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Appendix Critique Geriatrics

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					   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                           Page 1 of 66



Author / Title /       Purpose/             Design                       Analysis                            Participants: age/ gender/ groups      Intervention/ Duration       Follow-up:            Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                                sample size;
Country / Location                                                                                                                                                               dropout
Ames D. Psychiatric    To establish the     Non-controlled clinical      Participants interviewed using      n=86 participants underwent the GMS    4 year study, initial        Follow up 48-59        The follow up AGECAT diagnoses
diagnoses made by      reliability of the   series (VIII)                the GMS in 1985/6, and then         interview in 1985/6                    assessment done in 1985/6 months after              indicated impressive diagnostic stability
the AGECAT             AGECAT in            Strength of Evidence         again in 1990                                                              and patients contacted again initial GMS            for the organic psychosis cases diagnosed
system in residents    diagnosing           (SoE): Poor                                                                                             in 1990                      interview              in 1985/6 because as predicted, these
of local authority     patients                                          New GMS data were analyzed                                                                                                     cases either died or remained cases of
homes for the                               A computerized diagnostic    by the AGECAT program as                                                                                   25 of 86 subjects organic psychosis
elderly: Outcome                            system (AGECAT) utilizes     they had been done 4 years                                                                                 were still alive to
and diagnostic                              data derived from a semi     prior                                                                                                      be reinterviewed ( Frequent passing of subjects from one
stability after four                        structured interview (GMS)                                                                                                              71% or 61           category of depression to the other may
years. International                        to make diagnoses of         2 sets of diagnoses made 4                                                                                 patients did not have been due to the fact that the
Journal of Geriatric                        common psychiatric           years apart were compared in                                                                               receive follow up psychosis and neurosis categories seem
Psychiatry 1992;                            syndromes among the          order to cast light on the                                                                                                     to define levels of severity rather than
7(2):83-87.                                 elderly                      stability and predictive validity                                                                                              two clearly differentiated clinical
Australia                                                                of the AGECAT system in this                                                                                                   syndromes
                                                                         population




Anderson JL,           To examine           RCT (II)                     Quantitative data presented    64 patients qualified for the study (2 or   Dose was incremented at         13 patients        Study demonstrates highly significant
Gilbert EM, Alpert     transtelephonic      SoE: Good                                                   more PAF attacks documented within a        weekly intervals from 200-      dropped out of     correlation between perceived symptoms
BL, Henthorn RW,       monitoring in the                               Primary comparisons of the       4 week baseline period)                     300 and finally to              study              and documented PAF by transtelephonic
Waldo AL, Bhandari     evaluation of       Three various aspects of    study included the effects of    55 patients complete dose ranging           400mg/day                                          monitoring
AK et al. Prevention   paroxysmal          study design                flecainide and placebo therapy phase: treatment A                                                            7 because of
of symptomatic         arrhythmia's and                                on symptomatic PAF attacks       53 entering blinded phase: treatment B      16 week trial                   adverse effects    Rate of symptoms and PAF attacks
recurrences of         arrhythmia-         1: Baseline screening phase during blinded therapy for three 53 patients receiving both treatments in                                    (five cardiac)     significantly reduced by therapy
paroxysmal atrial      related symptoms                                independent measures             double-blind                                Patients used transtelephonic
fibrillation in        in outpatients      2: Open label, dose-ranging                                  Patients calculable for efficacy n=48       monitor to transmit data. A     5 for other        PAF was prevented in 15 patients during
patients initially                         phase                       McNemar's test for significant                                               total of 2375 transtelephonic   reasons            flecainide and four during placebo
tolerating             A patient initiated                             change was used to compare       Evaluable patients mean age 56 (range       rhythm strips and                                  therapy
antiarrhythmic         transtelephonic     3: Double blind, efficacy   the number of patients who had 23-83 years)                                  accompanying symptom            1 because of
therapy. A             monitor system phase                            no attacks while receiving                                                   reports were logged. Of         cardiac            Increased time between attacks
multicenter, double-   was used to                                     placebo and flecainide therapy m=30                                          these, 1314 (55.3%)             arrest/death
blind, crossover       evaluate the                                                                     f=18                                        represented symptomatic
study of flecainide    potential of                                                                                                                 calls and 1061 (44.7%) ,
and placebo with       flecainide in                                                                                                                asymptomatic (routine) calls.
transtelephonic        prevention of
monitoring.            symptomatic
Circulation 1989;      recurrences of
80(6):1557-1570.       PAF
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                            Page 2 of 66



Author / Title /         Purpose/           Design                         Analysis                          Participants: age/ gender/ groups         Intervention/ Duration           Follow-up:      Outcomes/ Socio-Economic Indicators
Journal / Year /         Objectives                                                                                                                                                     sample size;
Country / Location                                                                                                                                                                      dropout
Anon. Solid              How the Internet RCT (II)                         Not reported                      Participants identified with the use of   Participants were asked to       Not reported    Both intervention groups experienced
outcomes show e-         can help seniors SoE: Poor                                                          claims data and physician referrals       report on their pulse, weight,                   decreases in cardiac costs
heath and                                 Pilot study                                                                                                  BP, chest pain, shortness of
chronically ill senior                                                                                       n=69 elderly patients with moderate to    breath, whether they would                       Computer group seemed to fare better
populations are                                                                                              severe CHF                                like to speak to a nurse                         than telephone group in terms of
compatible. Disease                                                                                          62 patients were divided between an                                                        utilization, and experienced fewer
Management                                                                                                   Internet-based intervention group and     Participants in the IVR                          hospitalization rates
Advisor 2001;                                                                                                an interactive voice response (IVR)-      intervention were able to
7(7):103-106.                                                                                                based intervention group                  answer these questions using
USA                                                                                                          Remaining 7 patients received usual       the telephone key pad which
                                                                                                             care                                      took about 4 minutes

                                                                                                                                                       Computer users answered
                                                                                                                                                       these questions online in
                                                                                                                                                       about 5 minutes

                                                                                                                                                       Info transmitted reviewed by
                                                                                                                                                       a nurse


Ball C, Tyrrell J,        To assess the     Case-control - retrospective   The reliability of scores in the n=99 records of geriatric mental health    3 raters each scored 33 of the 99 participants   Results suggest that the written material
Long C. Scoring          reliability of     study (VII)                    video-link and fax modes were patients who had undergone a complete         MMSEs in each of the 3         completed the     of the MMSE can be reliably scored after
written material         scoring written    SoE: Poor                      compared with the in person      MMSE with scoring                          modes, over video-link,        study             transfer by fax machine, but the situation
from the Mini-           items of the Mini-                                mode using the kappa statistic                                              using a faxed copy, and in                       is less clear when a low cost V/C system
Mental State             Mental                                                                             mean age 80 years (range 45-91)            person                                           is used
Examination: a           Examination                                       McNemar test was used to         m=30
comparison of face-      (MMSE) using                                      compare the number of            f=69                                                                                        Sentences could be interpreted reliably
to-face, fax and         different modes:                                  responses that could not be                                                                                                  when viewed over the video link but the
video-linked             in-person, fax and                                scored between the fax and                                                                                                   interpretation of pentagrams was less
scoring. J Telemed       V/C                                               video-link modes                                                                                                             reliable
Telecare 1999;
5(4):253-256.                                                              All stats were calculated using
France, UK                                                                 SPSS




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                           Page 3 of 66



Author / Title /       Purpose/          Design                    Analysis                   Participants: age/ gender/ groups          Intervention/ Duration      Follow-up:        Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                    sample size;
Country / Location                                                                                                                                                   dropout
Berkman P, Heinik      Paper describes a Non Controlled Clinical   Data analyzed using SPSS   n=93 patients were randomly divided        Telephone calls were made   Final n=74;       A comparison of the characteristics of the
J, Rosenthal M,        telephone          Series (VIII)                                       into two groups: RS-NTP group that         once a week during a five   19 dropouts       RS-NPT group and the RS-PT group
Burke M.               "checking in "     SoE: Poor                Chi square                 comprised of 30 patients who were          week time frame                               showed no statistical difference between
Supportive             service provided                            t-tests                    selected to receive telephone support                                  Several weeks     the two with respect to demographic
telephone outreach     to elderly people                                                      calls from a three member secretarial      Asked questions about       after the end of  parameters and degree of success in
as an interventional   normally part of a                                                     staff (the non-professional team and the   anxiety and coping          the war, patients making telephone contact
strategy for elderly   hospital's home                                                        RS-PT group that consisted of 63                                       were sent a postal
patients in a period   care unit to whom                                                      patients who were selected to be called                                q'aire             There was significant statistical
of crisis. Social      services were                                                          by the three social workers ( the                                                         difference between the two groups with
Work in Health Care    disrupted during                                                       professional team)                                                                        respect to the number of calls made to
1999; 28(4):63-76.     th Gulf War in                                                                                                                                                   each household (professional team made
Israel                 1991                                                                   Mean age=74 years                                                                         more calls)
                                                                                              52% female




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                          Page 4 of 66



Author / Title /        Purpose/             Design                      Analysis                        Participants: age/ gender/ groups          Intervention/ Duration         Follow-up:         Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                                 sample size;
Country / Location                                                                                                                                                                 dropout
Bondmass M,             Objectives of the Non controlled clinical       Data for all variables were       50 self and physician referred patients   Interventions were             Four patients      Systolic and diastolic blood pressure
Bolger N, Castro G,     study were to     series (VIII)                 tested for normal distribution were screened for eligibility                conducted over the phone       dropped out        were both significantly reduced
Avitall B. The effect   determine         SoE: Poor                     using the Komolgorov-Smirnov                                                including patient education    leaving final
of home monitoring                                                      Goodness-of-Fit test              11 patients were excluded from data       and medication titration       n=33 whose data    Quality of life post scores were not
and telemanagement      Compliance with      One-group, pre-post design ANOVA with Tukey's post hoc analysis because they demonstrated              congruent with JNC-VI          were analyzed      statistically changed from baseline scores
on blood pressure       home blood                                      test used for within-subject      sufficient BP control                     guidelines
control among           pressure                                        comparisons for normally                                                                                   No follow-up
African Americans.      monitoring                                      distributed continuous variables 2 more excluded because they did not       90 day study
Telemedicine            among                                           Chi square tests for any discrete have phone
Journal 2000;           hypertensive                                    variables
6(1):15-23.             African                                         Pearson product-moment for        4 more excluded because of non
USA                     Americans, and                                  bivariate correlations            compliance
                                                                        Wilcoxon rank-sum test for non-
                        The effectiveness                               normally distributed categorical Final n=33 African Americans with one
                        of                                              and continuos variables           or more years of uncontrolled BP while
                        telemanagement                                  Descriptive stats and             on meds
                        in blood pressure                               frequencies were used for
                        control within 1-3                              demographics and patient          Mean age of cohort 51.5 years
                        months                                          characteristics
                                                                        SPSS                              24/33 patients were female
                                                                        Alpha level 0.05 determined
                                                                        level of significance
                                                                        QoL assessed at baseline and at
                                                                        study completion




Bratton RL, Short     Review of patient Survey (VIII)                    Patient satisfaction was        n=20 volunteer participants                Telemedicine visit consisted   Q'aire given to    Participants reported general patient
TM. Patient           satisfaction with SoE: Poor                        recorded on a 5 point likert                                               of recording the patient's     patients after 8   satisfaction with use of telemedicine
satisfaction with     telemedicine                                       scale                           Volunteers selected at random from         temperature, BP, pulse and     weeks, 18 of 20
telemedicine: a                         Recruitment of volunteers                                        those who attended a 30 minute             weight, and listening to       completed q'aire
comparison study of                                                                                      orientation session                        lungs
geriatric patients. J
Telemed Telecare                                                                                                                                    Once a week over 8 weeks
2001; 7 Suppl 2:85-
86.
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                          Page 5 of 66



Author / Title /     Purpose/            Design                    Analysis                             Participants: age/ gender/ groups       Intervention/ Duration           Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /     Objectives                                                                                                                                                  sample size;
Country / Location                                                                                                                                                               dropout
Brennan PF, Moore    ComputerLink        RCT (II)                Behavioural indicators of use          n=102 Primary Caregivers of a person    Computerlink provided 3          102 subjects         47 experimental group members
SM. Networks for     Project developed   SoE: Poor               (counts of computer access,            with AD (spouses or children of AD      support services to              began the study      accessed Computerlink 4364 times with
home care support:   to provide                                  content of messages) serve as          patients)                               caregivers:                      and 6 dropped out    a mean of 92 times
the ComputerLink     caregivers of       Randomized ComputerLink data in this experiment                n=51 experimental group                 - information (Electronic        over the course of
project. Caring      persons with        experiment                                                     n=51 comparison                         Encyclopedia re. AD),            the study            Greatest areas of use were private mail
1994; 8(8):64-66.    Alzheimer's                                 Computerlink use and                                                           - decision support                                    among caregivers and use of Electronic
USA                  Disease (AD)                                transcripts were recorded              f=66                                    - communication (electronic                           Encyclopedia, esp. re. Caring for the
Cleveland, Ohio      support in the                                                                     m=32                                    bulletin board, private e-mail                        Person with AD
                     home                                                                                                                       among participants,
                                                                                                        One nurse oversees the project: reads   anonymous e-mail to nurse)                            Private mail was used extensively and
                                                                                                        all public areas daily, maintains                                                             749 messages were posted where content
                                                                                                        Electronic Encyclopedia, responds to    Duration of study not                                 was reflective of all dimensions of social
                                                                                                        communications & troubleshoots for      reported (but is at least nine                        support
                                                                                                        participants (by e-mail).               months as one subject
                                                                                                                                                dropped out in month nine)                            Questions posted in Q&A focused on 4
                                                                                                                                                                                                      main themes: managing the person with
                                                                                                                                                Intervention was computer                             the disease, traveling with an AD person,
                                                                                                                                                use                                                   managing one's own feelings, preparing
                                                                                                                                                                                                      for death




Cameron K, Hughes Paper describes a Descriptive study (VIII)       Fall risk factors, age and gender No Participants                            None                             None                 A prototype system had been designed to
K, Doughty K.       fall prediction    SoE: Poor                   are identified                                                                                                                     automatically warn of an increase in the
Reducing fall       system based on                                                                                                                                                                   risk of a fall by an elderly person
incidence in        data collected via                             Statistical studies have been
community elders by a home based                                   used previously to derive
telecare using      sensor system                                  specific risk factors leading to a
predictive systems.                                                fall
Proceedings of the                                                 A multiple logistic progression
19th IE EE                                                         method was used to determine
Engineering in                                                     an adjusted odds ratio for each
Medicine and                                                       factor
Biology Society
Conference 1997;
3:1036-1039.
UK




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                                  Page 6 of 66



Author / Title /        Purpose/             Design                        Analysis                            Participants: age/ gender/ groups          Intervention/ Duration          Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                                        sample size;
Country / Location                                                                                                                                                                        dropout
Carroll DL,             To describe the      Qualitative                   Data was compiled as a log for      The participants were three APN's who      Each subject had a weekly       n=44 (patients in   Synthesis of the data revealed 4 themes
Robinson E, Buselli     activities of an     Data consisted of free-text   each subject.                       functioned as the APN coaches in this      contact for 12 weeks with       the APN-coached     of activities.
E, Berry D, Rankin      APN (advanced        comments written by the       The process of data reduction,      study.                                     the APN via the telephone.      intervention).      Patient education, validation/feedback,
SH. Activities of the   practice nurse) in   APN.                          data display, conclusion            They were all clinical nurse specialists   During the initial telephone    N=3 for APN's.      encouragement support and problem
APN to enhance          a nurse-coached                                    drawing, and verification were      with a cardiovascular focus to their       call, the APN explained who                         solving.
unpartnered elders      intervention study                                 grounded in the                     clinical practice.                         she was, and that she, with                         The APN provided patient education.
self-efficacy after     for unpartnered                                    recommendations of Miles and        They provided coaching to a randomly       the subject's permission,                           Self-management techniques about diet,
myocardial              elders post-                                       Huberman (qualitative data          assigned group of post-myocardial          would be calling each week                          activity, medication adherence were all
infarction. Clinical    myocardial                                         analysis).                          infarction elders (44)                     to provide a source of                              part of the content of the telephone
Nurse Specialist        infarction.                                        Validity was established by an                                                 support and guidance during                         intervention.
2001:60-66.                                                                extensive audit trail articulated                                              the patient's recovery.                             The APN listened attentively to the elder,
USA                                                                        all design decisions and                                                       Also during the first                               but then validated and affirmed the
                                                                           interpretations.                                                               telephone call, the APN                             patient's thinking, experiences, progress
                                                                                                                                                          ascertained the safety of the                       and accomplishments.
                                                                                                                                                          individual and initiated                            The APN provided significant support
                                                                                                                                                          relationship development.                           and encouragement. The elders
                                                                                                                                                          Questions were asked                                perceived themselves to be quite
                                                                                                                                                          regarding the patient's                             vulnerable during the study period. The
                                                                                                                                                          symptoms, level of activity.                        APN provided a level of professional
                                                                                                                                                          Further telephone calls                             social support.
                                                                                                                                                          proceeded on a weekly basis                         The APN assisted the elders with
                                                                                                                                                          to provide social persuasion                        decision making and facilitated
                                                                                                                                                          and to outline strategies to                        collaboration of the elders with their
                                                                                                                                                          manage the subjects                                 family and other members of the health
                                                                                                                                                          physiologic state.                                  team.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                     Page 7 of 66



Author / Title /       Purpose/          Design                      Analysis                         Participants: age/ gender/ groups       Intervention/ Duration        Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                           sample size;
Country / Location                                                                                                                                                          dropout
Castro CM, King        Purpose was to    RCT (II)                     An analysis plan was derived to Year 1 sample size not give             2 year study. During yr 1 all 179 participants     Counter to expectations, participants in
AC, Brassington        evaluate          SoE: Poor                    examine the differences in      Year 2: n=140                           participants received phone originally             the higher intensity condition who
GS. Telephone          telephone and     2 year randomized clinical adherence during the second       f=60; m=80                              counseling calls once a week enrolled in year 1,   received mostly mailings achieved
versus mail            mail-mediated     trial of four different      year of the study               average age = 56.3 years                for the first 4 weeks,        39 declined to       greater adherence than did those who
interventions for      interventions on exercise training conditions                                  most married, Caucasian, employed       biweekly for the following 4 continue in year 2    received monthly telephone counseling
maintenance of         physical activity Participants recruited       Analyses performed using SAS n=65 participants were originally          weeks, then monthly for 12                         and mail
physical activity in   maintenance in    through a random-digit-      statistical software            randomized to the lower intensity home months
older adults. Health   middle aged older dialed telephone survey in                                   based condition and n=75 participants                                                      Possible explanation for lack of added
Psychol 2001;          adults            Sunnyvale, California, and                                   randomized to the higher intensity      At the end of year 1,                              benefit of telephone counseling could be
20(6):438-444.                           a community wide                                             home based condition. Approx. equal     participants in the home                           participants' previous exposure to
USA                                      advertisement                                                proportions of participants were        based conditions were                              telephone delivered exercise counseling
                                         Eligibility criteria were                                    randomized to each of the two Year 2 randomized into one of 2                              in the first year of the trial
                                         current resident with no                                     maintenance programs: high intensity maintenance programs for
                                         intention of moving in 2                                     condition, 48% of participants assigned the 2nd yr of the trial:
                                         years; 50-65 years, no                                       to telephone and mail program and 52% telephone and mail contact
                                         cardiovascular disease or                                    assigned to a predominantly mail-       or predominantly mail
                                         stroke; no regular exercise;                                 mediated program; for low intensity     contact. During yr 2 all
                                         able to participate in                                       41% and 49% of participants assigned participants were encouraged
                                         moderate activity;                                           to telephone and mail and mail-         to continue exercising at the
                                         (females) post menopausal.                                   mediated programs, respectively         same intensity that they were
                                         The selection of                                                                                     assigned as baseline. All
                                         participants was stratified                                                                          participants were called
                                         by exercise training                                                                                 weekly for the first 4 weeks
                                         condition and intervention                                                                           of yr 2
                                         program to ensure equal,
                                         random sampling


Chan M, Bocquet H,     Review of         Descriptive study (VIII)    None                             None                                    None                          None                 Discusses various types of supervision
Campo E, Val T,        multisensor       SoE: Poor
Esteve D, Pous J.      systems for
Multisensor system     artificial
and artificial         intelligence in
intelligence in        housing for the
housing for the        elderly that may
elderly. Stud Health   warn
Technol Inform         professionals of
1998; 48:145-149.      change in patient
France                 behaviour




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                        Page 8 of 66



Author / Title /       Purpose/              Design                         Analysis                      Participants: age/ gender/ groups       Intervention/ Duration       Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                              sample size;
Country / Location                                                                                                                                                             dropout
Coogle CL, Osgood      An interactive        Descriptive (VIII)             Some statistical analyses     Potential participant number not given, 2 hour teleconference        134 participants     Significant overall knowledge gain for
NJ, Parham IA,         satellite             SoE: Poor                      mentioned t-tests and chi     but of the potential participants 134                                attended             the 115 participants
Helen E, Churcher      teleconference                                       square                        attended the teleconference                                          conference
CS. Effectiveness of   was scheduled to      Preconference and                                                                                                                                      Conclude that the live, interactive
videoconferencing      be broadcast          postconference                                               n=87 identified as service providers                                 115 completed        teleconferencing is an effective vehicle
in geriatric           nationwide            questionnaire                                                n=9 identified as adults or older                                    both the pre and     for the delivery of education about
alcoholism                                                                                                caregivers                                                           post test q'aire     alcoholism and substance abuse in older
education.             Providing                                                                          n=19 did not identify                                                                     adults
Gerontology and        education on
Geriatrics Education   elderly                                                                                                                                                                      Cost effective
1995; 16(2):73-83.     alcoholism to
USA                    older adults, their
Virginia               family caregivers,
                       service providers
                       in aging,
                       providers of
                       mental health and
                       substance abuse
                       services,
                       professionals

De Leo D, Carollo      To determine the      Cohort study (VI)              observed vs. expected suicides n= 12135 elderly service clients       4 year study                  Out of 2135         In the 4 year period studied, only one
G, Dello BM. Lower     impact on             SoE: Poor                                                     connected to Tele-Help/Tele-Check      Jan. 1, 1988 - Dec. 31, 1991 deaths over 4        case of suicide found by one woman
suicide rates          suicidal                                             standardized mortality ratio   service                                                              years, reliable     which represented a significantly lower
associated with a      behaviour of          Rate of suicide among                                         mean age 79.04 years                   Tele-Help - a portable device information was     suicide rate than was expected on the
Tele-Help/Tele-        telehelp,             telehelp/telecheck service                                                                           that lets users send alarm    obtained for only   basis on general population suicide rates
Check service for      telecheck, a          clients was determined                                       f=10150                                 signals activating help       2058, 1875 of
the elderly at home.   telephone service     through 2 separate data                                      mean age 79.05                          Tele-Check - trained staff    which were          Tele-Help/Tele-Check service provides
American Journal of    designed to           sources                                                                                              member contacts each client deaths of people      crisis intervention and social, medical,
Psychiatry 1995;       provide elderly                                                                    m=1985                                  ~ 2x/week                     aged >= 65 yrs      and psychological support.
152(4):632-634.        people with home      Authors determined the                                       mean age 79.03
Italy                  assistance            number of suicides among
                                             12135 elderly subjects who
                                             were connected to the tele
                                             service in the region over 4
                                             years and compared it with
                                             the suicide rate for the
                                             general population in the
                                             region




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                                       Page 9 of 66



Author / Title /       Purpose/              Design                        Analysis                            Participants: age/ gender/ groups            Intervention/ Duration            Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                                             sample size;
Country / Location                                                                                                                                                                            dropout
de Lusignan S,         To examine the        Small-sample RCT (III)       Effectiveness of telemedicine        n=20 total (24 asked to consent and 20 Intervention group                      2 patients          No significant differences between
Wells S, Johnson P,    acceptability,        SoE: Good to Fair            was evaluated by:                    did)                                     monitored their vital signs,          dropped out and 5   quality of life and chronic heart failure
Meredith K,            effectiveness, and                                 compliance with self                 geriatric Chronic Heart Failure patients info then transferred to              deaths              q'aire scores between the two groups
Leatham E.             reliability of        Controlled pilot             measurement regime;                                                           telephone and then to server
Compliance and         home                                               comparison of control weight,        Control group n=10                       at hospital for review by    n=13 completed               V/C started with enthusiasm but became
effectiveness of 1     telemonitoring        Patients identified with the pulse and BP in both groups;                                                  clinician                    the study                    less useful
year's home                                  diagnosis of heart failure   comparison of prescribed meds        Telemonitoring group n=10
telemonitoring. The                          from the computer database in both groups; q'aire on                                                       TM group also had ability to                              Video did not seem to offer advantages
report of a pilot                            and eligible patients were usefulness of V/C; Quality of          average age of participants 75.2 years consult                                                     over telephone consultation
study of patients                            invited to join the study    Life and Heart Failure Health
with chronic heart                           Those who agreed to          Status q'aires; reliability of the                                                Control group receives                                Patients would have preferred to see
failure. Eur J Heart                         participate received         technology                                                                        standard practice treatment                           physician face to face
Fail 2001; 3(6):723-                         confirmation of diagnosis
730.                                         Patients then randomly                                                                                         One year study
UK                                           assigned to the control or
                                             TM group

Fowkes W,              To characterize       Descriptive study (VIII)      Total number of calls were          Medical care providers, the staffs of 13     Information was logged on a       During the study Average time consumed by the call was 2
Christenson D,         the nature of the     SoE: Poor                     tabulated by patient and by         skilled nursing facilities, and an average   data collection form at the       period in the      minutes and 13 seconds.
McKAy D. An            telephone                                           facility. Reasons for call,         of 207 covered patients followed for 1       time the call was received        practice cared for Approximately 4 calls per patient per
analysis of the use of communication in      An archival descriptive       outcomes and timings were           year.                                        during the study period.          an average of      month.
the telephone in the the care of             study of phone message        tabulated.                          Only those calls received concerning         Data recorded included date,      more than 300      Different reasons for the initiation of the
management of          patients in skilled   data covering a period of 1                                       nursing home residents are represented.      time of day, the SNF in           patients on an     calls (new event, acute illness, new
patients in skilled    nursing facilities,   year. Includes intervention                                                                                    which the patient resided,        ongoing basis      observation, deterioration in an
nursing facilities.    noting numbers        and an evaluation of a                                                                                         the site of the origin of the     around the clock. established condition, consultation
JAGS 1997; 45:67- of calls, reasons          voice mail system at the                                                                                       call, the reason for the call,    An average of      request, to name a few).
70.                    for                   conclusion of the year's                                                                                       outcome of the call, and any      207 patients were 96% of the calls categorized were routine
USA                    communication,        study.                                                                                                         problems encountered.             cared for          or information only.
                       and the outcomes                                                                                                                     The level of urgency was          continuously in A voice mail system was instituted at the
                       of the                                                                                                                               determined at the time of         15 different       end of the study.
                       interactions, and                                                                                                                    coding based on the content       skilled nursing The voice mail system saved 35 minutes
                       to implement a                                                                                                                       of the call as urgent, routine,   facilities.        of time during an average work day.
                       voice mail system                                                                                                                    or information only.              During the year of Savings in cost is significant. Answering
                       to manage the                                                                                                                                                          study, 10, 264     service is $150/max 200 calls. If all
                       burden of                                                                                                                                                              calls were         voice mails came through the answering
                       communication                                                                                                                                                          received.          service, charge would be $850
                       more effectively
                       and describe the
                       impact of this
                       system.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                         Page 10 of 66



Author / Title /       Purpose/            Design                       Analysis                         Participants: age/ gender/ groups        Intervention/ Duration        Follow-up:             Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                               sample size;
Country / Location                                                                                                                                                              dropout
Friedman RH, Kazis     Study was           RCT (II)                    -Structured interviews were     Eligibility criteria described             2 home visits conducted 6     299 patients           -Use of routine, weekly computer based,
LE, Jette A, Smith     conducted to        SoE: Good                   conducted at baseline                                                      months apart                  enrolled in the        automated telephone monitoring of
MB, Stollerman J,      evaluate the effect                             -Q'aire used to evaluate        Total of 964 potentially eligible subjects                               study and 267          hypertensive patients was associated with
Torgerson J et al. A   of automated        Study compared patients     participants' attitudes about   were identified                            Weekly, subjects in the       completed the          significantly reduced DBP and possibly
telecommunications     telephone patient with hypertension who         computer technology applied to                                             telephone group reported self-study (32 patients     lower SBP
system for             monitoring and were randomly assigned to health care                            537 individuals were scheduled for a       measured blood pressures, did not complete)          -There were associations between TLC
monitoring and         counseling on       TLC (telephone linked       -Scales from the Short Form 36 home visit                                  knowledge and adherence to                           use, antihypertensive medication
counseling patients    patient adherence computer) and who             (SF36) were used to measure                                                antihypertension medication                          adherence, and blood pressure control.
with hypertension.     to                  continued to receive their health status                    299 confirmed as eligible to participate regiments and medication                               For TLC users, the most substantial
Impact on              antihypertensive regular medical care and       -t tests used to compare change in study                                   side effects                                         improvements in BP occurred in those
medication             meds and on         subjects who received their scores for TLC users and usual                                                                                                  who experienced an increase in
adherence and blood    blood pressure      regular medical care        care subjects                   TLC group                                  2 BP measurements were                               adherence to their antihypertensive med
pressure control. Am   control                                         -Ordinary least squares         n=133                                      taken at each home visit by                          regimen during the study
J Hypertens 1996;                          Conducted in 29 greater     regression was used to generate average age 76 years                       technicians                                          -Potential mechanism of action of TLC
9(4 Pt 1):285-292.                         Boston area communities adjusted change scores to           75% female                                                                                      monitoring might be to affect physician
USA                                                                    analyze differences between the                                            Antihypertensive medication                          behaviour ie. physicians could adjust
Massachusetts                                                          two groups                      Usual Care group                           adherence was assessed by a                          meds or counsel patient
                                                                       -Cost-effectiveness ratios were n=134                                      home pill count audit                                -May have been direct effects of the
                                                                       computed for medication         average age 77 years                                                                            telephone conversations on BP level
                                                                       adherence improvement and       79% female                                                                                      -Found inexpensive to use
                                                                       DBP decrease using simple
                                                                       linear regression analysis

Fulmer TT,             To determine        RCT (II)                     Mental status screen done for    Approx. 600 eligible patients were       Protocol included a 2 week      Subsequent to        There was a significant fall off in the
Hollander Feldman      whether daily       SoE: Good                    each patient (included SF-36     referred, and all offered $20 to         period of baseline              randomization, 4     control group's medication compliance
P, Sook Kim T,         videophone or                                    and MLHF questionnaire)          participate                              compliance monitoring, a 6      patients died, 2     rate over time compared to the rates of
Carty B, Beers M,      regular telephone   Three arms of the study:                                      60 agreed to participate                 week intervention phase         sets of caps were    the two intervention groups
Molina M, Putnam       reminders would     control group, daily         Computerized medication cap                                               with daily telephone or         lost, and 4 people   -Compliance of the control group fell
M. An Intervention     increase the        videotelephone call group,   placed on participant's bottle   n=18 participants in the control group   videotelephone calls, and a 2   withdrew from        24% but compliance in the two
Study to Enhance       proportion of       and daily telephone call     was used to measure              mean age 73.7 years                      week post-intervention          the study. These     intervention groups fluctuated no more
Medication             prescribed          group                        compliance                                                                period; caps were then          10 subjects were     than 2%
Compliance in          cardiac                                                                           n=15 participants in the group that      picked up and at this time a    excluded from the
Community-             medications taken   Elderly individuals (age    SPSS and MANOVA, ANOVA            received daily telephone calls           post interview was              analysis             There was an absence of significant
Dwelling Elderly       in a sample of      65+) were recruited to                                        mean age 76.2 years                      conducted                                            differences between the two intervention
Individuals. Journal   elderly             participate; participants                                                                                                                                   groups
of Gerontological      individuals with    were referred from 2                                          n=17 in the group that received daily
Nursing, 1999;         congestive heart    sources, a home health care                                   videotelephone calls                                                                          This method of monitoring is
August: 6-14.          failure CHF).       agency and an ambulatory                                      mean age 73.1 years                                                                           inexpensive
USA                                        care clinic
New York




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                Page 11 of 66



Author / Title /       Purpose/              Design                        Analysis   Participants: age/ gender/ groups     Intervention/ Duration         Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                          sample size;
Country / Location                                                                                                                                         dropout
Gallienne RL,          Article presents      Descriptive (VIII);                      47 caregivers had access to the       Three interaction interludes   47 caregivers had   Nurses provide instrumental, emotional,
Moore SM, Brennan      the creative use of   Qualitative                              Computerlink forum                    described to illustrate how    access to           and spiritual support to caregivers
PF. Alzheimer's        support of                                                                                           the network provided           computer forum,
caregivers:            caregivers (of        Three types of psychosocial              average age of caregivers was 60.3    emotional, spiritual, and      and 3 examples of   Exchanging messages helpful for
psychosocial support   Alzheimer's           support noted: instrumental              years (range 19-83)                   instrumental support to        interaction are     caregivers
via computer           disease) via a        support, emotional support,                                                    caregivers                     provided
networks. Journal of   computer network      and spiritual support                    n=32 female
Gerontological         called                                                         n=15 male
Nursing 1993;          Computerlink
19(12):15-22.                                                                         mean length of caregiving r'ship at
USA                                                                                   beginning of project was 30 months
Cleveland, Ohio




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                         Page 12 of 66



Author / Title /         Purpose/             Design                       Analysis                        Participants: age/ gender/ groups         Intervention/ Duration        Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /         Objectives                                                                                                                                                sample size;
Country / Location                                                                                                                                                                 dropout
Go RC, Duke LW,          To assess the        Case control study (VII)     differences in scores between   Phase 1                                 Phase 1                         Phase 2, ftf        STIDA is readily tolerated. All
Harrell LE, Cody H,      feasibility,         SoE: Fair                    Subject only and                n=18 AD patients and                    - all subjects administered     interview delayed   participants were willing to provide the
Bassett SS, Folstein     acceptability,                                    Informant/Subject methods       mean age 70.38                          STIDA in ftf sessions (first 2 2 weeks              requested information and completed the
MF et al.                validity of a        Phase 2, clinician blinded   tested using ANOVA              f=8 m=10                                parts only to Informants)                           interview successfully. Phase 1
Development and          structured           to previous telephone-                                                                               - Subject-only and              No drop out         Subject-STIDA agreed with clinician
validation of a          telephone            based STIDA results         sensitivity and specificity of   n=18 knowledgable informants for each Informant/Subject STIDA           reported            CDR in 15/18 cases; Informant/Subject
Structured               interview                                        subject-only and                 patient                                 scores & CDRs calculated                            STIDA agreed with clinincian CDR in
Telephone Interview      (STIDA) to                                       informant/subject STIDA                                                  - AD and non-AD patients                            17/18 cases.
for Dementia             distinguish          Note: STIDA consists of 3 reported, based on gold            n=5 non-AD patients                     administered ftf standardized                       Near-perfect inter-rater reliability.
Assessment               individuals with     parts:                      standard, i.e., CDR derived by                                           structured interview                                Phase 2
(STIDA): the NIMH        normal cognitive     1) relevant medical history clinician ftf interview          Phase 2                                 (clinician CDR)                                     STIDA shows excellent validity
Genetics Initiative. J   functioning from     used to indentify possible                                   n=28 subjects: mildly demented,         Phase 2                                             compared to ftf clinical interview
Geriatr Psychiatry       those with early     causes of dementia          Kappa coefficient to measure     questionably demented, or normal first- - STIDA administered to                             Informant/Subject method can detect
Neurol 1997;             Alzheimer's          2) reported current         agreement in scores              degree relatives of AD patients         subjects (first 2 parts only to                     impairment with sensitivity of .93 and
10(4):161-167.           disease              cognitive abilities and                                                                              informants) by phone                                specificity of .92 (Subject only method,
USA                      Two phases:          funtional status                                             n=28 knowledgable informants for each - Subject-only and I/S                                .80, .85)
                         1. Development       3) cognitive screening test                                  subject                                 STIDA scores & CDRs                                 While the Informant/Subject is the
                         study: feasibility   First 2 parts can be                                                                                 calculated                                          optimal form, the STIDA can be used
                         and acceptability    administered to a                                                                                    - ftf interview administered                        with subjects alone in many applications
                         of the STIDA,        knowledgable informant,                                                                              to subjects 2 wks later, CDR                        A short STIDA may be useful as a quick
                         correspondence       last part can only be                                                                                score obtained                                      screening toll to determine possible
                         with standard        completed by the patient                                                                                                                                 dementia.
                         Clinical Dementia
                         Rating (CDR)
                         Scale
                         2. Validation
                         Study



Hegarty K, Byrne G,      Evaluate general Cohort study (VI)                None                            102 eligible patients (came into the      Reception staff offered        No follow up       It was found that the computer based
Del Mar C. A pilot       practitioner (GP) SoE: Poor                                                       waiting room that day)                    patients a notebook                               screening instrument was acceptable to
study of computer-       and patient                                                                       age >=65                                  computer which delivered                          most elderly patients and their GPs
assisted screening       acceptability of a                                                                                                          the questionnaire and
for depression in the    computer based                                                                    n=58 not offered the computer test        recorded responses while
elderly in general       screening                                                                         (main reason was insufficient time for    they waited for their
practice. Informatics    instrument for the                                                                reception staff to give out and explain   consultation.
in Healthcare            purpose of                                                                        computer)                                 The patients then carried the
Australia 1996;          diagnosing                                                                        n=13 refused                              computer into the
5(4):166-168.            depression in                                                                                                               consultation where the GP
Australia                elderly patients                                                                  n=31 patients completed questionnaire     could generate a report of the
Brisbane                                                                                                                                             patients' responses.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                               Page 13 of 66



Author / Title /       Purpose/          Design                      Analysis                        Participants: age/ gender/ groups       Intervention/ Duration       Follow-up:         Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                         sample size;
Country / Location                                                                                                                                                        dropout
Hunkeler EM,           To evaluate the RCT (II)                     Hypotheses:                        Patients recruited during an 18 month Nurse TH consisted of total n=302 patients      Nurse telehealth care was superior to
Meresman JF,           efficacy of 2    SoE: Good                   1. that nurse telehealth care      period                                12-14 calls to each patient  enrolled           physician care with respect to reduced
Hargreaves WA,         augmentations to                             leads to better outcomes than      dx of major depression or dysthymia & over 16 week period          n=271              symptoms, improved functioning, and
Fireman B, Berman      antidepressant   Patients randomized to 1 of usual physician                    prescribed antidepressant medication  - discussed issues with      interviewed at 6   greater satisfaction with care for
WH, Kirsch AJ et al.   drug treatment   3 groups                    - intervention groups were                                               medications, offered         weeks              depression.
Efficacy of nurse                       1. Usual physician care     compared on each outcome           486 patients referred to study; 116   emotional support, reviewed n=256               At 6 mo., more nurse TH patients had
telehealth care and                     (control group)             variable while controlling for ineligible, 68 refused, 302 enrolled      patient activities           interviewed at 6   50% reduction in Hamilton Depression
peer support in                         2. Usual physician + nurse the baseline level of that          f=69%                                                              months             Rating Scale (p=.003) and Beck
augmenting                              TH care                     outcome                            average age 55.4 years, range 19-90   Peers were trained           total dropout      Depression Inventory (p=.05), and had
treatment of                            3. Usual physician care + - logistic regression and            demographics on education and race    volunteers who had a         n=46               higher treatment satisfaction (p <.001)
depression in                           nurse TH + peer support     Wilcoxon rank sum test             given                                 successfully treated episode                    and drug information satisfaction scores
primary care. Arch                                                                                                                           of depression or dysthymia                      (p <.01)
Fam Med 2000;                           Overall study population    2. effect of nurse telehealth care group 1: n=123                        - peers matched by age &
9(8):700-708.                           was allocated 40% to        on medication adherence            group 2: n=117                        sex to patients                                 There was no significant difference in
USA                                     condition 1, 40% to         - tested using 3 interview         group 3: n=62                         - made phone or in-person                       medication adherence between nurse TH
San Fransisco                           condition 2 and 20% to      questions covering current                                               contact with patient over 6                     and usual care groups.
                                        condition 3                 antidepressant drug use                                                  month period
                                        patients randomly assigned - chi square and t tests used                                                                                             Adding peer support to nurse TH did not
                                                                                                                                             Assessments conducted at                        improve outcomes
                                        Outcome measures            3. effects on outcomes of                                                baseline, 6 weeks and 6
                                        included the self report    adding peer support to nurse                                             months
                                        version of the Hamilton     TH
                                        Depression Rating Scale,
                                        the Beck Depression
                                        Inventory, and the SF12
                                        Mental and Physical
                                        Composite Scales




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                           Page 14 of 66



Author / Title /     Purpose/         Design                Analysis                           Participants: age/ gender/ groups        Intervention/ Duration      Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /     Objectives                                                                                                                                     sample size;
Country / Location                                                                                                                                                  dropout
Infante-Rivard C,    To determine      RCT (II)             Multiple linear regression was     All persons age 65+ at one hospital in The experimental              outcome data not     On average, those in the control group
Krieger M,           whether a         SoE: Good            performed in order to determine    Montreal during the last 6 months of   intervention consisted of     available for 40     visited the physician more often than the
Petitclerc M,        telephone support                      the effect of study group          1983 were identified                   regular telephone calls       subjects             subjects in the study group.
Baumgarten M. a      system could                           membership on the number of                                               initiated by a public health                       The significant variables that suggested
telephone support    reduce the                             physician encounters, while        n=182 subjects were assigned by simple nurse with specialized         final n=142;        higher utilization were subjects who were
service to reduce    frequency of                           controlling for important          randomization to a telephone support   training in geriatrics.        71 in each group.   older, female, received home care
medical care use     ambulatory                             prognostic factors.                group (TG n=71) or to a control group She telephoned participants                         services, lived alone, could walk without
among the elderly.   physician                              Interaction effects were tested.   (CG n=71) using a random number        every 8 weeks for 48 weeks,                        help, and had fewer diagnoses.
JAGS 1988; 36:306-   encounters.                                                               table                                  or for as long as they stayed                      In none of the subgroups analyzed (i.e.,
311.                                                                                                                                  in the study.                                      age, sex, social, dx) was there a
Canada                                                                                                                                During the conversation, the                       statistically significant difference re.
Quebec                                                                                                                                nurse aimed to reach the                           effectiveness of the intervention.
                                                                                                                                      following objectives:
                                                                                                                                      1. let the elderly person talk
                                                                                                                                      about his or her health and
                                                                                                                                      answer questions related to
                                                                                                                                      it.
                                                                                                                                      2. promote a healthy
                                                                                                                                      lifestyle.
                                                                                                                                      3. encourage self-care
                                                                                                                                      4. offer emotional support.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                          Page 15 of 66



Author / Title /        Purpose/             Design                        Analysis                         Participants: age/ gender/ groups           Intervention/ Duration           Follow-up:     Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                                       sample size;
Country / Location                                                                                                                                                                       dropout
Johnston D, Jones       This paper          Non-controlled clinical        Not reported                     40 patients                                 71 telepsychiatry                Not reported   Two years experience has demonstrated
BN, III.                describes the       series (VIII)                                                   mean age 79.3 years (range 60-95)           consultations via low cost                      that the weekly teleconsult service has
Telepsychiatry          operation of        SoE: Poor                                                                                                   ISDN V/C equipment were                         several advantages over the previous
consultations to a      telepsychiatry                                                                      Most common reason for referral was         provided over the 2 year                        arrangement of a monthly on site visit
rural nursing           consultation                                                                        dementia                                    period to 40 patients                           including:
facility: a 2-year      service provided                                                                                                                                                                -travel time eliminated
experience. J Geriatr   from an academic                                                                                                                Link established between                        -consultant maintains a weekly presence
Psychiatry Neurol       medical center to                                                                                                               academic medical centre and                     at the remote facility permitting more
2001; 14(2):72-75.      a skilled nursing                                                                                                               rural skilled nursing facility                  continuous contact with patients and staff
USA                     facility in a rural                                                                                                                                                             and more successful follow through of
North Carolina          setting                                                                                                                         Average duration of the                         recommendations
                                                                                                                                                        consultation period was                         -families and patient appreciate the
                                                                                                                                                        about 3 months                                  availability of the service




Johnstone HM.           The purpose of       Descriptive study (VIII)      Descriptive statistical analyses Participants were found at 2 sites                                                          There were no statistically significant
Quality outcomes of     this dissertation    SoE: Poor                     and inferential statistics were Site A: Kansas                                                                               differences in cost outcomes between
nursing tele-visits.    was to compare                                     used                             Site B: West Virginia                                                                       home health patients who received
George Mason            quality outcomes     A comparative, descriptive                                                                                                                                 nursing tele-visits and home health
University, 2000.       between home         design was used to plan the                                    Final sample consisted of 166 home                                                          patients who received traditional nursing
USA                     health patients      investigation                                                  health patients who had not been                                                            visits
                        receiving nursing                                                                   eliminated; 57 were from Site A (mean                                                       -When effects of age, location, and
                        tele-visits and                                                                     age 75.5 years) and 109 were from site                                                      severity of illness were controlled for,
                        home health                                                                         B (mean age 70.3 years). At site A, 12                                                      home health patients who received
                        patients receiving                                                                  patients received nursing tele-visits and                                                   nursing tele-visits were more satisfied
                        traditional                                                                         49 received traditional nursing visits.                                                     than home health patients who received
                        nursing visits                                                                      At site B all patients received                                                             traditional nursing visits
                                                                                                            traditional nursing visits.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                             Page 16 of 66



Author / Title /       Purpose/          Design                    Analysis                         Participants: age/ gender/ groups      Intervention/ Duration        Follow-up:        Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                        sample size;
Country / Location                                                                                                                                                       dropout
Jones III BN,          Goal was to test Case control study (VII)   Brief Psychiatric Rating Scale 3 clinicians involved: TM Interviewer, V/C assessments of 30           Missing data on 3 Ratings of psychiatric patients made
Johnston D,            the hypothesis      SoE: Fair-Poor          (BPRS)                           TM Observer, and Ftf Observer.         geriatric patients using low- interviews        using V/C equipment to see and hear
Reboussin B,           that V/C ratings                                                             Clinicians rotated positions.          bandwidth (ISDN)                                patients are generally reliable.
McCall WV.             based on visual Semistructured interview    BPRS items classified as                                                equipment were compared to Final n =27          Regardless of position, there was
Reliability of         observations of                             Subjective - relied primarily on n=30 geriatric psychiatric patients    gold standard ftf assessments interviews        significant agreement between clinicians
telepsychiatry         behaviour would                             patient's verbal responses, or   n=18 patients interviewed with Ftf and                               included for      in their overall ratings of geriatric
assessments:           be less reliable                            Observational - relied on visual TM Observers present                   Patient interviewed via V/C BPRS analysis       patients made using the BPRS.
subjective versus      than rating based                           assessment                       n=12 patients interviewed with Ftf     by TM Interviewer;
observational          on patients' verbal                                                          observer only                          interview observed by Ftf                       Lower reliability for observational BPRS
ratings. J or          reports of                                  Reliability for BPRS scores                                             Observer (in room with                          items
Geriatric Psychiatry   symptoms                                    evaluated by estimating the      f=22                                   patient) and TM Observer
and Neurology                                                      intraclass correlation between m=8                                      (in room with TM                                Visual ratings of geriatric patients do
2001; 14:66-71.                                                    two sets of ratings using a one average age 66.4 years                  Interviewer)                                    suffer when using low-bandwidth TM
USA                                                                way analysis of variance                                                                                                systems - though the differences were not
North Carolina                                                     random effects model                                                    blinding not discussed                          statistically significant.

                                                                   Also used: kappa stats                                                  duration not reported




Lyketsos CG,           Article discusses Descriptive - program     Compared                         All patients considered for            V/C system used for twice- None                 Telemedicine program served as an
Roques C, Hovanec      the Copper        evaluation (VIII)         # hospitalizations,              hospitalization                        weekly calls between the                        effective bridge between the long term
L, Jones BN, III.      Ridge/Johns       S0E: Poor                 # hospital days, and             - actual numbers not reported          hospital Neuropsychiatry                        and acute care teams in the continuum of
Telemedicine use       Hopkins                                     staff report of successful                                              unit and the Copper Ridge                       care
and the reduction of   telemedicine                                reintegration of residents       - no patient-specific data             (CR) long-term care facility
psychiatric            project and how                                                                                                     to discuss CR residents who                     During the first year of the operation of
admissions from a      its operation                               Comparison period:                                                      were about to be                                the TM program there was a decline in
long-term care         appears to have                             one year pre-TM (97/98) to one                                          hospitalized, who were                          the number of hospitalizations and the
facility. J Geriatr    brought about a                             year post-TM (98/99)                                                    currently or had been                           total number of days spent in the hospital
Psychiatry Neurol      reduction in                                                                                                        recently hospitalized.
2001; 14(2):76-79.     psychiatric                                                                                                         - if possible, hospital staff
USA                    admissions                                                                                                          also interviewed the patients
Maryland




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                       Page 17 of 66



Author / Title /       Purpose/             Design                        Analysis                      Participants: age/ gender/ groups       Intervention/ Duration            Follow-up:        Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                                 sample size;
Country / Location                                                                                                                                                                dropout
Macduff C et al.       To discuss           Descriptive study (VIII)      none mentioned.               The evaluation study they described      Describes how nurse-led          not applicable.   There were several issues that the article
Telemedicine in        findings of an       SoE: Poor                                                   focused on a small village population in telemedicine was                                   addresses, such as the nature and scope
rural care. Part 2:    evaluation study,                                                                Scotland.                                implemented in the village.                        of development, the experience of the
assessing the wider    and related to the   Descriptive study dealing                                                                            There is a video link                              video link, the perceived effectiveness,
issues. Nursing        wider picture of     with the issues raised the                                                                           consultation process in the                        perceived efficiency, and perceptions of
Standard 2001;         nursing              evaluation of a                                                                                      village.                                           users.
15(33): 33-37.         involvement in       telemedicine program in                                                                                                                                 The video link emerged as a small but
UK                     teleconsultation.    Scotland                                                                                                                                                useful contributor.
                                                                                                                                                                                                    Those who used it were generally
                                                                                                                                                                                                    satisfied with it.
                                                                                                                                                                                                    Some doubted as to whether the service
                                                                                                                                                                                                    was as good as seeing their doctor in
                                                                                                                                                                                                    person.
                                                                                                                                                                                                    It was convenient for the patients.

Magnusson L,           ACTION system        Qualitative                 No description of analysis on   Majority of carers female, older than 45 Future project activity will Not reported          Anticipated carer benefits include:
Berthold H, Brito L,   is designed to       Needs of family carers were q'aires or focus groups                                                  concentrate on validation of                       Direct access to care info and practical
Chambers M, Daly       maintain or          assessed using focus                                        Cared people noted as being mostly       the ACTION system in all                           advice which will improve the carers'
T, Emery D.            enhance quality      groups with family and                                      women over 75 years of age               partner countries.                                 competence and their ability to provide
ACTION: assisting      of life for older    professional carers and 451                                                                                                                             care
carers using           disabled and         completed q'aires                                                                                   The entire set of ACTION                            Opportunities for older people and their
telematics             carers;                                                                                                                  products and services will be                       family carers to plan for long term care
interventions to       enhance              Project seeks to develop a                                                                          tested and evaluated in 40                          and acquire info about the local respite
meet older person's    knowledge, skills    prototype including                                                                                 private homes, nursing and                          facilities available
needs. Nursing         and competence       equipment and Intranet                                                                              residential homes, hospitals                        Clarification so that family carers realize
informatics: the       of family carers;    system                                                                                              and health care centres,                            the financial benefits and econ support
impact of nursing      meet carers need                                                                                                         resulting in total 64 sites and                     they can claim
knowledge on health    to improve           Software is being produced                                                                          approx. 600 people                                  Using social cognitive learning theory
care informatics.      emotional            in areas such as caring in                                                                                                                              (Bandura, 1977) together with the work
Proceedings of         support; and         daily life, planning for                                                                                                                                of Folkman and Lazarus (1980) an
NI'97, Sixth           provide carers       respite and long term care,                                                                                                                             interactional coping model has been
Triennial              with ability to      coping and emergency                                                                                                                                    constructed with illustrates the
International          develop enriching    situations; and financial                                                                                                                               interaction between the environment, the
Congress of IMIA-      activities to        information                                                                                                                                             carers' cognitive appraisal and their
NI, Nursing            improve the QOL                                                                                                                                                              subsequent physical and emotional
Informatics of         of those cared for                                                                                                                                                           behaviour
International
Medical Informatics
Association.
Amsterdam,
Netherlands: IOS
Press, 1997: 551.
Europe




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                               Page 18 of 66



Author / Title /        Purpose/             Design                          Analysis                           Participants: age/ gender/ groups       Intervention/ Duration          Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                                      sample size;
Country / Location                                                                                                                                                                      dropout
Mahoney D,              Purpose was to       Case control study (VI)         The instruments used to            Convenience sample recruited from the   Intervention: Telephone         48 participants      Results indicated similarities between the
Tennstedt S,            test the validity    SoE: Fair                       measure functional disabilities    client population of one Mass. home     Linked Communications           originally           personal and automated telephone
Friedman R, Heeren      and reliability of                                   were adaptations of the            care agency                             (TLC) system                    contacted (41        assessments, but neither method captured
T. An automated         an automated         Criterion validity--the         individual item ratings from the   48 clients were contacted by phone                                      women and 7          as many impairments as the case
telephone system for    telephone            extent to which the same        ADL and the IADL scales            3 clients ineligible to participate      Within a 72-hour period,       men)                 manager's home assessment, and thus
monitoring the          monitoring           results as the gold standard                                       15 clients refused to participate        each participant received in                        telephone assessment cannot substitute
functional status of    system by            are produced                 To assess test-retest reliability,                                             random order two automated     3 clients            for a case manager's in home assessment
community-residing      measuring                                         the percentage of agreement           n=30 participants agreed to participate and one personal telephone      ineligible to
elders. Gerontologist   functional status    Reliability was evaluated between responses to the two                                                      functional assessment as       participate          TCL elder care system showed excellent
1999; 39(2):229-        in community         using a test-retest design   TLC automated calls was               mean age of clients in analytical sample well as a home visit                                test-retest reliability with a weighted
234.                    residing older       which measures the           calculated for each item of the       was 78.9 years (range 61-98)             assessment by a case           15 refused to        kappa of 0.76 for the ADL items and
USA                     adults and           consistency of scoring over ADL and IADL scales                    85% female                               manager                        participate          0.83 for the IADL itms
Massachusetts           comparing the        a short period of time when                                        all Caucasian
                        data with data       the participant's status has Weighted kappa statistics and                                                                                 30 agreed to and
                        gathered a) by a     not changed                  95% confidence interval were                                                                                  did participate
                        case manager                                      calculated for the combined set
                        during a home        Written informed consent of ADL items and the set of                                                                                       Only 20
                        visit and (b by a    obtained                     IADL items                                                                                                    completed all four
                        telephone                                                                                                                                                       protocol
                        interviewer                                                                                                                                                     components

Markson LJ,             To examine the       Descriptive study (VIII)        None                               None                                    None                            None                 Findings from the first pilot study
Friedman RH, Jette      role of computers    SoE: Poor                                                                                                                                                       reviewed suggest that having the
AM, Kazis L.            as clinician                                                                                                                                                                         computer check up on then weekly made
Computers as            extends for          No original study design,                                                                                                                                       them feel more secure or less worried
clinician extenders:    elderly patients     but does review two pilot                                                                                                                                       about their illness; patients feel like
monitoring chronic                           studies that were done to                                                                                                                                       active participants in their own medical
illness in elderly                           test the feasibility of using                                                                                                                                   care
patients.                                    the TLC system to monitor                                                                                                                                       2nd study reported findings suggest a
International Journal                        anti-hypertensive therapy                                                                                                                                       number of modifications could be made
of Technology and                            for elderly patients                                                                                                                                            to better adapt the system to various
Aging 1992;                                                                                                                                                                                                  types of disabilities
5(2):153-165.
USA                                                                                                                                                                                                          The two pilot studies reviewed suggest
                                                                                                                                                                                                             that the use of systems such as TLC may
                                                                                                                                                                                                             be feasible for many if not most elderly
                                                                                                                                                                                                             persons




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                               Page 19 of 66



Author / Title /      Purpose/             Design                     Analysis                           Participants: age/ gender/ groups     Intervention/ Duration         Follow-up:     Outcomes/ Socio-Economic Indicators
Journal / Year /      Objectives                                                                                                                                              sample size;
Country / Location                                                                                                                                                            dropout
McGrew KB, Quinn      To assess the     Case controlled study (VII)   No statistics reported             n=40                                  Two clinical researchers                      High level of consistency between
CA. Examining the     effectiveness of SoE: Poor                                                         Response rate approx. 50%             conducted face-to-face in-                    researcher (face-to-face) and agency
effectiveness of      telephone                                       Client satisfaction was                                                  home assessments of forty                     (telephone) assessment in areas of
telephone             assessment and                                  measured using a fourteen          Mean age of sample 76 years           ESP clients who had recently                  financial and demographic data
assessment and care   care planning for                               question semi-structured                                                 been assessed by telephone
planning for          homecare                                        interview exploring relationship   69% female                                                                          Differences between face-to-face and
homecare services.    services                                        between client expectations and                                                                                        telephone assessment did not affect the
Generations 1997;                                                     objectives and the service         African Americans (55% of sample)                                                   case planning process or services
21(1):66-67.          Elderly Services                                package                            were disproportionately represented                                                 received
USA                   Program (ESP) is
                      a homecare
                      program designed
                      to serve a
                      moderately
                      impaired older
                      population who
                      require a limited
                      number of
                      services to remain
                      independent




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                       Page 20 of 66



Author / Title /        Purpose/          Design                       Analysis                         Participants: age/ gender/ groups        Intervention/ Duration       Follow-up:            Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                            sample size;
Country / Location                                                                                                                                                            dropout
Montani C, Billaud      To evaluate the Case Control study (VII)      Quantitative and qualitative     n=15 geriatric hospital patients with no 4 month study                 15 participants       V/C method resulted in lower scores on
N, Tyrrell J,           psychological     SoE: Fair to Poor           data collected                   psychiatric history                                                    enrolled, 1           MMSE (p=.003) and CFT (p = .07)
Fluchaire I, Malterre   impact of remote                                                               average age 88 years                     The video consultation (6     refused to
C, Lauvernay N et       consultation in                               The duration of the two types of f=7                                      mins) was significantly       participate in part   67% of patients preferred ftf consultation
al. Psychological       elderly patients                              consultations were compared      m=8                                      shorter than the conventional of the study          40% of patients felt uncomfortable
impact of a remote                        Video and ftf consultations using t-tests                                                             one (10 mins)                                       because of the screen and felt inhibited
psychometric            Video             consisted of a preliminary Correlation (spearman's rho)      Exclusions: patients with serious visual Time taken to administer the                        by the presence of the equipment
consultation with       consultations     interview with a            between the patients'            or auditory defects                      psychometric tests (12 mins)
hospitalized elderly    were compared psychologist and 2              performances on each test in                                              was about the same in the                           Psychologists preferred ftf interviews
people. J Telemed       with conventional psychometric tests which the two consultations               2 psychologists; 1 did tests and the     two situations
Telecare 1997;          ftf consultations evaluated the patients'     Patients' scores from the two    other observed patients preference and                                                       Often difficult to hear and quality of
3(3):140-145.                             cognitive function -- the   consultations were compared      attitudes for TM vs. ftf                                                                     image sometimes poor
France                                    Mini-Mental State           using a paired non-parametric
Grenoble                                  Examination (MMSE) and test (Wilcoxon signed rank test)                                                                                                   May have been a decline in concentration
                                          the Clock Face Test (CFT)                                                                                                                                 for patients in V/C method

                                                                                                                                                                                                    Patients participated more in ftf
                                                                                                                                                                                                    consultations




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                    Page 21 of 66



Author / Title /        Purpose/             Design                    Analysis                          Participants: age/ gender/ groups       Intervention/ Duration        Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                             sample size;
Country / Location                                                                                                                                                             dropout
Montgomery AA,          To investigate the   Cluster RCT (II)          Stata Statistical software used  27 general practices recruited and       Patients were randomized to Of 810 randomly     Patients in the computer based clinical
Fahey T, Peters TJ,     effect of a          SoE: Good                                                  randomly allocated                       computer based clinical       selected patients,decision support system and chart only
MacIntosh C, Sharp      computer based                                 Descriptive statistics used for Groups                                    decision support system plus 95 were excluded   groups were no more likely to have
DJ. Evaluation of       clinical decision    Neither patients nor      baseline comparability of        1. Computer based clinical decision      cardiovascular risk chart, or before invitation cardiovascular risk reduced to below
computer based          support system       physicians were blinded   groups                           support system plus chart n=10           cardiovascular risk chart     (non ambulatory   10% than patients receiving usual care
clinical decision       and a risk chart                                                                practices)                               alone, or usual care          patients and thoseIn terms of the percentage of patients
support system and      on absolute                                    Multivariate regression models n=269 eligible patients                                                  with life         with a five year cardiovascular risk
risk chart for          cardiovascular                                                                  n=229 attend at baseline                                               threatening       greater than 10% neither the computer
management of           risk, blood                                    Corrected for clustering using n=202 attend at 12 month follow up                                       illness)          based clinical decision support system
hypertension in         pressure, and                                  procedures in Stata              2. Chart only (n=10 practices)                                                           plus chart or chart alone were any better
primary care:           prescribing of                                                                  n=264 eligible patients                                                A further 101     than usual care
randomized              cardiovascular                                 Tested for an interaction effect n=228 attend at baseline                                               failed to attend  The results do not support the use of this
controlled trial. BMJ   drugs in                                       of baseline risk level and trial n=199 attend 12 month follow up                                        the baseline      computer based clinical decision support
2000;                   hypertensive                                   arm                              3. Usual care patients (n=7 practices)                                 consultation      system in the management of
320(7236):686-690.      patients                                                                        n=182 eligible patients                                                                  hypertension
UK                                                                     Chi square and multinomial       n=157 attend baseline                                                  Of the remaining The benefits of computers are clearer
Avon                                                                   logistic regression              n=130 attend 12 month follow up                                        614 patients, 552 when they are used as administrative aids
                                                                                                        Age of patients was between 60 and 79                                  and 531 attended for detection, registration, and recall
                                                                                                        years with high blood pressure                                         the six and 12
                                                                                                                                                                               month follow up
                                                                                                                                                                               respectively




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                    Page 22 of 66



Author / Title /        Purpose/           Design                         Analysis                        Participants: age/ gender/ groups         Intervention/ Duration       Follow-up:      Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                               sample size;
Country / Location                                                                                                                                                               dropout
Neafsey PJ, Strickler   Describes the       RCT (II)                      SPSS used for statistical       Two focus groups of six people each       Experimental group was       All 60          Hypothesis 1: PEP group had
Z, Shellman J,          development and SoE: Good                         analysis                        evaluate PEP components ie.elements       tested post-use of PEP       participants    significantly greater knowledge of
Padula AT.              pilot evaluation of                                                               of software before RCT began                                           completed the   potential interactions of prescription
Delivering health       a computerized Pilot project                      Four instruments used to                                                  Control group was also given study           medications with OTC medications and
information about       drug interaction                                  measure outcomes were           n=60 total participants in RCT            the opportunity to use PEP                   alcohol than the control group
self-medication to      education           PEP hypotheses tested in      developed and validated:                                                  but they were tested pre-use
older adults: use of    program installed pilot study were:               -a self report measure of       Experimental group n=30                                                                Hypothesis 2: PEP group had
touchscreen-            on a notebook       Participants using PEP will   prescription of OTC drug and    mean age 73 years                         Pre and post scores were                     significantly greater self-efficacy for
equipped notebook       computer            show greater knowledge of     alcohol use                                                               compared.                                    avoiding drug and alcohol interactions
computers. J            equipped with a potential interactions of         -a measure of self-efficacy     Control group n=30                                                                     than control group
Gerontol Nurs 2001;     touch screen        prescription meds with        -an objective test to measure   mean age 68.8 years
27(11):19-27.                               OTC medications and           knowledge                       Both groups 88% women                                                                  No significant difference in the overall
USA                     Personal            alcohol than will non-users   -a satisfaction instrument      Sample randomly divided                                                                mean satisfaction scores between the
                        education           Users of the PEP will show                                                                                                                           groups, but both groups were satisfied
                        program (PEP)       greater self-efficacy for                                     Various inclusion/exclusion criteria of                                                Participants noted they learned a lot
                        delivered to older avoiding drug and alcohol                                      participants mentioned ie.participants                                                 study found important indications of
                        adults              interactions than will non-                                   must be over age of 60 years                                                           knowledge and behaviour changes
                                            users




Persson M,              To evaluate a      Descriptive (VIII)                                             A list of hypertensive patients was     The medical profiles of 338 consistent         Using DSS suggests total cost reduction
Mjorndal T,             computerized       SoE: Poor                                                      extracted from the computerized         hypertensive patients treated                  of 33-40% depending on doses chosen
Carlberg B, Bohlin      decision support                                                                  medical records of each health centre   with drugs against
J, Lindholm LH.         system (DSS) for                                                                  (from four centres in Sweden) and every hypertension were processed                    The DSS drug profile was more adherent
Evaluation of a         drug treatment of                                                                 fifth patient's medical profile was     by the DSS. The drug                           to guidelines in patients with major
computer-based          hypertension,                                                                     assessed by the team                    treatment proposed by the                      complicating diseases, suggesting an
decision support        regarding quality,                                                                                                        system was then compared                       improvement in treatment quality for
system for treatment    safety and cost                                                                   n=338                                   to actual treatment given by                   these patients by the DSS
of hypertension with    compared to                                                                                                               the physician
drugs: retrospective,   actual
nonintervention         antihypertensive
testing of cost and     drug treatment
guideline adherence.
J Intern Med 2000;
247(1):87-93.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                         Page 23 of 66



Author / Title /     Purpose/                 Design                     Analysis                           Participants: age/ gender/ groups     Intervention/ Duration           Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /     Objectives                                                                                                                                                    sample size;
Country / Location                                                                                                                                                                 dropout
Pringle Specht JK, Cost analysis in a         Descriptive study (VIII)   Cost analysis                      Not reported                          Fifteen telehealth               Not reported        In the pilot study, the average cost of a
Wakefield B,         chronic wound            SoE: Poor                                                                                           consultations per month                              telehealth chronic wound consultation
Flanagan J.          consultation                                        Three measures of cost                                                   were used to determine per                           was $136.16 compared to $246.28 if the
Evaluating the cost clinic                    Pilot study                avoidance were used in the                                               consultation costs for line                          patient had been transported and seen in
of one telehealth                                                        study: consultant travel time,                                           charges and                                          the traditional face to face consultation
application                                                              transporting the long-term care                                          depreciation/maintenance
connecting an acute                                                      patients to the acute care                                               costs
and long-term care                                                       setting for clinic appointments,
setting. J Gerontol                                                      and average time patients were
Nurs 2001; 27(1):34-                                                     gone from the facility
39.
USA

Riegel B, Carlson B,     To assess the        RCT (II)                   Intervention and usual care    Patients were identified at               Intervention group n=130         Final sample of     Acute care resources use was
Kopp Z, LePetri B,       effectiveness of a   SoE: Good                  groups assessed for balance on hospitalization and assigned to receive   was telephoned within 5          n=358 patients      consistently lower in the intervention
Glaser D, Unger A.       standardized                                    demographic and clinical       6 months of intervention or usual care    days after hospital discharge    (130 intervention   group than in the usual care group at 3
Effect of a              telephonic case      Patients were assigned to  characteristics at baseline    based on the group to which their         and thereafter at a frequency    and 228 control)    and 6 months
standardized nurse       management           groups on the basis of                                    physician was randomized                  guided by the software and       were used for the
case-management          intervention in      which group their         SPSS                            Intervention group n=130                  case manager judgment            analysis of acute   All-cause hospitalization rates dropped
telephone                decreasing           physician was randomized Covariates were used in the      Usual care group n=228                                                     care resource use   25.6% at 3 months and stayed 28.2%
intervention on          resource use in      to                        analyses if group differences   Overall sample mean age 72 years and      Patients received an average                         lower in the intervention group at 6
resource use in          patients with                                  were evident at baseline        51% female                                of 17 phone calls at             Data on             months
patients with            chronic heart                                  Cost analyses were conducted A total of 281 physicians were               decreasing levels of             outpatient
chronic heart failure.   failure                                        using logarithmically           randomized, and none were told what       intensity, length, and           resource use and    Heart failure remission rates were 36%
Arch Intern Med                                                         transformed data because of the group they were randomized to             frequency over the 6-month       satisfaction were   lower in the intervention group at 3 and 6
2002; 162(6):705-                                                       severe positive skewness        Differences between patients included:    follow up                        only available on   months
712.                                                                    caused by multiple zeros        -difference between the subsample of                                       a subsample of
USA                                                                     Descriptive stats               242 patients and the 116 on whom          Each patient was estimated       242 patients;       Significant cost savings found
California                                                              Multiple linear regression      outpatient resource data use were not     to have an average of 16         (intervention 130
                                                                                                        available as primary language             hours of a case manager's        and control 112)
                                                                                                        -Differences between groups on            time overall
                                                                                                        demographic or clinical descriptions
                                                                                                        were a higher use of B-blockers and a     Care for patients in the usual
                                                                                                        lower incidence of chronic lung disease   care group n=228 was not
                                                                                                        in the intervention group                 standardized.
                                                                                                                                                  No formal telephonic case
                                                                                                                                                  management program was
                                                                                                                                                  used.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                                Page 24 of 66



Author / Title /         Purpose/            Design                        Analysis                          Participants: age/ gender/ groups           Intervention/ Duration          Follow-up:         Outcomes/ Socio-Economic Indicators
Journal / Year /         Objectives                                                                                                                                                      sample size;
Country / Location                                                                                                                                                                       dropout
Roush RE, Teasdale       This study          2 studies:                    Statistical analyses included a   n=101                                       No intervention.                Not reported       Emergency department visits decreased
TA. Reduced              replicated a        1) Cohort study (VI)          description of the Tallahassee    Age range 36-93 years                                                                          slightly during the subscribers' first year
hospitalization rates    Canadian study      2) Descriptive study (VIII) - data and a comparison of          Mean age 76.5 years                         Utilization data from                              of PRS use, but the drop was not
of two sets of           done to determine   comparison of US and          known demographic features        87% females                                 patients subscribed to the                         statistically significant
community-residing       whether use of a    Canadian programs             and hospital utilization rates                                                Lifeline Program were taken
older adults after use   24-hour personal    Overall SoE: Fair             before and after PRS use          Comparisons were done between               for 1 year prior and 1 year                        Average reduction of days of
of a personal            response system                                                                     Tallahassee and Langley Lifeline            following their subscription.                      hospitalization per subscriber per year
response system.         (PRS) affected      All persons who subscribed                                      Program PRS subscribers                                                                        was statistically significant
Journal of Applied       selected hospital   to the Lifeline Program                                         -no substantive difference in mean age
Gerontology 1997;        utilization rates   PRS of Tallahassee                                              found
16(3):355-366.           among               Medical Centre for at least                                     -Tallahassee sample had slightly higher
USA, Canada              community           one full year between 1991                                      number of female subscribers
                         residing elders     through 1993 were                                               -mean number of ED visits prior to
                                             identified (n=101)                                              subscription was significantly greater in
                                                                                                             the US sample when compared to the
                                             Hospital data were charted                                      Canadian sample
                                             for 1 year prior to and 1
                                             year after initial
                                             subscription to the program

                                             Comparison to 106 PRS
                                             subscribers in Canada




Sanz F, Silveira C, To examine            Descriptive (VIII)         Respondents rated on likert             n=84 pharmacists                                                            All participants   High percent of respondents (81%)
Alonso A, Diaz C, programs                SoE: Poor                  scale ie.usefulness of program                                                                                      completed the      answered "probably" or "for sure" to the
Loza MI, Cordero L developed for the                                                                         Mean age 41.2 years                                                         study              question: "Do you think that a program
et al. Telematics    info and training TESEMED and TEEMED-                                                   sd 11.6 years                                                                                  like this would improve your knowledge
applications to      of community         II are research projects                                                                                                                                          and skills in treating the minor ailment
support the role of pharmacists with funded in Europe                                                        m=34                                                                                           covered?"
the community        the aim to                                                                              f=48
pharmacists as self- empower them as Pharmacists not involved in                                             gender not recorded=2
medication advisors. advisors of the      the development given
TESEMED              citizens about self- q'aires to ask about their
Consortium. Stud     medication topics opinions ie. re:usefulness
Health Technol
Inform 1999; 68:764-
767.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                      Page 25 of 66



Author / Title /        Purpose/             Design                        Analysis          Participants: age/ gender/ groups      Intervention/ Duration        Follow-up:        Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                sample size;
Country / Location                                                                                                                                                dropout
Scalvini S, Zanelli     To report on the     Non controlled clinical       None mentioned.   Practitioners in two north Italian     From February to July 1998, n=178 general       Overall the cardiologists reported no
E, Domenighini D,       preliminary data     series (VIII)                                   provinces.                             the general practitioners     practitioners.    action in 74% of the patients (n=1667),
Massarelli G,           collected over the   SoE: Poor                                                                              received a portable Card      2800 calls were   while for the remaining 578 patients
Zampini P,              first 6 months of                                                    Average age of participants 63 years   Guard 7100                    received.         there were several suggestions given
Giordano A,             a telecardiology     Looks at frequency of call,                     44% m                                  electrocardiograph                              (such as request for further diagnostic
Glisenti F.             service.             and the resulting diagnosis                     56%f                                   transferring, by mobile or                      tests as an out-patient, altering
Telecardiology                               and treatment resulting                                                                fixed telephone, a 12 lead                      medication, or new treatment).
community: a new                             from the calls.                                                                        ECG to a receiving station,
approach to take                                                                                                                    where a cardiologist was
care of cardiac                                                                                                                     available for the reporting
patients. Cardiologia                                                                                                               and interactive
1999; 44(10):921-                                                                                                                   teleconsultation.
924.                                                                                                                                The cardiologist then
Italy                                                                                                                               recorded his intervention:
                                                                                                                                    action not taken, referral to
                                                                                                                                    casualty, request for further
                                                                                                                                    investigations, start of new
                                                                                                                                    treatment, or treatment
                                                                                                                                    modifications.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                 Page 26 of 66



Author / Title /        Purpose/            Design                     Analysis                        Participants: age/ gender/ groups   Intervention/ Duration         Follow-up:           Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                        sample size;
Country / Location                                                                                                                                                        dropout
Shah NB, Der E,         A pilot study to    Non-controlled clinical      Primary efficacy end point of n=27 patients enrolled              Patients followed program      Four patients died   The number of hospitalizations per
Ruggerio C,             determine           series (VIII)                the study was the number of   mean age 62 years                   for 1 year                     during the course    patient-year of follow up after enrollment
Heindereich PA,         whether a less      SoE: Poor                    hospitalizations and hospital all male                                                           of follow up         was 0.4 compared with 0.8 per patient-
Massic BM.              intensive program                                days during the follow up                                         Mean length of follow-up                            year during the equivalent period before
Prevention of           with patient        Participants in the study    period compared with the same                                     period was 8.5 months                               enrollment
Hospitalizations for    education           were drawn from patients time period before entrance into
heart failure with an   materials,          admitted with the diagnosis program                                                            All patients were mailed at                         During the study there were 52 physician
interactive home        automated           of congestive heart failure                                                                    weekly intervals educational                        notifications by the monitoring service
monitoring program.     reminders for       (CHF) or those referred to Wilcoxon's sign rank test used                                      materials for the initial 8                         for 65 reported problems (weight gain,
Am Heart Journal        medication          the Heart clinic in San Fran for statistical analysis                                          weeks                                               shortness of breath, fatigue, and other
1998; 135:373-8.        compliance, self-   over the 6 month period                                                                        Patients also given a pager                         symptoms of CHF). There were 19
USA                     monitoring of       between December 1994                                                                          which was used to transmit                          physician interventions from these
                        daily weights and   and May 1995                                                                                   computer generated                                  notifications.
                        vital signs, and                                                                                                   reminders to the patient to
                        facilitated                                                                                                        take medications, weigh                             Patient satisfaction with program was
                        telephone                                                                                                          themselves, and measure BP                          rated as very high; physicians found the
                        communication                                                                                                      and heart rate                                      program helpful
                        with a nurse                                                                                                       Patients were contacted by
                        could reduce                                                                                                       phone once a week by the                            The reduction in hospitalization was
                        hospitalizations                                                                                                   nurse, and patients were                            most evident among patients with more
                        and whether this                                                                                                   given 24 hour telephone                             severe CHF
                        benefit could be                                                                                                   access to a nurse if needed
                        extended to                                                                                                        Information from patient
                        younger                                                                                                            passed on to physician once
                        outpatients                                                                                                        a month




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                               Page 27 of 66



Author / Title /      Purpose/             Design                         Analysis                 Participants: age/ gender/ groups       Intervention/ Duration          Follow-up:      Outcomes/ Socio-Economic Indicators
Journal / Year /      Objectives                                                                                                                                           sample size;
Country / Location                                                                                                                                                         dropout
Shea S, Starren J,    Columbia             Cannot evaluate the         Analysis has not yet been   Total n=1500 participants                 2 yr project                  Not completed   Study still ongoing
Weinstock RS,         University           strength of evidence as the performed                                                            -Intervention grp gets home
Knudson PE, Teresi Informatics for         study has not yet been                                  Telemedicine group n=750                 telemedicine unit that                         Main study outcomes are noted to be
J, Holmes D et al.    Diabetes             completed                                                                                        provides synchronous v/c                       glycosylated hemoglobin level, blood
Columbia              Education and                                                                Control group n=750                      with a project based nurse,                    pressure level, and cost of care
University's          Telemedicine         Proposed design for study                                                                        electronic transmission of
Informatics for       (IDEATel)                                                                    Half of participants from urban          home fingerstick glucose and                   Secondary outcomes include lipid levels,
Diabetes Education Project is a four       Randomized control trial                                component and other half from rural      BP data, and web access to a                   smoking, quality of life, and patient
and Telemedicine      year                 that is being conducted by                                                                       project web site                               satisfaction
(IDEATel) Project: demonstration           a state-wide consortium in                              Population of the urban area             -It is hypothesized
rationale and design. project with the     New York                                                predominantly Hispanic and African       intervention will improve
J Am Med Inform overall goals of                                                                   American                                 patient outcomes: more
Assoc 2002; 9(1):49- evaluating the        Technical component of                                  Population of the rural area mostly non- frequent interactions
62.                   feasibility,         intervention frozen at start                            Hispanic white                           between patients and
USA                   acceptability,       of the trial                                                                                     providers will enable
                      effectiveness, and                                                           Participants must have diabetes mellitus patients to initiate more
                      cost-effectiveness                                                           and live in a federally designated       rapid behaviour changes as
                      of telemedicine in                                                           medically undeserved area                well as changes in their
                      the management                                                                                                        treatment regimes without an
                      of older patients                                                                                                     office visit; closer
                      with diabetes                                                                                                         monitoring of glucose, BP
                                                                                                                                            will be coupled with quicker
                                                                                                                                            feedback from the provider;
                                                                                                                                            improve education for
                                                                                                                                            patients




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                          Page 28 of 66



Author / Title /     Purpose/             Design                        Analysis                      Participants: age/ gender/ groups     Intervention/ Duration       Follow-up:     Outcomes/ Socio-Economic Indicators
Journal / Year /     Objectives                                                                                                                                          sample size;
Country / Location                                                                                                                                                       dropout
Starren J, Hripcsak Informatics for       Study ongoing will be an      None                          Plan to recruit 1500 elderly diabetic  None                        None           No findings have yet been reported study
G, Sengupta S,       Diabetes             RCT                                                         patients who live at home in a                                                    ongoing
Abbruscato CR,       Education and                                                                    "medically undeserved area" or "health
Knudson PE,          Telemedicine         Focal point of the                                          professional shortage area"
Weinstock RS et al. (IDEATel)             intervention is the home
Columbia             project is s four    telemedicine unit (HTU)
University's         year                 which has 4 critical
Informatics for      demonstration        functions:
Diabetes Education project with the       -videoconferencing
and Telemedicine     overall goal of      -medical data acquisition
(IDEATel) project: evaluating the         through an electronic
technical            feasibility,         device interface
implementation. J    acceptability,       -secure web-based access
Am Med Inform        effectiveness, and   to clinical data and
Assoc 2002; 9(1):25- cost effectiveness   messaging
36.                  of telemedicine      -web-based access to
USA                                       tailored educational
                                          materials


Stiles N, Boosalis     Pilot study to     Non controlled clinical       Immediately following the      n=20                                 Interventions were           No follow-up   Both participants and consultants
M, Thompson K,         assess the         series (VIII)                 telemedicine consultation,                                          telemedicine consultations                  reported an overall very positive
Stinnett D, Rayens feasibility of         SoE: Poor                     participant and consultant                                          lasting an average of 48                    experience
MK. Nutrition          nutritional                                      completed standardized q'aires                                      minutes (range 37-75,
telemedicine           assessment and     Pilot Study                   about the experience using a 7                                      sd=9.65)                                    Info obtained during telemed interview
consultation for rural treatment using                                  point likert scale                                                                                              was sufficient to identify nutritional
elders. Journal of     telemedicine for   Nutrition consultant                                                                                                                          concerns in all participants and make
Nutrition for the      elderly patients   interviewed each                                                                                                                              dietary recommendations
Elderly 1998;          needing            participant via full motion
18(1):47-55. USA nutritional info         compressed video (V-TEL)

                                          After completion of
                                          nutritional assessment,
                                          consultant identified any
                                          nutritional concerns and
                                          made recommendations to
                                          participants




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                               Page 29 of 66



Author / Title /        Purpose/             Design                      Analysis                         Participants: age/ gender/ groups   Intervention/ Duration          Follow-up:     Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                            sample size;
Country / Location                                                                                                                                                            dropout
Strawn BD, Hester       This study           Non-controlled Clinical     Assessments were done at two n=14 caregiver participants             Duration 12 weeks               2 week post    Baseline period suggested a trend toward
S, Brown WS.            examined the         Series (VIII)               pre-Telecare baseline times, at                                                                      intervention   increasing psychological distress and
Telecare: a social      utility of a         SoE: Fair-Poor              midpoint and at endpoint, as                                         Mean number of days             follow-up      symptomatology but a significant
support intervention    telephone                                        well as at a 2 week post                                             between telecare contacts                      reduction in overall stress related
for family caregivers   intervention to      Within subjects baseline    intervention follow-up                                               was 8.8 and the mean                           responses was evident during the
of dementia victims.    provide support      treatment design                                                                                 number of telecare contacts                    treatment period
Clinical                and assistance to                                5 assessments in caregivers'                                         made was 11.8
Gerontologist 1998;     caregivers of                                    homes consisted of a                                                                                                Decreases in perceived burden also found
18(3):66-69.            individuals with                                 demographic interview, the                                           Telecare intervention
USA                     progressive                                      Brief Symptom Inventory                                              consisted of weekly                            Caregivers highly valued telecare
                        dementia                                         (BSI), and the Burden                                                telephone contacts from a
                                                                         Interview (BI)                                                       caring caller (CC)

                                                                         ANOVA

Subirana Serrate R,     To compare the       Non randomized controlled Cost comparison was based on n=20 total oncology patients              Jan - Oct 1997                                 The cost-minimization analysis showed
Ferrer-Roca O,          cost of telephone-   trial (IV)                  the variable costs paid by                                                                                          significant cost savings for oncology
Gonzalez-Davila E.      supported home       SoE: Fair                   insurance companies               Home group (prospective)           Home care group received 2                     patients nursed at home with telephone
A cost-minimization     care to inhospital                                                                 n=10                               types of service:                              support, with a reduction in treatment
analysis of oncology    care for elderly     2 groups                    Expenses divided into: costs      m=7                                (A1) home visits and 24 h                      costs and the number of home visits
home care versus        oncology patients    n=10 patients in control    derived from medical doctors f=3                                     telephone support from the
hospital care.                               group (hospital care)       and nurse team support; costs age range 54-84 years                  doctor on call
Journal of                                   n=10 in test group (home linked to lab and radiology                                             (A2) home hospitalization" =
Telemedicine and                             care)                       exams; costs linked to palliative Control group (retrospective)      hospital-like care from a
Telecare 2001;                                                           therapy or chemo                  n=10                               specialized nurse team
7:226-232.                                   Home medical attention      Statistical comparisons used      m=7                                dispensing specific tx (e.g.,
Spain                                        included home visits and    Student's t-test and chi-square f=3                                  chemotherapy, parental
                                             24 hour support from a                                        age range 47-75 years              feeding, intravenous tx,
                                             doctor or other health care                                                                      blood transfusions, pain tx,
                                             professional                                                                                     functional rehabilitation)
                                                                                                                                              6 patients received A2 only
                                                                                                                                              and 4 received both

                                                                                                                                              Control group received (B1)
                                                                                                                                              outpatient and (B2) inpatient
                                                                                                                                              care.
                                                                                                                                              3 patients received B2 only
                                                                                                                                              and 7 received both




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                         Page 30 of 66



Author / Title /       Purpose/             Design                      Analysis                            Participants: age/ gender/ groups        Intervention/ Duration Follow-up:                Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                           sample size;
Country / Location                                                                                                                                                          dropout
Tang WK, Chiu H,       Telepsychiatry is Cohort Study (VI)              Patient and provider            All elderly residents who had received V/C link between a hospital Some patients              Videoconferencing was found to be a
Woo J, Hjelm M,        a new              SoE: Fair                     questionnaires                  psychiatric assessments in the study     and a geriatric care and   received follow           suitable alternative covering the vast
Hui E.                 development in                                                                   period were included                     attention home for patient up on their               majority of existing services, including
Telespychiatry in      Hong Kong and Pilot Study                        Cost comparison of V/C vs. on-                                           assessment                 consultations             urgent consultations
Psychogeriatric        article discusses                                site visits Psychiatrist (using 149 psychiatric consultations applicable From August 1998 to June
Service: A Pilot       the feasibility,                                 estimates)                      to the 45 patients                       1999 total of 1001                                   Psychiatrist found V/C useful, but
Study.International    acceptability,                                                                   m=13                                     teleconsultations and of                             patients and nursing staff found it less
Journal of Geriatric   costs, benefits                                                                  f=32                                     these 149 were psychiatric                           favourable
Psychiatry, 2001;      and limitations of                                                               mean age 84.1 years                      consultations
16: 88-93.             telepsychiatry                                                                   - both dementia and non dementia
China                                                                                                   patients
Hong Kong
                                                                                                            8 new case assessments, and the rest
                                                                                                            were follow-up




Townsend CH,           To present           Descriptive study (VIII)     Every telephone call progress      The hospital is mainly used by veterans, Intervention was not really   Patient progress
Maxwell W, Sears       original research    SoE: Poor                    note was listed on an individual   and they are primarily male, WW two used. Study was a                  notes were
LT. Nurse              of a retrospective                                index card, along with who         veterans or Korean veterans.             retrospective chart review.   collected from
practitioner patient   study of             Retrospective study,         prompted the telephone call and    They were 65 or older.                                                 May 1, 1998
centered telephone     telephone calls by   exploratory chart review     the reason (subject) of the        Convenience sample of electronic                                       through to April
calls in a VA          nurse                and card-sort methods were telephone call.                      patient progress notes labeled                                         30, 1999.
primary care           practitioners (NP)   used for data collection and These cards were then sorted       "telephone call".
geriatric clinic.      to geriatric         analysis.                    into two piles; NP generated
Journal of the         primary care                                      telephone calls and non-NP
American Academy       patients over the                                 generated phone calls.
of Nurse               period of one year                                They then made separate
Practitioners          in a Veteran's                                    reason cards, and then they
1997::269-275.         Administration                                    were sorted into categories to
USA                    primary care                                      better identify the types of
                       clinic in the                                     telephone calls.
                       southeast.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                         Page 31 of 66



Author / Title /     Purpose/            Design                Analysis                           Participants: age/ gender/ groups       Intervention/ Duration   Follow-up:          Outcomes/ Socio-Economic Indicators
Journal / Year /     Objectives                                                                                                                                    sample size;
Country / Location                                                                                                                                                 dropout
Wagner MM, Hogan     To measure the Prospective cohort study   The EMR at the geriatric center    Original number of patient visits during No intervention         Of the original     Principle result of this study is the
WR. The accuracy     accuracy of       (VI)                    captures medication data both      3 week study n=208                                               208 visits that     demonstration of moderately high levels
of medication data   medication        SoE: Fair               directly from clinicians and                                                3 week study period     met the inclusion   of error in the medication records of an
in an outpatient     records stored in                         indirectly using encounter         Total number of patients included in                             criteria 91 were    EMR
electronic medical   the electronic                            forms and data entry clerks.       study n=117                                                      excluded, various
record. J Am Med     medical record                            During a scheduled office visit                                                                     reasons cited       Second result is that the main causes of
Inform Assoc 1996;   (EMR) of an                               for medical care, the treating                                                                                          error are problems in the capture of
3(3):234-244.        outpatient                                clinician determined whether                                                                                            medication data, not problems with the
USA                  geriatric centre                          the medication records for the                                                                                          accurate entry of data
Pittsburg, PA                                                  patient were an accurate
                     The authors                               representation of the meds that                                                                                         Direct entry of data by clinicians may
                     analyzed accuracy                         the patient was actually taking.                                                                                        produce improvements in data accuracy
                     from the                                  Using the available sources of
                     perspective of a                          info, the clinician determined
                     clinician using                           whether the recorded data were
                     the data and the                          correct, whether any data were
                     perspective of a                          missing, and the type and cause
                     computer-based                            for each discrepancy found
                     medical decision-
                     support system
                     (MDSS)




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                             Page 32 of 66



Author / Title /       Purpose/               Design                       Analysis                           Participants: age/ gender/ groups         Intervention/ Duration     Follow-up:             Outcomes/ Socio-Economic Indicators
Journal / Year /       Objectives                                                                                                                                                  sample size;
Country / Location                                                                                                                                                                 dropout
Wasson J, Gaudette Examined the               RCT (II)                     Patients were randomized and 14 members of the permanent medical Control group patients were After 24 months                   Telephone care significantly reduced
C, Whaley F,           hypothesis that        SoE: Good                    providers served as their own staff                                      scheduled to see the same      of follow up           clinical visits, use of medications and
Sauvigne A,            substituting                                        controls                                                                 provider at the                n=218 telephone        chemistry tests, medication use, and the
Baribeau P, Welch clinician-initiated         Compares telephone care                                       n=497 patients consented to participate recommended interval (e.g., care patients still       duration of both hospital and intensive
HG. Telephone care telephone calls            with ftf visits              Demographic and utilization                                              "return in 3 mo.")             participating and      care unit stays
as a substitute for    (telephone care)                                    differences between study        Telephone care group                                                   n=216 usual care
routine clinic follow- for some clinic        Blinding of patient &        groups were compared using       n=249                                   For patients randomized to patients                   Although similar proportions of patients
up. [see comments]. visits would              provider not feasible        chi square and Wilcoxon's rank- mean age 66 years                        receive telephone care, the                           were hospitalized in each group,
JAMA 1992;             reduce medical                                      sum test                         all men                                 recommended interval was n=28 died                    telephone care patients had fewer
267(13):1788-1793. care utilization           Balance randomization                                                                                 doubled (e.g., "return in 3                           hospital days
USA                    without adversely      strategy: patients were      Changes in health and            Usual care group                        mo." translated to "return in Patient q'aires re.
Vermont                affecting patient      randomized within each       satisfaction were compared       n=248                                   6 mo.") and 3 telephone        satisfaction with      Total charges (P=.05), outpatient charges
                       health                 provider panel, such that    using ANOVA                      mean age 66 years                       contacts were scheduled at access were                (P=.02) and inpatient charges (P=.006)
                                              individual providers cared                                    all men                                 standard intervals between completed at               were lower for the telephone-care group.
                                              for equal numbers of         Medical care charges between                                             visits                         baseline and
                                              telephone-care and usual-    these two groups were            Randomization resulted in comparable                                   completion of          After controlling baseline scores the two
                                              care patients                compared using Wilcoxon's        patient groups                          Approx. 8 telephone calls      study                  study groups had the same average
                                                                           rank-sum test and linear                                                 were made to each telephone                           change in satisfaction with provider
                                                                           regression                                                               care patient during the 2 year                        continuity, perceived access, and quality
                                                                           Logistic regression was used to                                          study period (total 1639                              of care
                                                                           adjust for potential differences                                         calls)
                                                                           in mortality between the study
                                                                           groups


Weinberger M,             Comparison of       Case control(VII)            HRQOL was assessed with the There were 42 eligible participants              subjects received a telephone not clear why 11 Telephone administration of SF-36 took
Nagle B, Hanlon JT,       telephone and       SoE: Poor                    SF-36                       following the 1-year RCT                         interview by a clinical       patients were not less time than ftf
Samsa GP,                 face to face                                                                                                                  pharmacist which included enrolled
Schmader K,               administration of   ftf interviewers were         Characteristics of eligible sub   n=31 elderly outpatients enrolled         administration of the SF-36                     Substantial, nonsystematic discrepancies
Landsman PB et al.        the SF-36, a        blinded to the results of the study patients who did and did    average age 68.5 yrs                                                                      in telephone vs. ftf scores for all eight SF-
Assessing health-         health-related      telephone interviews          not participate were compared     all male                                  subjects were then                              36 scales
related quality of life   quality of life                                   using t tests and chi square                                                administered the SF-36 by a
in elderly                (HRQOL)             (a RCT related to an in-      statistics                        All participants had been prescribed      ftf interviewer within 30                       No conclusions about which mode of
outpatients:              measure             person pharmacy visit                                           multiple medications                      days of the telephone                           administration is more valid, and study
Telephone versus                              during general medicine       Completion time for telephone                                               interview                                       did not determine whether the findings
face-to-face                                  visit is also described;      versus ftf administration was     1 telephone interviewer (clinical                                                         should be attributed to differences in the
administration.                               however, results from this compared using a t test              pharmacist)                                                                               mode of administration or to instability
Journal of the                                aspect of the study are not                                     3 ftf interviewers (1 research nurse, 2                                                   of subjects' responses over a short time
American Geriatrics                           mentioned in detail in the                                      other clinical pharmacists)                                                               (mean=16.7 days)
Society 1994;                                 article. It is the substudy
42(12):1295-1299.                             following the 1-year RCT
USA                                           that is the focus of this
North Carolina                                article).




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                                                                                                                                             Page 33 of 66



Author / Title /        Purpose/            Design                           Analysis                             Participants: age/ gender/ groups         Intervention/ Duration        Follow-up:      Outcomes/ Socio-Economic Indicators
Journal / Year /        Objectives                                                                                                                                                        sample size;
Country / Location                                                                                                                                                                        dropout
Welch HG, Johnson       In a previous year RCT (II)                          Patients were analyzed in the        n=512 patients entered into the study     In the telephone care group n=51 patients     Negative findings overall
DJ, Edson R.            a randomized trial SoE:Good                          group to which they were                                                       the recommended revisit       dropped out
Telephone care as an    at one outpatient                                    randomly assigned                    27 patients died in the ensuing 2 years   interval was doubled (e.g. to during 2 year   Intervention had little effect on
adjunct to routine      clinic             Pilot study conducted at                                               (13 telephone care and 14 usual care      6 months) and three           study           -self assessed health status
medical follow-up.      demonstrated that two veterans affairs               Simple parametric (chi-square        patients)                                 telephone appointment were                    -provider assessed health status
A negative              making telephone medical clinics from 1995-          and t-tests) and nonparametric                                                 scheduled at 0.25, 0.75, and Telephone call   -health care utilization
randomized trial. Eff   appointments part 1998                               (Wilcoxon rank-sum) methods          Additional 24 patients were lost to       1.5 times the originally      follow up
Clinic pract 2000;      of routine medical                                   were used to compare patient         follow-up (8 telephone care and 16        recommended interval (e.g.                    Overall patient satisfaction did not
3(3): 123-130.          follow-up could First is the intake visit            characteristics, process and         usual care)                               3, 9, and 18 weeks)                           change during the 2 year period in either
USA                     save money and where patient has routine             intervention monitoring, patient                                               Another three telephone                       group
Colorado,               reduce             visit after which the             health status, patient health        Complete follow up available for 461      appointments were                             Telephone care patients were
South Dakota            hospitalization    provider recommends               care utilization, and satisfaction   patients                                  scheduled at each                             significantly more likely than usual care
                                           revisit interval (ie. return in   with medical care and                Random assignment of patient into 2       subsequent visit until the                    patients to believe that telephone calls
                        The objective of three months)                       telephone care                       groups:                                   end of 2 yr FU                                could be an important component of
                        this study is to                                                                          Telephone care group n=257 patients       In the usual care group the                   medical care
                        ascertain the      Participants then randomly                                             mean age=68.3 years                       recommended revisit interval
                        effects of         assigned to the telephone                                              97% male                                  was not altered and no                        Overall failure to replicate the findings of
                        telephone care in care group or the usual care                                                                                      telephone calls were                          the original telephone care study, but
                        other clinics      group                                                                  Usual care group n=255 patients           scheduled                                     authors have no obvious explanation
                                           Using a balanced                                                       mean age =68.7 years                      Over 2000 telephone calls
                                           randomization scheme,                                                  98% male                                  were made to telephone care
                                           authors were able to ensure                                                                                      patients over the 2 year
                                           that each provider cared for                                                                                     period, an average of about 9
                                           a similar number of                                                                                              calls per patient
                                           telephone and usual care
                                           patients and thus acted as
                                           his or her own control




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                               Page 34 of 66



Author / Title /       Methodological Policy Recommendations                  Applicability to
Journal / Year /       Problems                                               Alberta
Country / Location
Ames D. Psychiatric    Very high     The AGECAT system is an
diagnoses made by      dropout rate  important development in
the AGECAT             (71%)         psychiatric epidemiology and a
system in residents                  satisfactory performance in the
of local authority     Absence of an diagnosis of the common
homes for the          AGECAT "well" syndromes of dementia and
elderly: Outcome       comparison    depression is essential to its future
and diagnostic         group
stability after four                 The high death rate found among
years. International   Lack of blind these elderly subjects after 4 years
Journal of Geriatric   follow up     indicates that future investigators
Psychiatry 1992;                     studying AGECAT outcomes
7(2):83-87.                          should select samples more
Australia                            representative of the age range of
                                     the total elderly population and
                                     reinterview their subjects earlier



Anderson JL,           Various            Careful risk/benefit ratio
Gilbert EM, Alpert     limitations of     assessment needed before
BL, Henthorn RW,       study noted        considering the use of flecainide
Waldo AL, Bhandari     ie.study design    in PAF
AK et al. Prevention   does not allow
of symptomatic         determination of   Transtelephonic monitoring is a
recurrences of         a minimum          useful method for documentation
paroxysmal atrial      effective drug     of the occurrence of paroxysmal
fibrillation in        dose               arrhythmia's such as PAF
patients initially
tolerating
antiarrhythmic
therapy. A
multicenter, double-
blind, crossover
study of flecainide
and placebo with
transtelephonic
monitoring.
Circulation 1989;
80(6):1557-1570.
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                        Page 35 of 66



Author / Title /         Methodological Policy Recommendations               Applicability to
Journal / Year /         Problems                                            Alberta
Country / Location
Anon. Solid              Control group May be cost effective
outcomes show e-         much smaller;
heath and                no results given
chronically ill senior   on control group
populations are
compatible. Disease      No tests to
Management               determine
Advisor 2001;            statistical
7(7):103-106.            significance
USA




Ball C, Tyrrell J,  inter-rater         Need for further studies of the      Some psychometric tests
Long C. Scoring     reliability not     different forms of cognitive testing are used on a limited
written material    discussed           to determine their reliability when basis in Alberta over v/c
from the Mini-                          administered by video-link           technology including the
Mental State                                                                 MMSE. This study
Examination: a                          Where the criteria for scoring are confirms reported
comparison of face-                     relatively loose and the examiner clinican experience with
to-face, fax and                        may use other clues from the task respect to administration
video-linked                            as is the case with sentences, then of the interlocking
scoring. J Telemed                      using fax machines or simple V/C pentagons question in
Telecare 1999;                          tools allows for reliable scoring. MMSE over video. It
5(4):253-256.                           When the rules are tighter, V/C      supports the need for
France, UK                              may not be a very reliable method validation of
                                                                             psychometric tests over
                                                                             v/c for not only geriatric
                                                                             clients but others as
                                                                             well.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                  Page 36 of 66



Author / Title /       Methodological Policy Recommendations                     Applicability to
Journal / Year /       Problems                                                  Alberta
Country / Location
Berkman P, Heinik      Questionable       Despite the methodological
J, Rosenthal M,        mental status of   problems, it is possible that
Burke M.               some patients      telephone support to elderly
Supportive             (some patients     persons during a time of crisis is a
telephone outreach     did not know a     readily applicable therapeutic tool
as an interventional   war was going
strategy for elderly   on)
patients in a period
of crisis. Social      Not all calls
Work in Health Care    taken by the
1999; 28(4):63-76.     patient, other
Israel                 respondents
                       included family
                       members and
                       the maid

                       No control
                       group who did
                       not receive
                       telephone calls

                       Methodologicall
                       y poor




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                 Page 37 of 66



Author / Title /        Methodological Policy Recommendations                   Applicability to
Journal / Year /        Problems                                                Alberta
Country / Location
Bondmass M,             No control         The general cardiovascular health
Bolger N, Castro G,     group              of African Americans is relatively
Avitall B. The effect                      poorer and has not improved as
of home monitoring      Generalization     much over the past decades
and telemanagement      of results not     compared with that of Caucasians
on blood pressure       possible as        and Hispanics. More
control among           results only       cardiovascular research is needed
African Americans.      apply to cohort    with interventions specifically
Telemedicine            studied            focused on African Americans
Journal 2000;
6(1):15-23.             Research
USA                     utilizing a
                        randomized
                        design is needed
                        to validate the
                        system and the
                        method's true
                        potential




Bratton RL, Short       Volunteers used
TM. Patient             as participants
satisfaction with
telemedicine: a         No control
comparison study of     group
geriatric patients. J
Telemed Telecare        No analysis
2001; 7 Suppl 2:85-     completed
86.
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                  Page 38 of 66



Author / Title /      Methodological Policy Recommendations                      Applicability to
Journal / Year /      Problems                                                   Alberta
Country / Location
Brennan PF, Moore     Project is           CompuerLink is a valuable vehicle
SM. Networks for      limited in that it   for promoting collaboration for
home care support:    employs only         caregivers of persons with AD
the ComputerLink      behaviours as
project. Caring       evidence of          It facilitates peer communication
1994; 8(8):64-66.     collaboration        and fosters collaboration among
USA                                        caregivers
Cleveland, Ohio       No results given
                      from                 Sense of control for caregivers in
                      comparison           having access to peer support
                      group.
                      No comparison        Fosters collaboration with
                      of experimental      professionals
                      & control
                      groups.              This work has primary relevance
                                           for informatics specialists and for
                      No clinical          researchers and clinicians
                      outcomes             interested in supporting caregivers
                                           with the task of caring for one
                                           with AD
                                           May also be useful information for
                                           other home care populations



Cameron K, Hughes
K, Doughty K.
Reducing fall
incidence in
community elders by
telecare using
predictive systems.
Proceedings of the
19th IE EE
Engineering in
Medicine and
Biology Society
Conference 1997;
3:1036-1039.
UK




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                    Page 39 of 66



Author / Title /        Methodological Policy Recommendations                      Applicability to
Journal / Year /        Problems                                                   Alberta
Country / Location
Carroll DL,             No mention of       Referral to cardiac rehabilitation
Robinson E, Buselli     how the             programs should also be
E, Berry D, Rankin      participants        emphasized as these programs
SH. Activities of the   were chosen, or     offer not only nursing and medical
APN to enhance          what their          surveillance, but also provide an
unpartnered elders      "baseline" was      important social support
self-efficacy after     before the          mechanism.
myocardial              intervention (ie.   The APN coached intervention is
infarction. Clinical    Possible co-        a cost-effective low-technological
Nurse Specialist        morbidities,        way to extend specialized nursing
2001:60-66.             level of            services to unpartnered elders post-
USA                     functioning)        myocardial infarction.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                               Page 40 of 66



Author / Title /       Methodological Policy Recommendations                  Applicability to
Journal / Year /       Problems                                               Alberta
Country / Location
Castro CM, King        No control        Given that patients in the high
AC, Brassington        group in year 2;  intensity category showed a more
GS. Telephone          year 1 results    gradual decline in activity,
versus mail            not reported      programs that promote fewer days
interventions for                        of physical activity at a somewhat
maintenance of         -Selection bias higher intensity level may be more
physical activity in   possible, as only optimal for maintaining longer
older adults. Health   those who were term activity in older adults
Psychol 2001;          more successful
20(6):438-444.         in the adoption Programs like those described in
USA                    phase were more this study could be cost-and
                       likely to         program-effective methods for
                       continue into a health care providers, private
                       maintenance       health care organizations, and
                       program           public health promotion agencies
                       -Sample           (ie. Heart Association) to promote
                       primarily         long term physical activity
                       Caucasian and participation in communities
                       well educated
                       and thus cannot
                       be generalized
                       -Multiple
                       exclusion
                       criteria




Chan M, Bocquet H,
Campo E, Val T,
Esteve D, Pous J.
Multisensor system
and artificial
intelligence in
housing for the
elderly. Stud Health
Technol Inform
1998; 48:145-149.
France




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                        Page 41 of 66



Author / Title /       Methodological Policy Recommendations                  Applicability to
Journal / Year /       Problems                                               Alberta
Country / Location
Coogle CL, Osgood      No real          Single outreach message may           There is a network of
NJ, Parham IA,         statistical      educate various types of people all   nearly 200 v/c sites (in
Helen E, Churcher      analysis done in at once                               operation or planned for
CS. Effectiveness of   study                                                  implementation) that has
videoconferencing                                                             only rarely been used for
in geriatric           Study                                                  client and family
alcoholism             participants                                           education sessions. This
education.             heavily                                                article speaks to the
Gerontology and        weighted to                                            potential to use v/c for
Geriatrics Education   providers                                              this purpose.
1995; 16(2):73-83.
USA                  Delivery of the
Virginia             same
                     information to
                     various types of
                     people may
                     leave some
                     unable to
                     understand
                     material
                     presented
De Leo D, Carollo differences
G, Dello BM. Lower between study
suicide rates        group (persons
associated with a    aged 65+) and
Tele-Help/Tele-      comparison
Check service for    group (general
the elderly at home. population)
American Journal of
Psychiatry 1995;     Utilization of
152(4):632-634.      service not
Italy                reported




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                       Page 42 of 66



Author / Title /       Methodological Policy Recommendations                  Applicability to
Journal / Year /       Problems                                               Alberta
Country / Location
de Lusignan S,         Sample size too Hometelemonitoring is an               In Alberta, telehome
Wells S, Johnson P,    small            acceptable and reliable               care has not yet been
Meredith K,                             intervention                          widely adopted. This
Leatham E.             Sample                                                 study contribues to the
Compliance and         selection bias   Benefit in terms of compliance of     evidence supporting
effectiveness of 1                      medication and self monitoring is     telehomecare.
year's home            No statistical   still seen after one year             Northwestern Health
telemonitoring. The    analysis, or any                                       Services Region has
report of a pilot      other analysis   Careful consideration needs to be     recently purchased
study of patients      described        given as to which patients will       equipment for this
with chronic heart                      benefit most from this type of        purpose. There are
failure. Eur J Heart                    monitoring                            presently outstanding
Fail 2001; 3(6):723-                                                          questions with need for
730.                                                                          development of technical
UK                                                                            standards for this
                                                                              application.

Fowkes W,              Study analyzes   Many states have regulations
Christenson D,         only through     covering nursing homes that
McKAy D. An            medical          augment Medicare directives.
analysis of the use of provider.        This likely results in an increased
the telephone in the Only calls about   call burden even for the most
management of          nursing home     trivial of conditions. Serious
patients in skilled    residents        problems are buried in the myriad
nursing facilities.    examined.        of regulation-driven phone calls
JAGS 1997; 45:67-                       that are unnecessary and
70.                                     counterproductive.
USA                                     The adoption of this alternative
                                        would likely decrease the need for
                                        communication and enhance the
                                        quality of rendered care.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                           Page 43 of 66



Author / Title /       Methodological Policy Recommendations                    Applicability to
Journal / Year /       Problems                                                 Alberta
Country / Location
Friedman RH, Kazis     Generalizability Found to be cost effective              Interesting approach,
LE, Jette A, Smith     of study findings                                        could be compromised
MB, Stollerman J,      to other          Use of TLC may reduce overall          by existing Fee for
Torgerson J et al. A   hypertensive      health services utilization and cost   Service Billing plan,
telecommunications     patients may be                                          probably most applicable
system for             affected by       Use of TLC can reduce DBP in           to physicians
monitoring and         features of study patients                               compensated under
counseling patients    design and                                               alternative payment
with hypertension.     execution         Might be reasonable to use a           plans.
Impact on                                telecommunication system like
medication             1. Participants TLC in the care of patients with
adherence and blood    were 60 years of hypertension to complement or
pressure control. Am   age or older, and substitute for some routine office
J Hypertens 1996;      therefore         visits
9(4 Pt 1):285-292.     findings may not
USA                    be applicable to
Massachusetts          younger patients




Fulmer TT,             Small sample                                             This article speaks to the
Hollander Feldman      size                                                     merit of Alberta
P, Sook Kim T,                                                                  telehealth business cases
Carty B, Beers M,      Very low                                                 including consideration
Molina M, Putnam       participation                                            of the simplest/most cost
M. An Intervention     rate (approx.                                            effective technology.
Study to Enhance       10%)                                                     Some already do this.
Medication                                                                      For example, the Capital
Compliance in          Monitoring                                               Health Authority
Community-             bottle caps                                              Telehealth Business Plan
Dwelling Elderly       makes it easy for                                        template includes
Individuals. Journal   patients to                                              analysis of alternative
of Gerontological      remove the cap,                                          approaches.
Nursing, 1999;         but not take any
August: 6-14.          medicine from
USA                    the bottle
New York
                       Exclusion of
                       patients who
                       routinely relied
                       on pre-poured
                       medication




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                       Page 44 of 66



Author / Title /     Methodological Policy Recommendations            Applicability to
Journal / Year /     Problems                                         Alberta
Country / Location
Gallienne RL,                       Advantages of the provision of
Moore SM, Brennan                   psychosocial support via this
PF. Alzheimer's                     medium are:
caregivers:                         -social interaction among
psychosocial support                members permits options to be
via computer                        defined and opinions to be shared
networks. Journal of                -anonymity
Gerontological                      -24-hour access to ComputerLink
Nursing 1993;                       -messages of emotional and
19(12):15-22.                       spiritual support and vital
USA                                 information are saved on the
Cleveland, Ohio                     network and can be easily
                                    retrieved

                                    The support provided to
                                    caregivers through this network is
                                    very important considering that
                                    empathetic communication of this
                                    nature cannot happen in an office
                                    setting.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                            Page 45 of 66



Author / Title /         Methodological Policy Recommendations                    Applicability to
Journal / Year /         Problems                                                 Alberta
Country / Location
Go RC, Duke LW,          Small sample         Information on change in            A limited number of
Harrell LE, Cody H,      size                 functional status can be obtained   psychometric tests have
Bassett SS, Folstein                          over the telephone                  been validated for use
MF et al.                Level of             - functional status questions       via telehealth (phone
Development and          motivation,          contribute useful assessment        and v/c). The short form
validation of a          anxiety, and         information beyond that obtained    of the STIDA is
Structured               education as         with cognitive testing alone        potentilly a useful tool
Telephone Interview      well as listening                                        for the provincial mental
for Dementia             conditions and       The evidence of validity of both    health help line which is
Assessment               auditory deficits    the full and the short STIDA at     slated for integration
(STIDA): the NIMH        may affect           detecting cognitive impairment      with the Health Link
Genetics Initiative. J   performance          through telephone screening         Service
Geriatr Psychiatry       Telephone            suggests that both instruments
Neurol 1997;             screening cannot     have utility as screens for
10(4):161-167.           substitute for ftf   detecting dementia
USA                      clinical
                         evaluation in
                         determining the
                         causes of
                         impaired
                         performance




Hegarty K, Byrne G,      Small n
Del Mar C. A pilot
study of computer-       No measures of
assisted screening       benefit /
for depression in the    outcome
elderly in general
practice. Informatics    Receptionists
in Healthcare            participated in
Australia 1996;          study and had
5(4):166-168.            no training
Australia                about study
Brisbane




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                   Page 46 of 66



Author / Title /       Methodological Policy Recommendations                     Applicability to
Journal / Year /       Problems                                                  Alberta
Country / Location
Hunkeler EM,           Highly educated     Further research is needed to  This article presents an
Meresman JF,           sample does not     determine why nurse telehealth augmentation to
Hargreaves WA,         allow for           care is not superior to usual  physician care for
Fireman B, Berman      generalization to                                  depression. The
                                           patient care in terms of increasing
WH, Kirsch AJ et al.   non-educated        patients' adherence to their   challenge is who would
Efficacy of nurse      sample              prescribed medication          be responsible for
telehealth care and                                                       delivery of the nurse
peer support in        Guidelines of   Findings of this study need to be telecare. Care of
augmenting             those providing replicated in other circumstances geriatric psychciatric
treatment of           peer support    to judge how confidently a broad patients in the
depression in          unclear         adoption can be recommended        community often falls to
primary care. Arch                                                        home care although
Fam Med 2000;                          Nurse telehealth care improves     other parties including
9(8):700-708.                          clinical outcomes of               mental health clinic
USA                                    antidepressant drug treatment and staff, community
San Fransisco                          patient satisfaction and fits well geographic or outreach
                                       within busy primary care settings teams (eg Central
                                                                          Alberta Psychogeriatric
                                                                          Community Outreach
                                                                          Service). Divestiture of
                                                                          teh AMHB clinics to the
                                                                          health authorities may
                                                                          help in coordinating
                                                                          opportunities for this
                                                                          kind of intervention.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                        Page 47 of 66



Author / Title /   Methodological Policy Recommendations               Applicability to
Journal / Year /   Problems                                            Alberta
Country / Location
Infante-Rivard C,                 A telephone support service may
Krieger M,                        not reduce the number of
Petitclerc M,                     physician visits, but could affect
Baumgarten M. a                   factors which in turn affect
telephone support                 utilization of care, such as a sense
service to reduce                 of security, contentment, and
medical care use                  satisfaction with care.
among the elderly.
JAGS 1988; 36:306-
311.
Canada
Quebec




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                   Page 48 of 66



Author / Title /        Methodological Policy Recommendations                     Applicability to
Journal / Year /        Problems                                                  Alberta
Country / Location
Johnston D, Jones       No analysis          Recommendations for
BN, III.                reported             implementing psychiatry
Telepsychiatry                               teleconsultation programs
consultations to a                           -interest and commitment from the
rural nursing                                remote facility is essential and
facility: a 2-year                           must be developed through a
experience. J Geriatr                        process that identifies needs and
Psychiatry Neurol                            priorities at the remote site
2001; 14(2):72-75.                           -training and orientation to the
USA                                          equipment and the consultation
North Carolina                               protocol will improve efficiency
                                             and effectiveness
                                             -arrangements must be made for
                                             technical support of the equipment
                                             -equipment technical
                                             specifications such as band width
                                             must be taken into consideration

                                             TM services should be created in
                                             response to a legitimate need, be
                                             preceded by adequate training of
                                             personnel, and use the simplest
                                             equipment



Johnstone HM.           Primary
Quality outcomes of     limitation noted
nursing tele-visits.    by the author is
George Mason            that the
University, 2000.       characteristics
USA                     of the sample of
                        interest were
                        previously
                        determined by
                        criteria set forth
                        in a federal
                        telemedicine
                        grant




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                Page 49 of 66



Author / Title /       Methodological Policy Recommendations                   Applicability to
Journal / Year /       Problems                                                Alberta
Country / Location
Jones III BN,          Low cost        V/C assessment of geriatric
Johnston D,            equipment used patients is a reliable method for
Reboussin B,                           examining mental status and
McCall WV.             Results would behavior.
Reliability of         not be
telepsychiatry         applicable to   V/C equipment, particularly low
assessments:           higher quality bandwidth systems, should be
subjective versus      equipment       employed for clinical use only
observational                          after consideration of the
ratings. J or          Rater bias was applicant, patient population, and
Geriatric Psychiatry   present in that image quality of the system
and Neurology          some clinicians
2001; 14:66-71.        rated higher on Federal regulations for TM
USA                    average than    reimbursement do not specify
North Carolina         others          requirements in terms of video
                                       technology or clinical accuracy.
                       Small sample    Professional organizations need to
                       size            articulate the clinical standards for
                                       TM in special populations such as
                                       geriatric psychiatry.

Lyketsos CG,           no clinical     TM program brought about a shift
Roques C, Hovanec      measures        in perspective. The clinical teams
L, Jones BN, III.                      in each organization, although
Telemedicine use       no experimental distinct, became part of a whole
and the reduction of   control         and together comprised an
psychiatric                            effective continuum of care
admissions from a
long-term care
facility. J Geriatr
Psychiatry Neurol
2001; 14(2):76-79.
USA
Maryland




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                   Page 50 of 66



Author / Title /       Methodological Policy Recommendations                      Applicability to
Journal / Year /       Problems                                                   Alberta
Country / Location
Macduff C et al.       Not an empirical    Queries whether telemedicine;
Telemedicine in        study, and          that is, it is wrong to assume that
rural care. Part 2:    cannot              telemedicine is necessarily a
assessing the wider    determine if the    benefit to nurses.
issues. Nursing        discussion of       Because of this, there are some
Standard 2001;         results are based   procedural and professional
15(33): 33-37.         on an empirical     change issues for consideration,
UK                     study.              such as organization and how the
                                           concept is introduced to the user.
                                           Professional issues relate to
                                           individual involvement, and effect
                                           on scope of practice, colleagues,
                                           competence, autonomy and
                                           performance.

Magnusson L,           No analysis or      By development and
Berthold H, Brito L,   description of      implementation of info and
Chambers M, Daly       focus groups or     communication technology
T, Emery D.            questionnaires,     confidence and competence in the
ACTION: assisting      no statement        family care setting can increase
carers using           about original      and nursing and social service
telematics             number of           support work can be further
interventions to       participants,       developed
meet older person's    sample size,
needs. Nursing         how participants    Can increase the quality of life for
informatics: the       came to be          disabled and elderly and their
impact of nursing      involved in         family carers
knowledge on health    study, no
care informatics.      statistical
Proceedings of         analysis
NI'97, Sixth           described, but
Triennial              some
International          percentages
Congress of IMIA-      provided
NI, Nursing
Informatics of
International
Medical Informatics
Association.
Amsterdam,
Netherlands: IOS
Press, 1997: 551.
Europe




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                 Page 51 of 66



Author / Title /        Methodological Policy Recommendations                   Applicability to
Journal / Year /        Problems                                                Alberta
Country / Location
Mahoney D,              Small sample  If costly services are provided to
Tennstedt S,            size          older individuals who do not
Friedman R, Heeren                    perceive them as needed and thus
T. An automated         Convenience   refuse to use them, then system
telephone system for    sample        inefficiency and financial waste
monitoring the                        occurs. At a practical level, a
functional status of    High dropout  more realistic approach may be to
community-residing      rate          identify what the client perceives
elders. Gerontologist                 as a need and wants help to
1999; 39(2):229-        No comparison address
234.                    group
USA                                   Automated telephone inquiry
Massachusetts                         could be used to monitor less
                                      disabled older persons who are
                                      determined to be ineligible for the
                                      home care services or whose
                                      services have been reduced or
                                      terminated



Markson LJ,             No study          System could be adapted to
Friedman RH, Jette      conducted         accommodate a wide range of
AM, Kazis L.                              disabilities and therefore would be
Computers as            Pilot study       helpful to elderly persons
clinician extenders:    described are a
monitoring chronic      group of
illness in elderly      volunteers
patients.
International Journal
of Technology and
Aging 1992;
5(2):153-165.
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                 Page 52 of 66



Author / Title /      Methodological Policy Recommendations                     Applicability to
Journal / Year /      Problems                                                  Alberta
Country / Location
McGrew KB, Quinn      1/4 of the        Judicious use of telephone
CA. Examining the     telephone         assessment and care planning in
effectiveness of      assessments       similar programs can be
telephone             were completed    successful
assessment and care   by an informant   Development of mechanisms for
planning for          who was not the   communication and feedback is
homecare services.    client            essential to effective utilization of
Generations 1997;                       telephone practice
21(1):66-67.                            Using the telephone assessment as
USA                                     a baseline, a mechanism for
                                        feedback from service providers
                                        and care managers should be
                                        established to contribute relevant
                                        info to the ongoing assessment
                                        and to substitute ftf assessment
                                        and care planning where needed
                                        Time costs of phone contact with
                                        multiple sources need to be
                                        weighed against time costs of ftf
                                        in home assessments to evaluate
                                        the CE of phone practice




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                           Page 53 of 66



Author / Title /        Methodological Policy Recommendations                   Applicability to
Journal / Year /        Problems                                                Alberta
Country / Location
Montani C, Billaud      Small sample     Further work needed to investigate     Some psychometric tests
N, Tyrrell J,           size             the impact of remote consultation      are used on a limited
Fluchaire I, Malterre                    with elderly patients in other types   basis in Alberta over v/c
C, Lauvernay N et       Findings are not of health care settings                technology including the
al. Psychological       generalizable to                                        MMSE. This study
impact of a remote      wider                                                   confirms reported
psychometric            population                                              clinican experience with
consultation with                                                               respect to administration
hospitalized elderly                                                            of the interlocking
people. J Telemed                                                               pentagons question in
Telecare 1997;                                                                  MMSE over video. It
3(3):140-145.                                                                   supports the need for
France                                                                          validation of
Grenoble                                                                        psychometric tests over
                                                                                v/c for not only geriatric
                                                                                clients but others as
                                                                                well.
                                                                                (prefernce for ftf)-- In
                                                                                Alberta v/c technology
                                                                                has been used for
                                                                                geriatric psychiatry
                                                                                consultation since 1997.
                                                                                The technology has been
                                                                                well accepted by clients.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                  Page 54 of 66



Author / Title /        Methodological Policy Recommendations                    Applicability to
Journal / Year /        Problems                                                 Alberta
Country / Location
Montgomery AA,          Target reduction   Computer based clinical decision
Fahey T, Peters TJ,     of 20 percentage   support systems which combine
MacIntosh C, Sharp      points in the      risk estimation and management
DJ. Evaluation of       proportion of      recommendations for hypertension
computer based          patients at high   require further development and
clinical decision       absolute risk      evaluation
support system and      was large
risk chart for          Outcome            Further studies are required on
management of           measures were      -newer computer based clinical
hypertension in         patient based      decision support systems
primary care:           but both           -how the understanding of
randomized              interventions      absolute risk can influence health
controlled trial. BMJ   were aimed at      professionals' decision making
2000;                   health care        -how interactive computers can
320(7236):686-690.      professionals      assist patients in decision making,
UK                      The computer       treatment preferences, and
Avon                    based system       adherence to treatment schedules
                        that was used
                        only estimated
                        risk and did not
                        include other
                        aspects of
                        hypertension




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                            Page 55 of 66



Author / Title /      Methodological Policy Recommendations                Applicability to
Journal / Year /      Problems                                             Alberta
Country / Location
Neafsey PJ, Strickler                Delivery of health info to older
Z, Shellman J,                       adults via touchscreen-equipped
Padula AT.                           notebook computers has the
Delivering health                    potential to revolutionize patient
information about                    education provided by
self-medication to                   gerontological nurses
older adults: use of
touchscreen-                         Computer assisted education
equipped notebook                    about meds offers older adults
computers. J                         opportunity to proceed at a pace
Gerontol Nurs 2001;                  and level effective for learning
27(11):19-27.
USA




Persson M,                            The DSS which fully implements
Mjorndal T,                           current guidelines may improve
Carlberg B, Bohlin                    the quality of anti-hypertensive
J, Lindholm LH.                       treatment, concurrently leading to
Evaluation of a                       a considerable reduction in drug
computer-based                        costs
decision support
system for treatment
of hypertension with
drugs: retrospective,
nonintervention
testing of cost and
guideline adherence.
J Intern Med 2000;
247(1):87-93.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                        Page 56 of 66



Author / Title /     Methodological        Policy Recommendations                  Applicability to
Journal / Year /     Problems                                                      Alberta
Country / Location
Pringle Specht JK,                         The chronic wound clinic is a cost
Wakefield B,                               effective method of delivering
Flanagan J.                                care to residents in a long term
Evaluating the cost                        care facility as well as an effective
of one telehealth                          mechanism for nurses to consult
application                                with one another
connecting an acute
and long-term care
setting. J Gerontol
Nurs 2001; 27(1):34-
39.
USA

Riegel B, Carlson B,     Randomization     Telephonic case management can    Follow-up of CHF
Kopp Z, LePetri B,       of physicians     significantly decrease physician  clients (particularly ones
Glaser D, Unger A.       rather than       office visits, hospital days,     who do not refuse to
Effect of a              patients which    emergency visits, and             take medications) often
standardized nurse       may have          rehospitlaization rates           falls to home care. This
case-management          introduced some                                     article represents a cost
telephone                selection bias  Future studies would be enhanced effective modell for
intervention on                          by careful logging and reporting of treatment of CHF clients
resource use in          Sample size not actual hours spent per case         in an era of limited home
patients with            adequate to     manager with each patient rather care resources in may
chronic heart failure.   detect          than applying an estimated          jurisdictions in Alberta.
Arch Intern Med          differences in  average per patient
2002; 162(6):705-        outpatient
712.                     resource use
USA
California




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                 Page 57 of 66



Author / Title /         Methodological Policy Recommendations                  Applicability to
Journal / Year /         Problems                                               Alberta
Country / Location
Roush RE, Teasdale       No control         PRS programs can be effective in
TA. Reduced              group              reducing hospital utilization
hospitalization rates                       If quality of care can be
of two sets of           Study cannot be    maintained in conjunction with
community-residing       generalized to     marked reductions in hospital
older adults after use   wider              usage by older PRS users, then
of a personal            populations        perhaps a reduction of some
response system.         given that only    magnitude in Medicare
Journal of Applied       people who         expenditures would follow. Were
Gerontology 1997;        subscribed for 1   this to be documented
16(3):355-366.           year were          prospectively, the obvious policy
USA, Canada              eligible           question would be: "Should
                                            modest monthly PRS charges be
                         Comparison of      included in health care reform
                         US and Canada      packages that emphasize
                         not overly         preventative measures?" p. 362
                         feasible given     Given that elderly people often
                         the different      prefer to stay in their own homes
                         health care        as long as possible, health care
                         systems in each    providers and policy makers
                         country            should support complementary
                                            measures such as home care, PRS
                                            use, and respite care that may
                                            produce that desired result


Sanz F, Silveira C,                         Positive results indicate a high    Poor
Alonso A, Diaz C,                           users' acceptance of the
Loza MI, Cordero L                          TESEMED applications for
et al. Telematics                           community pharmacists
applications to
support the role of                         Pharmacists can benefit from
the community                               internet training
pharmacists as self-
medication advisors.
TESEMED
Consortium. Stud
Health Technol
Inform 1999; 68:764-
767.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                   Page 58 of 66



Author / Title /        Methodological Policy Recommendations                     Applicability to
Journal / Year /        Problems                                                  Alberta
Country / Location
Scalvini S, Zanelli     Does not specify   Cardiovascular disease represents
E, Domenighini D,       how the sample     the major epidemiological issue in
Massarelli G,           of general         terms of morbidity and mortality
Zampini P,              practitioners      in Western countries.
Giordano A,             was chosen.        On these grounds it seems useful
Glisenti F.             Present only       to test a territorial project aiming
Telecardiology          distribution       at shortening decision time,
community: a new        statistics.        greater appropriateness of hospital
approach to take                           admission, and when possible, out
care of cardiac                            of hospital care.
patients. Cardiologia                      A distinctive interesting finding of
1999; 44(10):921-                          this project is the frequent request
924.                                       by general practitioners to have
Italy                                      optional teleconsultation (besides
                                           the ECG).
                                           This aspect confirms reliance and
                                           compliance of the general
                                           practitioners towards the specialist
                                           and outlines the potentials of a
                                           project.




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                  Page 59 of 66



Author / Title /        Methodological Policy Recommendations    Applicability to
Journal / Year /        Problems                                 Alberta
Country / Location
Shah NB, Der E,         The study was
Ruggerio C,             not randomized
Heindereich PA,
Massic BM.              Results may be
Prevention of           affected by a
Hospitalizations for    number of
heart failure with an   biases related to
interactive home        the selection of
monitoring program.     patients and
Am Heart Journal        timing of
1998; 135:373-8.        entrance into the
USA                     program

                        Sample size
                        small and does
                        not allow for
                        definite
                        generalizations
                        or conclusions




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                Page 60 of 66



Author / Title /      Methodological   Policy Recommendations                  Applicability to
Journal / Year /      Problems                                                 Alberta
Country / Location
Shea S, Starren J,                     The IDEATel project is designed
Weinstock RS,                          to provide data that will inform
Knudson PE, Teresi                     policy formation in several ways
J, Holmes D et al.                     -Demonstrate the feasibility of a
Columbia                               large-scale, web-based system for
University's                           electronic delivery of health care
Informatics for                        services
Diabetes Education                     -If the intervention improves
and Telemedicine                       processes and outcomes of care
(IDEATel) Project:                     for persons with diabetes, and the
rationale and design.                  CE of electronic HC service
J Am Med Inform                        delivery is supported by project
Assoc 2002; 9(1):49-                   findings, policies regarding
62.                                    reimbursement are likely to evolve
USA                                    -Reimbursement issues need to be
                                       considered, policies developed
                                       i.e.what is a reimbursable service
                                       unit?
                                       -Legal environment where medical
                                       and nursing professions are
                                       credentialed, licensed etc. needs to
                                       be considered as is different for all
                                       states




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                 Page 61 of 66



Author / Title /     Methodological Policy Recommendations                      Applicability to
Journal / Year /     Problems                                                   Alberta
Country / Location
Starren J, Hripcsak
G, Sengupta S,
Abbruscato CR,
Knudson PE,
Weinstock RS et al.
Columbia
University's
Informatics for
Diabetes Education
and Telemedicine
(IDEATel) project:
technical
implementation. J
Am Med Inform
Assoc 2002; 9(1):25-
36.
USA



Stiles N, Boosalis     Small sample        Study demonstrates that geriatric
M, Thompson K,         size                nutrition consultation can be
Stinnett D, Rayens                         performed through telemedicine,
MK. Nutrition          No control          but more research is required
telemedicine           group
consultation for rural                     Increased resources targeting the
elders. Journal of     Few participants    nutritional health of rural elders
Nutrition for the      reported            with chronic medical conditions
Elderly 1998;          negative            and supports consideration for the
18(1):47-55. USA reactions, but            use of telemed in underserved
                       the selection of    areas
                       participants
                       could have
                       biased these
                       results as only
                       participants who
                       agreed to a
                       telemed
                       consultation
                       were included in
                       the pilot project




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                   Page 62 of 66



Author / Title /      Methodological Policy Recommendations               Applicability to
Journal / Year /      Problems                                            Alberta
Country / Location
Strawn BD, Hester                    Telecare is effective in stress
S, Brown WS.                         reduction of caregivers who care
Telecare: a social                   for persons with AD
support intervention
for family caregivers                Telecare is a cost and time
of dementia victims.                 efficient means of providing social
Clinical                             support and an effective medium
Gerontologist 1998;                  for disclosure of psychological
18(3):66-69.                         distress that may buffer the effects
USA                                  of caregiving and enhance general
                                     well being and perhaps maintain
                                     the physical health of the
                                     caregiver


Subirana Serrate R, Small sample      Telephone service to patients at   Maz encourages
Ferrer-Roca O,       size             home should be covered by          alternate models of care.
Gonzalez-Davila E.                    private insurance companies and    It is interesting to note
A cost-minimization                   24 hour telephone support should   that one support to a
analysis of oncology                  be carefully considered for        service of this kind in
home care versus                      oncology patient care at home      Alberta could be the
hospital care.                                                           Link Service which is
Journal of                                                               rolling out provincially
Telemedicine and                                                         and is including new
Telecare 2001;                                                           services/ innovations.
7:226-232.
Spain




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                               Page 63 of 66



Author / Title /       Methodological Policy Recommendations                  Applicability to
Journal / Year /       Problems                                               Alberta
Country / Location
Tang WK, Chiu H,       Sample size too   -Response time is greatly
Woo J, Hjelm M,        small to draw     improved with the use of TM as
Hui E.                 any firm          opposed to the average waiting
Telespychiatry in      conclusions       time in the local clinic
Psychogeriatric                          -Nursing staff do find that
Service: A Pilot       No control        teleconsultation provided more
Study.International    group             health care support and saved
Journal of Geriatric                     time, but it was not easy to use
Psychiatry, 2001;      Some patients -Telepsychiatry must be
16: 88-93.             had dementia      comparable to on-site visits in
China                  and thus had      terms of cost in order for it to
Hong Kong              questionable      survive
                       ability to answer -CE studies should be done in all
                       questions         areas (geographically) as
                                         generalization of costs from one
                                         region to another is not
                                         appropriate
                                         Advantages of telepsychiatry over
                                         on-site visits
                                         -saving on traveling time of
                                         personnel
                                         -providing a service to persons in
                                         rural populations
                                         -facilitation of emergency
                                         consultations
                                         -CE in certain settings
Townsend CH,
Maxwell W, Sears
LT. Nurse
practitioner patient
centered telephone
calls in a VA
primary care
geriatric clinic.
Journal of the
American Academy
of Nurse
Practitioners
1997::269-275.
USA




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                              Page 64 of 66



Author / Title /     Methodological Policy Recommendations                   Applicability to
Journal / Year /     Problems                                                Alberta
Country / Location
Wagner MM, Hogan     Medication        Authors conclude that the most
WR. The accuracy     records in an     effective extension to the EMR
of medication data   outpatient EMR    studied would be to expand its
in an outpatient     may have          scope to include all clinicians who
electronic medical   significant       can potentially change meds.
record. J Am Med     levels of data    Even with EMR extensions,
Inform Assoc 1996;   error             ineradicable error due to patients
3(3):234-244.                          and data entry will remain
USA                  Clinicians may
Pittsburg, PA        not have
                     completed forms
                     accurately due
                     to lack of time
                     or interest




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                                      Page 65 of 66



Author / Title /       Methodological         Policy Recommendations                 Applicability to
Journal / Year /       Problems                                                      Alberta
Country / Location
Wasson J, Gaudette Despite the                If results were replicated and
C, Whaley F,           random                 found to be positive, telephone
Sauvigne A,            assignment of          care could have widespread appeal
Baribeau P, Welch patients                    to patients
HG. Telephone care differences in
as a substitute for    important              For most patients with chronic
routine clinic follow- variables              disease, telephone care offers
up. [see comments]. between groups            significant benefits:
JAMA 1992;             might still have       1.increased frequency of clinician
267(13):1788-1793. influenced the             contact
USA                    findings               2. Less waiting and travel time
Vermont                                       3.lower cost
                       Participating          4. possibility for reduced mortality
                       patients and           and improved function
                       clinicians knew
                       which study         Telephone care will not be widely
                       protocol was        adopted unless changes are made
                       used                in current reimbursement policies
                                           to encourage office visits and test
                          Generalizability ordering and to pay for telephone
                          of study         care
                          questionable
                          ie.only men
                          used in study

Weinberger M,             Did not             Additional research is needed to
Nagle B, Hanlon JT,       randomize the       determine whether these findings
Samsa GP,                 order in which      are unique to this particular
Schmader K,               the SF-36 was       patient sample, elderly persons in
Landsman PB et al.        administered        general, or to broader groups of
Assessing health-         (telephone / ftf)   individuals
related quality of life
in elderly                Small selected      Until additional research is
outpatients:              sample              conducted we conclude that the
Telephone versus                              two modes of administration may
face-to-face              Did not test        not be interchangeable
administration.           inter-rater
Journal of the            reliability
American Geriatrics
Society 1994;
42(12):1295-1299.
USA
North Carolina




   Note: Abbreviations used in this document are described in Appendix D
   APPENDIX F: CRITIQUE GERIATRICS                                                              Page 66 of 66



Author / Title /        Methodological Policy Recommendations                Applicability to
Journal / Year /        Problems                                             Alberta
Country / Location
Welch HG, Johnson       Possible          The question of how frequently
DJ, Edson R.            problems in the   physicians should see patients
Telephone care as an    failure to        with chronic disease needs to be
adjunct to routine      replicate the     studied more directly
medical follow-up.      previous study
A negative              are discussed
randomized trial. Eff
Clinic pract 2000;
3(3): 123-130.
USA
Colorado,
South Dakota




   Note: Abbreviations used in this document are described in Appendix D

				
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