free for 14 families who had a computer and webcam. Families completed questionnaires about clinical management before the addition of telemedicine and 2-3 months after they had used telemedicine. They also completed a questionnaire about their experience with videoconferencing. There were 27 telemedicine encounters during the 9-month study. Families reported higher confidence in clinical care with telemedicine compared to telephone. They also reported that the videoconferencing was high-quality, easy to use, and did not increase their telecommunication costs. The telemedicine encounters supported clinical decision-making, especially in patients with active clinical problems or when the patient was acutely ill. The telemedicine encounters prevented the need for 23 clinic visits, three emergency room visits, and probably one hospital admission. Although the study was small, videoconferencing appears useful in the management of medically fragile patients on home ventilator support, producing high levels of family confidence in clinical management and value to clinicians in their decision-making.
authors.affiliation: Department of Anesthesia, Division of Critical Care, Boston Children's Hospital, Harvard Medical School, USA david.casavant@childrens.harvard.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Casavant
authors.affiliation: Department of Anesthesia, Division of Critical Care, Boston Children's Hospital, Harvard Medical School, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: McManus
authors.affiliation: Departments of Medicine and Pediatrics, Tufts University School of Medicine Institute for Clinical Research and Health Policy Studies, USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.affiliation: Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Anesthesia, Division of Critical Care, Boston Children's Hospital, Harvard Medical School, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Graham
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods* / Q000592:standards; D012122:Ventilators, Mechanical; D049269:Videoconferencing / Q000592:standards*