The telehealth evidence database includes a number of items that relate to children and adolescents, across a variety of conditions. It is therefore logical to focus on the types of technology used for or by children and adolescents in order to capture the range and extent of methods employed. We look at three types of technology: telephone, internet and videoconferencing.
While digital images have been successfully used for the assessment and treatment of pressure ulcers in adult patients with spinal injuries, a US case series documents how mobile phone cameras have improved paediatric neurosurgery, focusing on young patients who required regular dressing changes and treatment for wound infections.1 Long distances between the patients' homes and health centres that offered the necessary services made appointments impractical. However, phone camera images were sent electronically to surgeons, allowing for remote wound evaluation and treatment.
An Australian randomised trial involving several hundred parents is using 30-minute telephone calls to increase fruit and vegetable consumption by 3-5-year-olds.2 Trained interviewers provide guidance over one month, while a control group receives paper-based information during the same period. Researchers hope to show that this type of telephone intervention is effective and transferable to other health areas.
Another randomised controlled trial (RCT) dealing with nutrition focused on an automated telephone counselling system for the parents of overweight children aged between 8 and 12.3 This RCT recorded greater reductions in body mass index (BMI) among children whose parents used the service compared with those receiving advice through other methods.
Telephone coaching for parents of 5-12-year-olds with asthma found increased quality of life (QOL) scores among participating parents of 0.67 units, against 0.28 units in a control group that had access to regular care.4 However, the children's QOL scores and number of emergency health events did not differ between the intervention and control groups.
Focus groups of 12-18-year-old asthma sufferers highlighted the potential of the internet to increase knowledge of the condition for the patients themselves, their peers and carers.5 They considered sharing information to be important, and viewed the internet as a means of facilitating this.
'Store and forward' systems, using the internet to hold and then transmit clinical data, have been used with some success for young asthma patients. A 2003 study supplied home PCs and internet connection for patients to access an interactive website and to submit videos of medication and monitoring equipment use.6 This process ran alongside regular clinic visits. Although patients did not report changes to their quality of life, care professionals felt that patients’ QOL scores had improved. A wider, subsequent study involving some of the same research team compared 'office-based' care with an internet-based intervention.7 One hundred and twenty patients aged between 6 and 17 participated. The office-based control group performed less well with submitting diaries and inhaler use, leading the study to conclude that internet-based monitoring assisted in asthma management.
A less positive outcome for internet use was highlighted in a UK study assessing the reliability of online advice on children’s health.8 Five hundred websites were accessed via a search engine to answer five common child health questions. Accurate information was found at 39 per cent of sites, with 11 per cent giving incorrect information. Almost half the sites did not answer the given question. Researchers suggest that NHS or other websites recommended by health care professionals are far more likely to give reliable information than, for example, sponsored sites.
A recent pilot study compared the delivery of speech language therapy for children using videoconferencing and face-to-face consultations.9 Thirty four patients participated. Half the children underwent four months of videoconferencing therapy followed by four months of regular (face-to-face) therapy. The others received the same treatment, but in the opposite order. Progress was similar for each group, although particular satisfaction was recorded with the videoconferencing method among both patients and their parents.
Childhood depression was the focus of a feasibility study using videoconferencing for cognitive behavioural therapy (CBT).10 Researchers found that CBT could be successfully delivered by video whereby patients, carers and therapists could interact in real time. A post-treatment remission rate of around 80 per cent was recorded immediately after both video and face-to-face therapies. Advantages of the telemedicine method are improved access to therapists, in terms of the removal of travel requirements, as well as therapists’ capacity to treat. Stigma issues are also addressed, to some extent, by the patient being treated at home.
Videoconferencing has been used post-hospital discharge to maintain regular supervision of young patients in recognition of their reduced contact with health care professionals once they leave hospital.11 While satisfaction levels were the same for both hospital care and home care, researchers found that parents with children who had serious health needs were especially keen on the videoconferencing option.
Looking at just three methods – telephone, the internet and videoconferencing – we can see how new technologies have been used by young patients and their parents to assist with monitoring and treatment of long-term conditions. The technologies can also play a preventive role when utilised to counsel against certain behaviours.
The internet, in particular, holds significant potential for helping children and adolescents to manage their condition, as this client group is arguably more inclined than other age groups to embrace information and communications technology and maximise its benefits. By the same token, children who look after older relatives with long-term conditions might adapt well to using telemedicine as a principal element of care.
- 1. Pirris S, Monaco E, Tyler-Kabara E (2010). 'Telemedicine through the use of digital cell phone technology in pediatric neurosurgery: a case series'. Neurosurgery, vol 66, no 5, pp 999-1004. Available at: http://journals.lww.com/neurosurgery/Fulltext/2010/05000/Telemedicine_Through_the_Use_of_Digital_Cell_Phone.22.aspx (accessed on 29 October 2010).
- 2. Wyse R, Wolfenden L, Campbell E, Brennan L, Campbell KJ, Fletcher A, Bowman J, Heard T, Wiggers J (2010). 'A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: study protocol'. BMC Public Health, vol 10. Available at: www.biomedcentral.com/content/pdf/1471-2458-10-216.pdf (accessed on 29 October 2010).
- 3. Estabrooks P, Shoup J, Gattshall M, Dandamudi P, Shetterly S, Xu S (2009). 'Automated telephone counseling for parents of overweight children: a randomized controlled trial'. American Journal of Preventive Medicine, vol 36, no 1, pp 35-42. Available at: www.ncbi.nlm.nih.gov/pubmed/19095163 (accessed on 29 October 2010).
- 4. Garbutt J, Banister C, Highstein G, Sterkel R, Epstein J, Bruns J, Swerczek L, Wells S, Waterman B, Strunk RC, Bloomberg G (2010). 'Telephone coaching for parents of children with asthma'. Archives of Pediatrics & Adolescent Medicine, vol 164, no 7, pp 625-30. Available at: http://archpedi.ama-assn.org/cgi/content/short/164/7/625 (accessed on 29 October 2010).
- 5. Rhee H, Wyatt T, Wenzel J (2006). 'Adolescents with asthma: learning needs and internet use assessment'. Respiratory Care, vol 51, no 12, pp 1441-49. Available at: www.ncbi.nlm.nih.gov/pubmed/17134525 (accessed on 29 October 2010).
- 6. Chan D, Callahan CW, Sheets SJ, Moreno CN, Malone FJ (2003). 'An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children'. American Journal of Health System Pharmacy, vol 60, no 19, pp 1976-81. Available at: www.ncbi.nlm.nih.gov/pubmed/14531243 (accessed on 29 October 2010).
- 7. Chan D, Callahan CW, Hatch-Pigott VB, Lawless A, Proffitt HL, Manning NE, Schweikert M, Malone FJ (2007). 'Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial'. Pediatrics, vol 119, no 3, pp 569-78. Available at: www.ncbi.nlm.nih.gov/pubmed/17332210 (accessed on 29 October 2010).
- 8. Scullard P, Peacock C, Davies P (2010). 'Googling children's health: reliability of medical advice on the internet'. Archives of Disease in Childhood, vol 95, no 8, pp 580-82. Available at: http://adc.bmj.com/content/95/8/580.full (accessed on 29 October 2010).
- 9. Grogan-Johnson S, Alvares R, Rowan L, Creaghead N (2010). 'A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy'. Journal of Telemedicine and Telecare, vol 16, no 3, pp 134-9. Available at: http://jtt.rsmjournals.com/cgi/content/abstract/16/3/134 (accessed on 29 October 2010).
- 10. Nelson E, Barnard M, Cain S (2006). 'Feasibility of telemedicine intervention for childhood depression'. Counselling and Psychotherapy Research, vol 6, no 3, pp 191-5. Available at: www.ingentaconnect.com/content/routledg/rcpr/2006/00000006/00000003/art00008? (accessed on 29 October 2010).
- 11. Dick P, Bennie J, Barden W, Daniels C, Young NL (2004). 'Preference for pediatric telehome care support following hospitalization: a report on preference and satisfaction'. Telemedicine Journal and e-Health, vol 10, supplement 2, pp 45-53. Available at: www.liebertonline.com/doi/abs/10.1089/tmj.2004.10.S-45?journalCode=tmj.2 (accessed on 29 October 2010).