Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses.

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.

Patient education combined in a music and habit-forming intervention for adherence to continuous positive airway (CPAP) prescribed for sleep apnea.

OBJECTIVE: As many as 50% of patients diagnosed with obstructive sleep apnea stop adhering to the prescribed medical treatment of continuous positive airway pressure (CPAP) within 1-3 weeks of onset. Thus, a theory-based intervention using music to support habit formation was designed to improve CPAP adherence at onset. The intervention materials included directions for CPAP nightly use, a diary for recording nightly use and writing about CPAP benefits or problems. In addition, an audiotape with softly spoken instructions for placing the CPAP mask comfortably, using deep breathing and muscle relaxation along with the slowly decreasing music tempo was provided to listen to at bedtime each night. METHODS: Effects of this music intervention were tested in a randomized, placebo-controlled trial of 97 patients with 53 males (55%) and 44 females (45%). Moderate to severe apnea/hyponea scores (per sleep laboratory data) and medical diagnosis of OSA were required for study inclusion. RESULTS: Compared to placebo controls, a greater proportion of experimental patients were adhering (chi(2)=14.67, p<0.01; a large difference, Phi=0.39) at the end of the first month of CPAP onset. There were no differences in CPAP adherence at 3 (X(2)=0.065, p=0.79) and 6 (X(2)=.118, p=0.73) months. Patients' diary data and satisfaction survey results indicated the intervention was rated as helpful and guided formation of a relaxing, habitual routine of CPAP nightly use. CONCLUSION: The intervention had a strong effect for improving adherence to CPAP at 1 month. PRACTICE IMPLICATIONS: Adherence at the onset of treatment is critical and the audio music intervention was easily administered. Other interventions that target problems interfering with longer-term CPAP adherence are needed.

Feasibility of in-home telehealth for conducting nursing research.

The purpose of this study was to determine the feasibility of using home audio/ video telehealth equipment for administering nursing interventions to families, observing the client response, and collecting research data over specific intervals of time. The study design was a descriptive comparison with observational data collection. The subjects were adult patients (n = 5) using nighttime mechanical ventilators for obstructive sleep apnea and their home caregivers (n = 7). Skin color vital signs, spirometry, and pulse oximetry data collected simultaneously through telehealth equipment and through nurse observation in the home were the same. Care and the caregiver's use of the patient equipment were also observed. When nursing interventions, equipment demonstrations, visual illustrations, and audiotaped educational directions were used to facilitate patient care, they were transmitted across telehealth with a few exceptions. Costs of telehealth visits were less than traditional home visits, and client evaluations of telehealth were positive.

Telehealth services to improve nonadherence: A placebo-controlled study.

The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (chi 2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was 30 dollars while the total cost of the telehealth intervention for each patient was 420 dollars. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended.