Family Caregivers of Stroke Patients in the Home - Telehealth and Technology

Transcription

1 Acceptance/Use of Telehealth Technology by Family Caregivers of Stroke Patients in the Home K. M. Buckley 1, B.Q. Tran 2, and C. Prandoni 1 1 School of Nursing & 2 Dept of Biomedical Eng The Catholic University of America

2 Objectives Identify factors that influence the receptiveness of family caregivers of stroke patients in the home towards telehealth Describe utilization patterns of telehealth by caregivers. Compare nurses and caregivers acceptance of the telehealth technology

3 Target Subjects Men or women at least 40 years of age Primary caregiver Primary caregiver of a family member who had a stroke in the past year

4 Methodology Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Initial Home Visit - - Follow-up Home Visit - - Scheduled Telehealth Visit Unscheduled Telehealth Visit

5 Selection Criteria for Telehealth Equipment Appropriateness Affordability Availability Accessibility User-friendliness

6 Technologies Used Desktops & set-top top videophones with color or B&W monitor (~5 size)

7 Readiness for Technology Level of comfort with technology Interest in using technology Visual and auditory assessment Fine motor skills

8 Patient-Caregiver Functional Unit Scale (PCFUS) Patient s level of dependence Caregiver burden Stability of patient-caregiver dyad

9 Receptiveness to Telehealth 21 out of 75 eligible caregivers enrolled in study Reasons for refusal to participate: Timing Additional Burden Concerns for privacy & visualization of their personal effects

10 Demographics of Study Population Mean Age 63.2 ± 10.8 years Gender - Female: 20 Male : 1 Ethnicity - Black: 17 White: 4 Relationship to Patient - Wife : 15 Family: 6 Educational Level - Grade School: 1 High School: 9 College: 11 Income Level - Below Avg: 6 Avg: 12 Above Avg: 3

11 Readiness for Technology 95% at least moderately comfortable with and moderately interested in technology 66% had a computer in the home Self-assessments: Audio/Visual - Good to Excellent Fine motor dexterity - Good to Excellent

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13 PCFUS Criteria Measured Patients Level of Dependence Caregivers Burden Patient-Caregiver Level of Stability Mean ± SD 12.7 ± 8.8 (moderate) -7.4 ± 5.6 (low to moderate) 4.1 ± 11.3 (low stability)

14 Utilization Patterns 72 Visits attempted by RN or Caregiver 60 (83%) Completed connections 12 (17%) Non-completed connections» Occurred in 7 of 21 subjects» More common in 1st or 2nd visits Who Initiated the Visits? RN - 64% of the visits Caregiver - 36% of the visits Establishing Rapport

15 Content of Telehealth Calls Patient Centered Physical care Changes in behavior Caregiver Centered Physical limitations Psychosocial issues Need for support

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17 Evaluation of Technology Poor Audio Poor Image RN 39.7%* 49.2%* Caregiver 14.3%* 17.5%* * p<0.05

18 Issues Related to Nursing Satisfaction Lighting an issue in most installations Connection problems: some dropouts reported Haziness of picture and voice distortion more frequently reported by nurses

19 Satisfaction with Telehealth Overall, how would you rate the visit? 1- Excellent 2 - Very good RN Good 4 - Fair Caregiver Poor p<0.05 Caregivers were highly satisfied with the as is technology

20 Discussion - Receptiveness Receptiveness of telehealth is dependent upon timing of services, perceived need for support, and level of patient dependence and caregiver burden. Family s concerns about home security need to be addressed when introducing use of videophones for home care. Self-assessment of client s comfort with and interest in technology and audio, visual and fine motor skills is useful.

21 Discussion Utilization Patterns Training caregivers in the use of telehealth takes time and is important in their acceptance of the technology. Rapport with the client affects the utilization of telehealth and the content of interactions. There is a need for family-centered care when providing services.

22 Discussion Acceptance Differences in experience and expectation levels between nurses and caregivers may lead to a disparity in their satisfaction with the performance of the equipment.

23 Conclusion Identification of potential blocks to use of telehealth is vital prior to developing and evaluating programs using telehealth. There is a need for future research on the use of telehealth by caregivers of patients with other diagnoses and at different stages of an illness.

24 Acknowledgements NIDRR, Dept of Education: RERC on Telerehabilitation MedStar, Visiting Nurses Association (Washington, DC) Graduate and undergraduate students at The Catholic University of America s School of Nursing and the Dept of Biomedical Engineering