Increasing Access to Chronic Disease Self-Management Programs in Rural and Remote Communities Using Telehealth
Increasing Access to Chronic Disease Self-Management Programs in Rural and Remote Communities Using Telehealth
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DOI：
10.1089/tmj.2012.0197
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发表时间：
2013-06-01
影响因子：
4.7
通讯作者：
Bereket, Tarik
中科院分区：
文献类型：
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作者：
Jaglal, Susan B.;Haroun, Vinita A.;Bereket, Tarik
目的：本研究探讨远程健康慢性病自我管理计划(CDSMP)是否能改善居住在加拿大安大略省北部的慢性疾病成年人的自我效能感、健康行为和健康状况。使用了两种远程保健模式：(1)单一地点，由参与者在一个远程保健地点组成的小组；(2)多地点，来自多个地点的参与者链接成一个远程保健小组，作为一种战略，以增加农村和偏远社区个人获得干预的机会。对象和方法：自2007年9月至2008年6月，213名被诊断患有心脏病、中风、肺部疾病或关节炎的参与者在安大略省远程医疗网络演播室参加了CDSMP。该计划包括每周六次由同行推动的课程，旨在帮助参与者发展重要的自我管理技能，以改善他们的健康和生活质量。进行基线和4个月的跟踪调查，以评估自我效能信念、健康行为和健康状况信息。对单点和多点给药模式的结果进行比较。结果：从基线到4个月的随访，在自我效能(6.6+/-1.8to 7.0+/-1.8p<；0.001)、运动行为、认知症状管理、与医生的沟通、角色功能、心理幸福感、精力、健康苦恼和自我评估健康方面均有显著改善。单部位组和多部位组之间的结果在统计学上没有显著差异。结论：自我效能感、健康状况和健康行为的改善在单部位组和多部位组中同样有效。通过在农村和偏远社区使用单站点和多站点组的远程医疗，可以大大增加获得自我管理方案的机会。
Objective: This study examined whether a telehealth chronic disease self-management program (CDSMP) would lead to improvements in self-efficacy, health behaviors, and health status for chronically ill adults living in Northern Ontario, Canada. Two telehealth models were used: (1) single site, groups formed by participants at one telehealth site; and (2) multi-site, participants linked from multiple sites to form one telehealth group, as a strategy to increase access to the intervention for individuals living in rural and remote communities. Subjects and Methods: Two hundred thirteen participants diagnosed with heart disease, stroke, lung disease, or arthritis attended the CDSMP at a preexisting Ontario Telemedicine Network studio from September 2007 to June 2008. The program includes six weekly, peer-facilitated sessions designed to help participants develop important self-management skills to improve their health and quality of life. Baseline and 4-month follow-up surveys were administered to assess self-efficacy beliefs, health behaviors, and health status information. Results were compared between single-and multi-site delivery models. Results: Statistically significant improvements from baseline to 4-month follow-up were found for self-efficacy (6.6 +/- 1.8 to 7.0 +/- 1.8; p < 0.001), exercise behavior, cognitive symptom management, communication with physicians, role function, psychological well-being, energy, health distress, and self-rated health. There were no statistically significant differences in outcomes between single-and multi-site groups. Conclusions: Improvements in self-efficacy, health status, and health behaviors were equally effective in single-and multi-site groups. Access to self-management programs could be greatly increased with telehealth using single- and multi-site groups in rural and remote communities.