Gately Megan E, Trudeau Scott A, Moo Lauren R
Tufts University, Bedford VA Medical Center-GRECC.
American Occupational Therapy Association.
Curr Geriatr Rep. 2019 Sep 1;8(3):239-249. doi: 10.1007/s13670-019-00297-3.
The progressive nature of dementia requires ongoing care delivered by multidisciplinary teams, including rehabilitation professionals, that is individualized to patient and caregiver needs at various points on the disease trajectory. Video telehealth is a rapidly expanding model of care with the potential to expand dementia best practices by increasing the reach of dementia providers to flexible locations, including patients' homes. We review recent evidence for in-home video telehealth for patients with dementia and their caregivers with emphasis on implications for rehabilitation professionals.
Eleven studies were identified that involved video visits into the home targeting patients with dementia and/or their family caregivers. The majority describe protocolized interventions targeting caregivers in a group format over a finite, pre-determined period. For most, the discipline of the interventionist was unclear, though two studies included rehabilitation interventions. While descriptions of utilized technology were often lacking, many reported that devices were issued to participants when needed, and that technical support was provided by study teams. Positive caregiver outcomes were noted but evidence for patient-level outcomes and cost data are mostly lacking.
More research is needed to demonstrate implementation of dementia best care practices through in-home video telehealth. Though interventions delivered using in-home video telehealth appear to be effective at addressing caregivers' psychosocial concerns, the impact on patients and the implications for rehabilitation remain unclear. Larger, more systematic inquiries comparing in-home video telehealth to traditional visit formats are needed to better define best practices.
痴呆症的渐进性需要多学科团队提供持续护理,包括康复专业人员,这种护理要根据患者和护理人员在疾病轨迹不同阶段的需求进行个性化定制。视频远程医疗是一种迅速发展的护理模式,有潜力通过将痴呆症护理人员的服务范围扩大到包括患者家中在内的灵活地点,来推广痴呆症最佳实践。我们综述了近期针对痴呆症患者及其护理人员的家庭视频远程医疗的证据,重点关注其对康复专业人员的影响。
共确定了11项研究,这些研究涉及针对痴呆症患者和/或其家庭护理人员的家庭视频问诊。大多数研究描述了在有限的预定时间段内以小组形式针对护理人员的标准化干预措施。对于大多数研究来说,干预人员的专业领域并不明确,不过有两项研究包括了康复干预措施。虽然通常缺乏对所使用技术的描述,但许多研究报告称,在需要时会向参与者发放设备,并且研究团队会提供技术支持。注意到了护理人员的积极结果,但大多缺乏患者层面结果和成本数据的证据。
需要更多研究来证明通过家庭视频远程医疗实施痴呆症最佳护理实践的情况。虽然使用家庭视频远程医疗提供的干预措施似乎能有效解决护理人员的心理社会问题,但对患者的影响以及对康复的意义仍不明确。需要进行更大规模、更系统的调查,将家庭视频远程医疗与传统问诊形式进行比较,以更好地确定最佳实践。