Striking a balance between in-person care and the use of eHealth to support the older rural population with chronic pain.

New and existing information communication technologies (ICT) are playing an increasingly important role in the delivery of health and social care services. eHealth has the potential to supplement in-person home visits for older, rural adults with chronic pain. The Technology to support Older Adults' Personal and Social Interaction project-TOPS-examines interactions between older people and their health/social care providers and considers how eHealth could play a part in enhancing the life experiences of older people with chronic pain, who live in remote/rural areas. This paper reports findings from the TOPS study, drawing upon observations of health/social care home visits to chronic pain patients and interviews with patients and health/social care providers in rural Scotland. Patients and care professionals believe in-person care promotes the general well-being of older people with pain. However, our findings show that the potential recipients of eHealth are open to the use of such technologies and that although they cannot be expected to replace existing models of care, eHealth may provide opportunities to sustain and enhance these interactions.

Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare.

BACKGROUND: Providing health services to an ageing population is challenging, and in rural areas even more so. It is expensive to provide high quality services to small populations who are widely dispersed; staff and patients are often required to travel considerable distances to access services, and the economic downturn has created a climate where delivery costs are under constant review. There is potential for technology to overcome some of these problems by decreasing or ceasing the need for patients and health professionals to travel to attend/deliver in-person appointments. A variety of eHealth initiatives (for example Pathways through Pain an online course aimed to aid self-help amongst those living with persistent pain) have been launched across the UK, but roll out remains at an early stage. METHODS: This mixed-methods study of older adults with chronic pain examines attitudes towards, current use of and acceptance of the use of technology in healthcare. A survey (n = 168, 40% response rate) captured broad experiences of the use of technology in health and social care. Semi-structured interviews (four with technology and seven without technology participants) elicited attitudes towards technology in healthcare and explored attributes of personal and social interaction during home visits. RESULTS: People suffering from chronic pain access healthcare in a variety of ways. eHealth technology use was most common amongst older adults who lived alone. There was broad acceptance of eHealth being used in future care of people with chronic pain, but older adults wanted eHealth to be delivered alongside existing in-person visits from health and social care professionals. CONCLUSIONS: eHealth has the potential to overcome some traditional challenges of providing rural healthcare, however roll out needs to be gradual and begin by supplementing, not substituting, existing care and should be mindful of individual's circumstances, capability and preferences. Acceptance of technology may relate to existing levels of personal and social contact, and may be greater where technological help is not perceived to be replacing in-person care.

Territorial tensions: misaligned management and community perspectives on health services for older people in remote rural areas.

This paper presents findings from a qualitative study investigating older people's health service provision in remote rural Scotland. Comparing stakeholders' perspectives, contested issues were exposed where community members, service managers and policymakers disagreed. Considering these, led to the proposal that fundamental tensions exist between community and management/policy stakeholders' perspectives and these underlie service change conflicts. While highlighting issues for older people's service design, findings suggest that impacts of the current planning process require to be understood, and aspects need to be changed, before the voice of older people can inform local service policy.