Telemedicine and Telehealth in Nursing Homes: An Integrative Review.
Lisa L Groom, Margaret M McCarthy, Amy Witkoski Stimpfel and 1 others
PMID 33819450WHAT IT FOUND
Nursing home telehealth often helped residents see specialists sooner, reduced some transfers, and was accepted by staff and families.
Evidence is mixed, and bundled monitoring plus video visits cannot show which part helped.
Key findings
01Telehealth studies reported mixed facility-level results: some showed fewer hospitalizations or avoidable transfers, but a randomized after-hours trial found no significant overall difference and a wound care telehealth study found a non-significant 1.3 times larger ED visit rate.
02Residents with dementia in facilities with telemedicine access to geropsychiatric specialists were 75% less likely to be physically restrained and 23% less likely to develop a urinary tract infection than control residents.
03Clinicians, residents, and families often accepted telehealth, but barriers included poor audio, missing functions, connection time, device charging and cleaning, reimbursement issues, and lack of workforce.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The 16 studies varied widely in design, technology, and outcomes, so they are hard to compare. Many samples were small, poorly described, and drawn from few facilities, so results may not apply to other nursing homes. Several studies used historical comparison groups without proper matching, which can bias results. Many studies used author-developed surveys, so measurement may be unreliable. Some positive hospitalization findings came from subgroup comparisons after the overall trial result was not significant. Several interventions combined teleconsults, remote monitoring, and point-of-care testing, so the effect of any one component cannot be separated. The review excluded telepharmacy, teledentistry, telerehabilitation, surveillance technology, passive monitoring, robotics, family videoconferencing, and caregiver support studies. The review included only English-language studies published from January 2014 through October 2020.
The easy way to misread this
Do not conclude that telehealth alone improves nursing home outcomes. Many studies combined video consults, remote monitoring, point-of-care testing, and specialist advice, and some positive hospitalization findings came from subgroup comparisons rather than a significant overall trial effect.