Traumatic brain injury state planning grant: preparing for change in a rural state.

PURPOSE: The overarching purpose of this work was to generate a framework on which to build a traumatic brain injury (TBI) system-support action plan for individuals with a TBI living in a rural state. METHODS: Four research questions were posed aimed at describing rural service/support needs and service satisfaction among persons with a TBI, as well as rural service/support availability as defined by providers. One hundred and ninety-four providers/agencies and 250 individuals/family members completed one of two versions (provider/agency, individual/family member) of a Needs and Resources Assessment. RESULTS: Data analyses indicated that the majority of individual respondents lived at an impoverished income level and lived with a TBI for approximately 12 years. Quality of life was perceived as significantly lower after the TBI than before. Employment decreased significantly following a TBI. Reasons for unemployment included a perceived inability to work, problems regarding proper accommodation and/or perceptions regarding being chosen as suitable job candidates. CONCLUSIONS: Provider data confirmed that many important services are rarely available or specific to TBIs. Basic assistance with employment, cognitive training and occupational therapy were among those most needed. Paradoxically, a high proportion of individuals reported feeling satisfied with most services. Applications of these data along with recommendations for other rural states are described.

Study of participating and nonparticipating states' telemedicine Medicaid reimbursement status: Its impact on Idaho's policymaking process.

Although Medicare currently reimburses for telemedicine services, advocates are struggling to increase state Medicaid reimbursement. This study provides data from a national study of Medicaid telemedicine reimbursement policies and examines Idaho as a case study for developing telemedicine reimbursement policies. Idahoans have actively advocated for Medicaid telemedicine reimbursement by forming a statewide network. Working with policymakers, Idaho Medicaid and telemedicine advocates established interpersonal connections, providing policymakers information and support. With developing academic, private, and legislative interest, a window of opportunity opened to allow for positive, albeit minimal, movement. To establish protocols for Idaho's use of telemedicine, a national electronic policy survey was conducted to evaluate the direction of telemedicine policy in state Medicaid agencies. Surveys to explore Medicaid reimbursement status were sent to states that were both participating and non-participating in telemedicine. Responses were received from 10 of the 25 states providing Medicaid telemedicine reimbursement and 17 of the 25 states and one U.S. territory not providing reimbursement. Issues common among participating states included provider and reimbursement complications, allowable services, and modification of reimbursement codes. Nonparticipating states indicated an interest in reimbursing for telemedicine and a need to enhance advocate and state Medicaid agency relationships. In addition, the survey results demonstrated the need to provide cost-benefit analysis on the viability of Medicaid reimbursement for telemedicine. Research outcomes were used to develop Idaho's Interactive Video Telemedicine Protocols. These address identified barriers and fears regarding Medicare reimbursement and state budgetary concerns--the additional major issue identified for state Medicaid agencies.

Prison telemedicine and telehealth utilization in the United States: state and federal perceptions of benefits and barriers.

Although national justice and technology associations have endorsed the utilization of telemedicine and telehealth, little is known about the current utilization of this technology across our nation's correctional facilities. Several voluntary registries and state Web sites exist, but only limited information on telemedicine utilization may be gleaned from these. The purpose of the present study was to fill this void by reporting the utilization patterns in telemedicine programs in state and federal correctional facilities throughout the United States. Using telephone-administered interviews, data were collected from all 50 states. Respondents were asked about utilization, benefits, and barriers to the use of technology in healthcare in state and federal correctional facilities. Slightly over half of state correctional institutions and 39% of federal institutions are using some sort of telehealth or telemedicine applications. The most common benefits cited were improved security, personnel safety, costs savings, and access to specialists. The most common barriers cited were costs of technology, resistance from medical personnel, lack of staff technical expertise, and difficulties coordinating services.

Modeling telehealth and telemedicine: a global geosociopolitical perspective.

Telehealth and telemedicine can encompass many applications including direct patient care, training, supervision, consultation, continuing education, and consumer health. The field uses an array of technology from the simplest telephony to advanced robotics. Therefore, it is important to work from a model in design or implementation. This rapidly changing and sometimes chaotic environment presents engineers with a unique opportunity to address the digital divide that is reflective of the geosociopolitical makeup of the world economy. The paper begins a developmental perspective of service delivery models currently used, likening the early years to a feudal system and the current time to a mosaic. After a brief look at the digital divide and the role of culture in technology, the paper concludes with application examples from projects around the world and suggests ways that model systems can be designed with various levels of technology.

Establishing a rural telehealth project: the Wyoming network for telehealth.

The State of Wyoming, USA, is developing a series of demonstration projects on the use of telehealth technology to improve health care accessibility and quality in a frontier region. The Wyoming Network for Telehealth (WyNETTE) will focus on increasing the awareness and usage of technology for patient care, professional education, and informatics resources. The project objectives will include enhancing information access for practitioners and creating links between community health centers, public health offices, and state health officials. The need for this project was established through a number of community-oriented data collections, including a statewide survey of health care providers on the topic of using technology to improve delivery of health care survey in the state. The research showed a general lack of awareness of or experience with telehealth in the state. Nonetheless, there was considerable interest in developing partnerships to support a network of telehealth services. This paper will present the results of this data collection and how they are being used to guide the development of the WyNETTE project.

Psicoterapia por videoconferencia: Una revisión crítica de los estudios de tratamiento / Psychotherapy via teleconferencing

Dado que los recursos en salud mental no están igualmente distribuidos a lo largo del país (Canadá), algunas regiones geográficas carecen de adecuados servicios. El uso de la videoconferencia puede dar respuesta a esta inequidad y facilitar la provisión de servicios de salud mental a distancia. Con el advenimiento de la psicoterapia suministrada vía videoconferencia, han surgido inquietudes acerca de su eficacia. Por lo tanto, el propósito de este trabajo fue revisar los estudios de tratamientos (N=13) publicados y no publicados que examinaron la eficacia de la psicoterapia brindada mediante videoconferencias. Esta investigación sustenta la posibilidad y potencial eficacia de los tratamientos provistos vía videoconferencia para algunas condiciones específicas. En vista de sus falencias metodológicas, se hacen recomendaciones para el futuro.

Psicoterapia por videoconferencia: Una revisión crítica de los estudios de tratamiento / Psychotherapy via teleconferencing

Dado que los recursos en salud mental no están igualmente distribuidos a lo largo del país (Canadá), algunas regiones geográficas carecen de adecuados servicios. El uso de la videoconferencia puede dar respuesta a esta inequidad y facilitar la provisión de servicios de salud mental a distancia. Con el advenimiento de la psicoterapia suministrada vía videoconferencia, han surgido inquietudes acerca de su eficacia. Por lo tanto, el propósito de este trabajo fue revisar los estudios de tratamientos (N=13) publicados y no publicados que examinaron la eficacia de la psicoterapia brindada mediante videoconferencias. Esta investigación sustenta la posibilidad y potencial eficacia de los tratamientos provistos vía videoconferencia para algunas condiciones específicas. En vista de sus falencias metodológicas, se hacen recomendaciones para el futuro.(AU)