This study will determine the effectiveness of a telehomecare intervention on adherence to medication regimens by elderly home health patients. The intervention is designed to promote continuity-of-care by a collaborative team of home health nurses and pharmacists with the goal of reducing adverse outcomes associated with improper adherence to medication regimens. With demands on health care providers to improve quality, efficiency, and cost-effectiveness, identifying the appropriate use of technology in the provision of health services is critical. The use of telehomecare (a telemedicine system that connects the nurse to the patient over ordinary telephone lines) is one technology that can be used in the home care setting. In addition to benefiting patients, this study will advance nursing practice. The development of a telehomecare model of patient care will impact the nursing profession, home health care organizations, telehomecare practice standards, policy positions, competency definitions, and curricular needs. Our conceptual model proposes that the telehomecare intervention enhances patient empowerment, which has a direct effect on clinical outcomes. Specific research questions are as follows: (a) what is the differential impact of a telehomecare intervention (TI) on medication adherence and clinical outcomes, as compared to standard home visits (SHVs)?; (b) which delivery mechanism (TI or SHV) is the most cost-effective in providing patient counseling to improve adherence to medication regimens?; and (c) how does nurse-pharmacist collaboration in the patient's care plan contribute to the efficacy and effectiveness of medication managements? Home health patients with a diagnosis of congestive heart failure will be assigned randomly to one of three groups: (1) standard home care and telehomecare with a registered nurse (RN) and a clinical registered pharmacist(RP); (2) standard home care and telehomecare with RN; and (3) control group-standard home care only. Outcomes to be measured include adherence to medication regimen, cardiac status, empowerment, quality of life, patient satisfaction, and cost-effectiveness.
