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BACKGROUND: In recent years, telemedicine has gained increasing importance in the delivery of pharmaceutical care. The use of video technologies for remote communication between different parties offers the potential to meet the future challenges which arise from the increase in elderly and chronically ill patients. However, the influence of these technologies on patient-related outcomes in pharmaceutical care is not yet sufficiently known.; METHOD: In December 2018 a systematic literature search was conducted in the databases Medline, Cochrane Library and PubPharm. Randomized controlled trials were considered, which investigate real-time video conferencing between pharmacists on the one hand and patients or other healthcare providers on the other hand. The influence on patient related outcomes compared to standard care was assessed. The bias potential was evaluated using the Cochrane Risk-of-Bias instrument. A total of 4 randomized controlled trials could be included.; RESULTS: The studies describe partly complex intervention settings with adults and adolescents suffering from asthma, chronic renal failure, HIV infection, hyperlipidemia, hypertension and/or diabetes. None of the studies considers the interprofessional communication of pharmacists with other service providers. No influence on clinical or psychological endpoints was found. In some cases, an increase in adherence and correct medication use is evident. Healthcare utilization is not influenced. In all studies there is an increased risk of systematic bias.; DISCUSSION: Teleconsultations with pharmacists can rather be used to ensure the general provision of pharmaceutical care than to improve patient-related outcomes. Further studies are necessary to fully depict the influence of telemedical interventions in pharmaceutical care. Copyright © 2020 Elsevier Inc. All rights reserved.

Media reporting can influence the perception and development of attitudes through the frequency and the way certain topics are presented. The German Medical Journal “Deutsches Arzteblatt” is one of the most important media for agenda-setting in Germany. It thus has an influence on opinion-forming and acceptance within the medical profession in regard to innovative healthcare technologies. The aim of this work is to quantify the media representation of telemedicine and deduce the qualitatively depicted acceptance factors. All articles on telemedicine published in “Deutsches Arzteblatt” between 01/01/2008 and 01/01/2018 were reviewed. The type of article, the focus, the connotation, and the degree of explanation were recorded quantitatively as well as the discussed topics and content aspects. In a structured content analysis, acceptance factors were derived based on the unified theory of acceptance and use of technology (UTAUT). The representation of telemedicine in the German Medical Journal has increased significantly in the last 10 years, and shows a tendency towards neutral and balanced reporting. A change in content can be seen. While the focus was still on technical aspects until 2012, it is currently increasing in the scientific–medical field. Emphasis is put on the presentation of expectations of performance and effort as well as the description and modification of framework conditions. Further research is needed, focusing on the relevance of media representation of new forms of care such as telemedicine in order to increase acceptance and to develop attitudes on an individual, organizational, and systemic level.

Background Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. Objective The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. Methods A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. Results In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. Conclusions Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.

Background: The use of information and communication technologies (ICT) in health care is increasing attention. To describe health inequalities and equity with regard to the use of digital health technologies in a care context and to understand interrelationships, it is of particular importance for the field of care research to use models and theories that explain health inequalities and equity in the use of digital technologies. Aims: This article aims to identify models and theories from the field of nursing and health research that explain the phenomenon of health inequalities and the influence of digital health technologies on the emergence of inequalities. Methods: Relevant articles were searched in electronic databases (MEDLINE, CINAHL & SocINDEX) between July and August 2019 in German and English, within the methodological framework of a scoping review. The systematic literature search and data extraction were performed by 2 reviewers. The description of data refers to standard criteria by 8-1Christiansen and Baum (1997). Results: From a total of 25 relevant articles, 2 were identified for inclusion in the current overview. One model is focusing on ICT for health and the other model focuses on eHealth. No nursing theory could be identified in the context of describing the phenomenon of digital inequality. Conclusions: In both models, there is a lack of discussion about the impact of nursing aspects on the use and acceptance of eHealth technologies. One point should also be the development of models and theories that consider the user perspective of vulnerable groups.

Background Digital games–based learning is a method of using digital games to impart knowledge. Virtual reality (VR) programs are a practical application of this method. Due to demographic changes, the nursing profession will become increasingly important. These VR applications can be of use in training nurses for future professional challenges they may encounter. The continuous development of VR applications enables trainees to encounter simulated real life effectively and to experience increasingly concrete situations. This can be of great importance in nursing education, since 3-dimensionality enables a better visualization of many fields of activity and can prevent potential future errors. In addition to this learning effect, VR applications also bring an element of fun to learning. Objective The aim of this qualitative research effort is to observe the degree of acceptance of VR applications by nursing students in Germany. Various factors, including social influences, performance expectations, and effort expectations, are taken into consideration. Methods With a qualitative cohort study, the acceptance of nursing students towards VR applications in anatomy teaching was determined. The 12 participants were first asked to fill out a quantitative questionnaire on their sociodemographic characteristics and the extent to which they valued and liked using technology. The participants were then allowed to test the VR application themselves and were finally asked about their experience in a qualitative interview. For the collection of data and the analysis of results, the unified theory of acceptance and use of technology was used in this study. Results Overall, the study shows that the interviewed persons rated the VR application quite positively. The greatest influence in this was the personal attitude towards technology; the higher this affinity is, the more useful the VR application appears. Social influences can also increase the participant’s own acceptance if peers have a positive attitude towards such applications. The study shows that the trainees' motivation to learn was increased by using VR. We believe this is because each trainee could learn individually and the VR application was perceived as an enjoyable activity. Nevertheless, the cost factor of implementing VR applications in nursing training is currently still an obstacle, as not every institution has such financial capacities. Conclusions The extent to which the use of VR applications in the training of nursing staff is justified depends on the degree of personal acceptance. The collected results give good practice-oriented insight into the attitude of trainees towards VR. Many of the interviewed persons saw benefits in the use of VR technologies. As VR applications are constantly developing, it is necessary to conduct further studies on VR applications in nursing education and to include other possible disciplines in which these applications can be helpful.

Zusammenfassung. Hintergrund: Der Einsatz von Informations- und Kommunikationstechnologien in der ambulanten Pflege erfolgt vor dem Hintergrund des demografischen Wandels mit dem Ziel, auch in Zukunft die Qualität der pflegerischen Versorgung sicherzustellen. Die Akzeptanz der telematischen Anwendungen ist dabei entscheidend für die erfolgreiche Implementation. Ziel: Das Ziel der Untersuchung war eine Erfassung der subjektiven Haltungen und Einstellungen sowie der Nutzungsintention der Pflegekräfte hinsichtlich telematischer Anwendungen in der ambulanten Pflege. Methoden: Auf der theoretischen Grundlage der „Unified Theory of Acceptance and Use of Technology“ (UTAUT) wurde eine Onlineumfrage erstellt, anhand derer deutschlandweit ambulante Alten- und Krankenpflegekräfte sowie Auszubildende in Pflegeschulen befragt wurden. Insgesamt konnten 371 Befragte in die Analyse eingeschlossen werden. Ergebnisse: Der Informationsstand zur Telematik und die eigenen technischen Kompetenzen werden als gering eingeschätzt. Es wird eine verbesserte Transparenz des Pflegeprozesses erhofft; genauso wie eine Erleichterung des Austausches sektorintern und -übergreifend. Dagegen wird befürchtet, dass die telematischen Anwendungen mit erhöhten Kosten, Schulungsaufwand und Technikabhängigkeit einhergehen. Schlussfolgerungen: Die Ergebnisse zeigen die Relevanz der Einstellungen und Bedürfnisse von Nutzerinnen und Nutzern für eine erfolgreiche Implementierung. Aus-, Fort- und Weiterbildungen sollten in Zukunft verstärkt die technologische Kompetenz der Pflegekräfte fördern.

Background Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. Objective The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. Methods A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. Results From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0%), followed by relatives (68/175, 38.9%), and both target groups (30/175, 17.1%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1%) and randomized controlled trials (44/175, 25.1%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5%) of the technology, while others targeted feasibility or usability or were explorative. Conclusions This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users’ informational needs is required. Moreover, there is a need for larger studies on the technologies’ effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives.

Background Heart failure is one of the most common and cost-intensive chronic diseases worldwide. Telemonitoring offers the potential to improve care of heart failure treatment and reduce cost. Empirical findings of its efficacy are inconsistent up to now. This systematic review examines the current state of research regarding health-related and economic endpoints. Methods A systematic review was conducted in July 2016 using the PubMed database and randomised controlled trials for the years 2011-2016. Only clinical research trials with heart failure patients were considered where the intervention was performed using external monitoring devices which transmitted data via information and communication technology. In all, 10 clinical trials were included. Results There is no definite evidence regarding improvement in care based solely on the most recent literature. Hospitalisation for heart failure and health-related quality of life were most positively influenced. There was no correlation between mortality and hospitalisations for all causes regarding telemonitoring. The overall costs tended to be higher for telemonitoring. Conclusion Further research is needed to examine the health-related and economic benefits of telemonitoring for heart failure. A particular challenge is the evidence of cause-effect relationships within complex technology-supported health-care settings. The latest studies support the previous state of research.

In June 2015 the scientific academies "Leopoldina" and "acatech" and the union of the German academies of sciences and humanities published a statement on public and global health in Germany. The statement contains many valuable albeit generic and well-known recommendations. The few specific recommendations focus on centralizing research while weakening the role of universities and on the relative increase of research on public health genomics. These recommendations are not based on empirical or theoretical analyses and risk subverting successful developments of the recent past. To actually strengthen public and global health in Germany the existing institutions need to be backed up while designated funding of public and global health needs to be extended.

Hintergrund: Der Schlaganfall ist eine der haufigsten Todesursachen weltweit, eine der zentralen indikationsbezogenen Ursachen fur Behinderung und damit eine wesentliche Herausforderung fur die Gesundheitsversorgung. Teleneurologische Ansatze zeigen in der praklinischen, klinischen und rehabilitativen Versorgung ihre Wirksamkeit mit Blick auf die Verbesserung gesundheitsbezogener Endpunkte sowie die Reduktion der Versorgungskosten. Entscheidend fur die nachhaltige Implementierung telemedizinischer Versorgung ist die Akzeptanz der Nutzerinnen und Nutzer. Fragestellung: Der gewahlte qualitative Forschungsansatz untersucht, welche Haltungen, Motive und Einstellungen die Verhaltensintention zur Nutzung telemedizinischer Versorgungskonzepte in der Sekundarpravention nach Schlaganfall bei Patientinnen und Patienten beeinflussen. Material und Methode: Im Rahmen der stationaren Rehabilitation wurden 8 Fokusgruppen mit insgesamt 40 Patientinnen und Patienten durchgefuhrt und inhaltsanalytisch ausgewertet. Zur Abbildung der Einstellungsprozesse gegenuber dem Technikeinsatz wurde den Teilnehmerinnen und Teilnehmern ein telemedizinisches Versorgungssetting vorgestellt. Als strukturgebende Theorie in der Erhebung des Materials rekurriert die vorliegende Studie auf die Unified Theory of Acceptance and Use of Technology (UTAUT). Ergebnisse: Haltungen und Einstellung zur Nutzung telemedizinischer Verfahren in der poststationaren Versorgung sind bei Patientinnen und Patienten eindeutig nutzwertorientiert – auch wenn latente Angste (z. B. hinsichtlich des Datenschutzes oder eines zu unpersonlichen Kontaktes zu den Arztinnen und Arzten) vorliegen. Der Prozess der Entscheidungsbildung lasst sich durch die Adoptoren „Leistungserwartung“, „Aufwandserwartung“, „soziale Einflusse“ und „handlungserleichternde Rahmenbedingungen“ charakterisieren. Schlussfolgerungen: Die Einstellungen und Haltungen von Patientinnen und Patienten mussen in der Weiterentwicklung telemedizinischer Versorgungssettings zielgruppenspezifische Berucksichtigung finden. Aufgrund der klaren Nutzwertorientierung kommt der evidenzbasierten Entwicklung und Implementierung der Telemedizin ein besonderer Stellenwert zu.

Zusammenfassung Hintergrund In den vergangenen Jahren lässt sich eine deutliche Zunahme an onlinebasierten Therapieangeboten für Menschen mit depressiven Erkrankungen beobachten. In einer Vielzahl von wissenschaftlichen Arbeiten konnten bereits die Wirksamkeit und Effizienz dieser Programme bestätigt werden. Einen wesentlichen Erfolgsfaktor für eine erfolgreiche Etablierung dieser neuen Versorgungsangebote stellt die Nutzerinnen- und Nutzerakzeptanz dar. Theoriebasierte Akzeptanzanalysen können für eine langfristige Einführung wertvolle Erkenntnisse liefern. Methoden Im Rahmen einer bundesweiten Onlineerhebung wurden Einstellung und Haltung gegenüber internetgestützten Psychotherapieangeboten bei depressiven Erkrankungen, der aktuelle Wissenstand sowie die Nutzungsintention von 186 Studienteilnehmerinnen und -teilnehmern erfasst. Die Rekrutierung erfolgte über Selbsthilfegruppen für depressive Erkrankungen. Die in die binär logistische Regression einfließenden Determinanten der Nutzungsintention von Onlinetherapie beruhen auf der Unified Theory of Acceptance and Use of Technology (UTAUT). Ergebnisse Fast zwei Drittel der Befragten können sich vorstellen, Onlinetherapieangebote zukünftig zu nutzen. Als signifikant einflussnehmende Prädiktoren auf die Nutzungsintention erwiesen sich die wahrgenommenen Leistungs- und Aufwandserwartungen. Hierzu zählen insbesondere die Bewertung des Einsatzes von E-Mental-Health als Hilfsmittel zur Krankheitsbewältigung, zur Aktivierung und besseren Einschätzung des eigenen Krankheitsverlaufes. Schlussfolgerungen Ob E-Mental-Health-Angebote langfristig einen Beitrag zur Verbesserung der psychosozialen und psychotherapeutischen Versorgung leisten können, wird, neben technik- und rechtwissenschaftlichen Begutachtungen, ganz maßgeblich von Fragen der Evidenzbasierung und der Nutzerinnen- und Nutzerorientierung innerhalb von Forschung, Entwicklung und Implementation abhängen. Die vorliegenden Ergebnisse bieten einen ersten theoriegeleiteten Ansatz im Bemühen um eine stärker nutzerinnen- und nutzerorientierte Technikforschung im Gesundheitswesen, innerhalb der zukünftig weitere Diversitätskriterien berücksichtigt werden müssen.

Innovative healthcare services and technologies show great promises for reducing individual and societal burdens, but predominantly fail to attract sufficient end user acceptance and usage. This renders the aspect of technology adoption as key weakness of most health technology development endeavors, but also as most promising area for implementing changes that can dramatically increase the likelihood of project success. The purpose of this paper is to discuss some core assumptions of a user-centered process framework for technology adoption that addresses three major weaknesses of many current adoption models: First, the inadequate consideration of the process character of health technology adoptions. Second, the restricted view of human motivation, information processing, and behavior as being primarily rational and utilitarian in nature. And third, the insufficient attention to situational and social influences, and the role of individual differences. Theoretical, methodological, user inclusion-related and communication-related implications of the proposed prespective changes are discussed.