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Telecare promises to deliver healthcare services more efficiently while, at the same time, improving the quality of care. The purpose of this paper is to challenge these promises by analysing the implications of introducing telecare in the rehabilitation of patients suffering from chronic obstructive pulmonary disease.

Empirically, the paper is based on interviews with and observations of rehabilitation therapists and patients taking part in a Danish telerehabilitation programme. Theoretically, the paper draws on Science and Technology Studies.

The introduction of telecare alters rehabilitation practices in multiple ways. First, several new time-consuming work routines, carried out in collaboration between therapists, patients and technical professions, emerge. Although crucial in establishing and maintaining telerehabilitation infrastructures, this work remains invisible in evaluations of the programme. Second, rather than simply increasing patient agency, responsibilities are redistributed and negotiated in subtle and non-uniform ways. These negotiations make it less transparent where one responsibility begins and where another potentially conflicting one ends.

Evaluations of telecare technologies should pay more attention to work- and responsibility-related effects of introducing telecare in order better to account for predicted and unpredicted as well as desirable and undesirable socio-technical changes.

Using an ethnographic approach, the paper points to the discrepancy between simplistic political promises that telecare technologies can serve as tools for improvement, on the one hand, and the substantial changes in the organisation and management of healthcare observed in practice, on the other. Rather than regarding telecare as technologies of improvement, it is more productive to regard them as technologies of change.

The purpose of this paper is to investigate patient perspectives on attending pulmonary rehabilitation (PR). This qualitative case study identifies the benefits and challenges to attending PR and presents areas of improvements as recommended by patients.

A qualitative case study of a UK case study based on a PR programme based on undertaking focus groups (n=3) and interviews (n=15) with current and former patients.

The findings report patient perspectives of the challenges and benefits of attending a PR programme along with recommendations on how the service could be improved.

The authors focussed solely on a UK PR programme, so the findings might not be applicable to other countries if PR is organised and provided in a unique way or setting.

This paper provides valuable insights to patient perspectives offrom patients attending PR programmes, which are useful to those running and designing these services.

The findings identify the benefits and challenges for patients attending PR programmes and suggest areas where improvements can be made.

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.

Objective. To evaluate a health and fitness programme conducted within a New South Wales, Australia correctional facility for male inmates with a chronic illness. Design. A randomised control trial. Sample. Twenty male inmate participants with a chronic illness, two risk factors for developing a chronic illness or who were over the age of 40 years. Measurements. Pre and post programme health assessments that included resting blood pressure and heart rate, weight, body mass index, waist girth, peak flow measures, peripheral saturation of oxygen, blood glucose levels and 6 minute walk test. Intervention. A 12‐week structured exercise programme focusing on cardio respiratory endurance, strength and flexibility training. Results. Statistically significant improvements in resting heart rate and endurance were found. Conclusions. The health and fitness programme positively impacts on the health of inmates with a chronic illness. A further study with a larger sample size would be productive.

Patients with chronic obstructive pulmonary disease (COPD) suffer many physical disabilities which cause many problems in their life. These patients really need to have continuity of care based on cooperation between patient, the family and their care givers in order to achieve an integration of care. The purpose of this paper is to assess the impact of continuous care on quality of life of patients with COPD.

A before–after quasi-experimental study was carried out with 72 patients with COPD at Beheshti educational hospital of Hamadan University of Medical Sciences. The patients who met inclusion criteria were randomly allocated into an intervention group (n=36) and a control group (n=36). The patients completed the St George’s Respiratory Questionnaire before and after their care. The intervention comprised continuous care with orientation and sensitization sessions (2 weeks), control and evaluation sessions (45 days) for intervention group and with routine care in the control group. Data were analyzed with SPSS, descriptive and inferential statistics were conducted to measure differences between intervention and control group.

Continuity of care improved significantly the quality of life of COPD patients in general, and in the symptoms, activity and impact domains (P=0.001). In contrast, routine care did not improve quality of life for patients in general, and in the symptoms, activity and impact domains (P=0.05).

Continuity of care has a positive impact on quality of life for COPD patients. Health care system should utilize continuity of care models as an overall plan for patients with COPD. Moreover, managers of health care system could reduce burden of chronic diseases by employing continuity of care models in planning patient care.