Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients.

OBJECTIVE: The value of home telehealth self-monitoring with nurse oversight has been demonstrated; however, there is a dearth of objective documentation of patients' experiences with such a model. We used a mixed methods approach to examine the value of home telehealth monitoring with remote care nurse (RCN) support from the perspective of participants in our study. MATERIALS AND METHODS: Thirty-three patients who used remote technology to self-monitor their health at home participated in a semistructured interview. The instrument was designed to help identify facilitators and barriers and to evaluate patient satisfaction with and effectiveness of home telehealth self-monitoring. RESULTS: Overall, patients reported high levels of satisfaction with RCN support as they received efficient feedback, were better able to identify changes in their health status, and experienced enhanced accountability, self-efficacy, and motivation to make health behavior changes. The most frequently cited barriers related to malfunctioning equipment or trouble with Internet connections, forgetfulness, and feeling poorly. CONCLUSIONS: The results suggest that home telehealth self-monitoring with RCN support is effective in empowering patients to take a more active role in their healthcare and indirectly improve quality of life for those living with chronic illness.

Effects of pain controllability and discrepancy in social support on depressed mood among patients with chronic pain.

BACKGROUND: Preference of types of social support may vary across recipients, and social support that is less than the amount preferred may be associated with depressed mood. PURPOSE: This study aimed to investigate the interaction effects between pain controllability and discrepancy in social support and the additive utility of discrepancy in social support over perceived social support in predicting depressed mood among patients with chronic pain. METHOD: A total of 173 patients seeking treatment at two outpatient pain management clinics in Hawaii participated. RESULTS: The results indicated that (1) patients with low pain controllability preferred significantly more social support than those with high pain controllability, for all types of social support; (2) patients preferred significantly more informational and emotional support than instrumental support for both pain controllability levels; (3) discrepancy in informational or instrumental support was not associated with depressed mood, whereas discrepancy in emotional support was significantly associated with more depressed mood for low pain controllability, but not for high pain controllability; and (4) discrepancy in emotional support added a significant increment of variance in predicting depressed mood over and above perceived emotional support, whereas discrepancy in informational or instrumental support did not. CONCLUSION: Findings suggest the relative importance of discrepancy in emotional support from a significant other, especially for patients with low pain controllability.

The effects of working alliance and client-clinician ethnic match on recovery status.

Sixty-seven clients with severe and persistent mental illnesses (SPMI) recruited from community mental health centers were interviewed to assess their subjective quality of life, self-efficacy, importance of ethnic matching and level of working alliance (WA) with their clinicians. Results revealed that clients in the ethnically matched group reported significantly higher WA compared to the non-matched group. Clients who reported a higher level of WA also reported better recovery status. Results suggest that, in a multicultural community, ethnic matching may help augment WA and address potential barriers to treatment engagement, and identifying strategies to promote WA may enhance treatment effectiveness in programs for SPMI.