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OBJECTIVES: To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs). DESIGN: Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair. SETTING: A 240-bed, county-managed, urban nursing home. PARTICIPANTS: NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003. MEASUREMENTS: Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument. RESULTS: For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment. CONCLUSION: FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.
Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.
The goal of this study was to describe the effects of using videoconferencing on participant enrollment, research measure administration and responses, study retention, and satisfaction. We recruited 400 patients from the Portland Veterans Affairs Primary Care Clinics for a randomized clinical trial of a care management intervention for depression. Patients recruited from distant clinic sites had the option of traveling to Portland, Oregon, for initial interviews or being interviewed using videoconferencing. Interviews included obtaining informed consent and administration of research measures. Remote participants were subsequently asked to complete a 12-item mail survey regarding the interview. There were no significant problems with the process of interviewing and obtaining informed consent by videoconferencing, as reported by patients and clinic staff. Twenty of the 31 participants interviewed by videoconferencing returned the satisfaction questionnaire. Participants indicated a high degree of satisfaction with these interviews, and expressed willingness to recommend videoconferencing to others. No differences were observed between the Patient Health Questionnaire depression scores of videoconferencing and in-person participants, and there was no significant difference in the 6-month rate of loss to follow-up in the randomized trial. Videoconferencing allows patients in rural and remote locations to participate in psychiatric research and expands sources of recruitment for research projects.
The Alberta Telehealth Network uses a provincial scheduling system, which allows use of the network to be monitored via reporting procedures. We developed a province-wide costing model for videoconferencing in Alberta, including administrative, clinical and educational activities. In 2003, there were 212 different videoconferencing sites. During the year, 5766 videoconferencing sessions were provided and in these sessions the sites were connected to the network a total of 21,596 times. About 27% of the connections were from providing sites and about 73% of the connections were from receiving sites. On average, one site in the telehealth system was connected to another site about 100 times, and the average videoconferencing session included about 3.8 sites, varying from mainly two sites in clinical sessions to 4.2 sites in administrative sessions and 6.1 sites in educational sessions. The total cost of videoconferencing in Alberta for administrative, clinical and educational activities was about CA $5.74 million in 2003. About 52% of the annual cost was for educational sessions, 34% for administrative meetings and 14% for clinical consultations. The average cost of videoconferencing at a single site ranged from $223.48 (for providing clinical consultations) to $278.57 (for receiving educational sessions). The costing model provides information for decision-makers about the cost of videoconferencing activities and can be used in the development of a sustainable telehealth system in Alberta.
Videoconferencing is used in psychiatry for various purposes. There is a need for research on videoconferencing in family therapy, as there are hardly any reports on the topic: in a literature search, we found only four references to family therapy and videoconferencing. In the Department of Psychiatry at Oulu University Hospital, the use of videoconferencing has steadily increased over the last few years, and in 2002 the equipment was used for 600 hours, of which 84 hours (14%) involved consultation and 12 hours (2%) family therapy. We postulate that the use of videoconferencing for family therapy will incur various restrictions, but may also open up new opportunities. Videoconferencing may allow people in remote regions to benefit from family therapy services. Using modern equipment, it is possible to attain television broadcast quality in a videoconference, but we do not know the effect of videoconferenced delivery on the outcome of therapy. It will therefore be important to collect systematic data on family therapy delivered via videoconference.
Home videoconferencing links for families of children recently discharged with complex congenital heart disease may be useful in monitoring potentially unstable patients. A randomized controlled trial was carried out comparing home videoconferencing with telephone contact. Patients were randomized to an interventional videoconferencing group (n = 14), or to one of two control groups: the first (n = 9) received the same ad hoc telephone support that was available to all patients; the second group (n = 13) received regular telephone calls with the same protocol as those in the videoconferencing group. The results from the trial are still being analysed. Our experience with commercial cable modem transmission quickly showed that this is an unsuitable modality. Preliminary results with ISDN videoconferencing are encouraging. Initial results and feedback from families strongly suggest that videoconferencing provides significant benefits over telephone follow-up.
INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.
INTRODUCTION: Grand rounds are a traditional means of continuing education for specialist physicians. The purpose of this study was to determine the need for and feasibility of interactive videoconferenced grand rounds between an academic health center and community specialists practicing in the three provinces served by the health center. METHODS: Using questionnaires, we studied two populations: the academic center's clinical department and division heads and community specialists in three provinces. RESULTS: We received 27 of 34 (79%) questionnaires from department heads. Nine reported that they already videoconferenced their rounds, 12 expressed a willingness to do so, and 4 responded that they may be interested. Fourteen departments responded that they were willing to include community specialists in planning and presenting. Using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), respondents rated the statement "Regional specialists would benefit from videoconferenced grand rounds" as 4.2. The return rate from community specialists was 333 of 876 (38%), of which 274 indicated that they would attend videoconferenced rounds, 42 said "maybe," and 9 said "no." Using the same 5-point scale, respondents rated both the following statements as 3.8: "Videoconferenced grand rounds would benefit me" and "These rounds would help me keep in touch with my colleagues." One hundred and two (31%) indicated that they would help plan rounds from the academic center. DISCUSSION: This study demonstrated the willingness on the part of one academic center to videoconference grand rounds to community specialists and interest from community specialists in participating. It raises logistical and educational issues, including scheduling and how to effectively include community physicians in needs assessment and planning. As requirements for specialists to participate in accredited learning activities become more rigorous, videoconferencing grand rounds may be one way to increase access to important learning activities.
Videoconferencing has been used to provide distance education for medical students, physicians and other health-care professionals, such as nurses, physiotherapists and pharmacists. The Dalhousie University Office of Continuing Medical Education (CME) has used videoconferencing for CME since a pilot project with four sites in 1995-6. Since that pilot project, videoconferencing activity has steadily increased; in the year 1999-2000, a total of 64 videoconferences were provided for 1059 learners in 37 sites. Videoconferencing has been well accepted by faculty staff and by learners, as it enables them to provide and receive CME without travelling long distances. The key components of the development of the videoconferencing programme include planning, scheduling, faculty support, technical support and evaluation. Evaluation enables the effect of videoconferencing on other CME activities, and costs, to be measured.
Recent technological advances and reducing costs have meant that videoconferencing is a possible new medium for health-care teams. The IMPaCT (Interactive Multimedia Palliative Care Training) project began in 1997 with the aims of assessing the practicalities of videoconferencing in palliative care and assessing its educational effectiveness. The use of videoconferencing was closely evaluated during the first 2 years of the project and this paper presents the results of that monitoring. Twenty-two sites were linked worldwide, reaching 136 professionals without the costs or time needed to travel. The savings on travel and time within the UK alone would have paid for the equipment in 1 year. Sites only continued with videoconferencing if they reached a point where their organization saw the advantages of videoconferencing. Links were easy to establish and rarely failed regardless of distance. Users rapidly adapted to the new medium, and links could be used in a variety of settings and audiences, including journal clubs and expert workshops. Videoconferencing offers a new and unique way of supporting palliative care professionals while reducing time and costs for both tutors and learners.
As part of a four-year study into the use of videoconferencing in palliative care, the delivery of workshops on palliative care to community nurses was evaluated by the Open University. Twenty nurses were randomly allocated to alternating videoconferencing and face-to-face modes of presentation. The quantitative study measured the amount of learning that occurred in each workshop with pre-tests and post-tests, and the mode of presentation. Forty-nine workshop attendances were analysed. The qualitative study used observation and analysis of videorecordings to assess the activity and attention spans in interactive communication during workshops, while a combination of interviews and questionnaires was used to assess the participants' level of satisfaction with presentation. The results showed that the nurses' level of satisfaction with the instructional presentation was high in both modes of presentation. Despite difficulties at the start of the project in the videoconferencing presentation, there was little difference between the modes of presentation in achievement scores or the gain in achievement scores. Although the learners preferred face-to-face workshops, they learnt as much from a videoconferenced workshop. Videoconferencing was less suitable for psychological or emotional discussions, but this may have been due to the time constraints on the workshops. Some features of videoconferencing suggest it could be used effectively in helping learners discuss sensitive issues. The Current Learning in Palliative Care (CLiP) worksheets were found to be an effective means of delivering learning.
This paper reviews the literature on the provision of psychological services using videoconferencing. First, mental health assessments are considered in terms of both the initial interview and the use of scales for rating symptoms of mental state dysfunction, including psychosis, depression and anxiety. Ways to increase the reliability of initial assessment data collected by videoconference are provided, and the consumer's experience of receiving this service by videoconference is also considered. Research comparing the administration of psychometric tests in person and by videoconference is then reviewed, as is the client's experience of receiving this service by videoconference. Psychological interventions provided for individuals, families and groups by videoconference are also considered. Positive and negative experiences relate to issues of empathy, working alliance, a sense of control and a sense of presence. The levels of comfort and satisfaction expressed by both counsellors and clients with the use of the medium are discussed. Recommendations for how best to use videoconferencing for psychological interventions are offered and contraindications are reviewed. Videoconferencing for the purposes of supervision is also briefly covered. The legal issues associated with the use of videoconferencing to provide psychological services include consent, reimbursement, professional licensing and liability. It seems that videoconferencing is a new and potentially beneficial means of bringing psychological services to isolated communities. However, it may be necessary to explore the technique cautiously. There is a dearth of evidence regarding the reliability of psychological services provided using videoconferencing and consequently there is vast opportunity for further research.
We have investigated the role of videoconferencing in allied health service provision to high-care clients in rural residential facilities. Videoconferencing equipment was set up at a rural aged-care facility and a metropolitan allied health centre; ISDN transmission at 384 kbit/s was used to link the equipment. Twelve residents were assessed by both videoconference and face to face across five allied health disciplines (a total of 120 assessments). User satisfaction was measured using questionnaires and focus groups. Face-to-face assessment took significantly longer than videoconferencing assessment. However, the mean satisfaction ratings for face-to-face assessments were higher than for videoconferencing and the majority of the staff preferred the face-to-face format. Videoconferencing was particularly useful for consultations and the initial stages of the assessment process. A number of issues relating to the videoconferencing equipment, to the environment in which assessments were performed and to the clients themselves need to be addressed in order for this form of service delivery to be effective.
Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists. Telehealth technologies provide opportunities to meet the rapidly growing needs of consumers and healthcare practitioners. Many in need of services have limited access to high-end technologies. An argument has been made that the lowest level of technology needed to carry out a task should be used, if it is capable of providing the necessary services. Videoconferencing capabilities allow healthcare practitioners to engage in virtual face-to-face encounters with patients or other healthcare providers. A variety of levels of sophistication in these videoconferencing systems are available. In an effort to evaluate the effectiveness and consumer satisfaction with videoconferencing, 3 pilot studies were conducted to compare face-to-face, low-bandwidth, and high-bandwidth approaches to performing common assessments and patient education activities. In one study, a variety of experienced healthcare practitioners performed functional assessments of stroke subjects using a collection of validated scales by varying approaches (face-to-face, low-bandwidth, and high-bandwidth videoconferencing) in a randomized order. In a second study, undergraduate nursing students performed similar performance measures and taught an unfamiliar individual how to program and use an intravenous pump device, take a tympanic temperature, or to draw up insulin in a syringe. In the third study, advanced practice nursing students assessed vital signs and performed cardiopulmonary assessments on community-dwelling subjects using low-bandwidth and face-to-face approaches. Healthcare practitioners and students generally preferred high-bandwidth approaches over low-bandwidth alternatives when videoconferencing was performed; however, most participants and practitioners were satisfied with the encounters, regardless of the level of technology used.
This paper addresses the use of videoconferencing in PBL (Problem Based Learning) counselling in a nursing bachelor programme. How suitable is the use of videoconferencing in counselling? Preparations for the use of videoconferencing are described. The paper is based on a study in which both qualitative and quantitative methods have been used. Results from the study are presented and discussed. To claim any degree of objectivity in this matter would be rather ambitious, but we maintain that our paper could pinpoint some of the critical issues that should be met in the planning and the management of videoconferencing when used in counselling. The study shows that videoconferencing is well suited for counselling of PBL groups.
Videoconferencing is an established method for providing medical education over long distances. Our aims were to assess the feasibility of videoconferencing in dental postgraduate education, to evaluate its practicability, teacher satisfaction and evaluate equipment. Twenty-seven teachers from the 4 London Dental Schools provided 41 postgraduate dental education sessions on a range of topics to regional postgraduate centres and dental practices as part of the Thames Health Region's programme. Videoconferencing was carried out using a relatively inexpensive personal computer system link using ISDN2 telephone lines and Z350 protocol. Presenter views and assessment were obtained by questionnaire, interview and videotape. Teachers felt that minimal additional preparation time was required for videoconferencing and 21/27 preferred it to in-person teaching, most noting the saving in travel time. Only 3 of the teachers were dissatisfied with their ability to communicate, 4 were equivocal and 20 were either pleased or very pleased. The teachers largely enjoyed the experience and performed well in the new medium. However, sound quality proved inadequate in 5/41 links and most sessions included some periods of suboptimal sound. Only 4 teachers were satisfied with their ability to perform question and answer interaction with the audience. We conclude that experienced teachers adapt readily to videoconferencing and learn to communicate effectively very quickly. Teachers were positive about the medium despite its shortcomings and improvements in sound quality would allow a rapid expansion of postgraduate dental education by videoconference.
The objective was to review multipoint videoconferencing in Queensland Health from July 1996 to June 1999. Most videoconferencing has been conducted using desktop systems connected by integrated systems digital network (ISDN) at 128 kbps. Data on utilization and problems were extracted from monthly reports and a survey was conducted. Multipoint videoconferencing increased steadily over the 3 years from just and handful of conferences per month to 101 conferences and 703 hours of bridge use per month. Primary uses were education and administration. Relatively few technical failures and operator errors were recorded. But by 1999, late connection and low attendance were major problems. Survey responses indicated that multipoint videoconferencing met expectations at the great majority of sites. Most respondents were satisfied with the level of administrative and technical support provided. In this large and decentralized state, multipoint videoconferencing has proven a useful and effective means of bringing healthcare workers together for a common purpose, supplementing face-to-face events and other encounters mediated by communications technology such as satellite broadcasts and audioconferences.