Table 4.
Summary of information of studies.
| Study; location | Groups, participants covered and sample size | Study design | Aim or discussion | Types of technology intervention | Key findings and planned or actual effectiveness |
| Study 1: Fox et al (2013) [41]; United Kingdom | Care home managers; Senior nurses from care homes; Health care assistants from care homes; Domiciliary managers from care homes; Combined sample of n=779 (20 studies) | Mixed-methods approach | Diabetes management in care homes and the use of guidelines for good standards of care in residential and nursing homes in the United Kingdom | Workshops led by health care professionals including focus group to identify key educational needs; educational presentation using VCa; and electronic learning | Identification of lack of written policy for diabetes management, knowledge, and training for staff in diabetes care, inadequate assessment of residents, lack of communication and specialist support from diabetes team, lack of resources for identification of risk of diabetes, access to specialist services, care planning and quality indicators. Educational needs supported by electronic learning seen as an inferior form of education when compared with a skilled, experienced educator. |
| Study 2: Benetos et al (2013) [42]; France | Elderly, frail residents in care homes living with diabetes and related comorbidities; sample size n=339 and n=675 (15 studies) | Mixed-methods approach, compilation of simple pragmatic advice for HCPs. | Initiatives for diabetes management in nursing homes. | Pragmatic advice for HCPsb concerning the management of elderly, frail diabetic patients tailored by a multidisciplinary team of French experts; eye slit lamp technology used by visiting HCP to the care home | To prevent complications associated with diabetes and comorbidities with emphasis on personal individual care planning for residents to adapt and individualize treatment together with education and training of patient, family, physician, nurses, and carers including individualized monitoring of glycemic targets. Access to specialists is recommended to be onsite. |
| Study 3: Kilvert & Fox (2015) [43]; United Kingdom | Older people living with diabetes with reference to the care home setting; sample size audit: 49,000; 2 case studies | Case studies, focus groups, and audit. | Recommendations and acknowledgment of policies and guidelines relating to diabetes management. | Improved technology using smart glucose meters; basal bolus regimes; insulin pumps and CGMc. | CGM could be employed to alert carers of undesirably low or high blood glucose levels, recognition of the need to individualize treatment, inability to access education, and training and communication between care home and primary care poor. Guidance produced by Diabetes UK |
| Study 4: Hausken & Graue (2013) [44]; Norway | HCPs in nursing homes who care for older people with diabetes; sample size: 20 HCPs | Mixed-methods approach | Adequate training and support for enhanced professional competence of diabetes management in nursing homes and home-based services. | Educational training using a pilot program for health care workers; online learning and Web-based technology a potential source. | In Norway, it is a legal requirement to educate specialist health care workers to promote enhanced professional competence and ensure knowledge transfer between HCPs. Nurses and nursing aides are recognized as having different educational needs. This program provided enhanced evidence-based practice skills. Further research is recommended in this area. |
| Study 5: NHS England (2015) [45]; United Kingdom | Care homes and the care home community; sample NHSd reports and case studies about care services in England representing 9 areas across the United Kingdom (Sunderland, Nottingham-shire, London, Sussex, Stoke-on-Trent, Shropshire, Telford, Calderdale, Airedale, and Blackpool) | Case studies and reports | Various implementations to develop technological initiatives between care home and care provider to ensure multidisciplinary team engagement and reshape how care is delivered across England | Teleswallowing to provide Remote Assessment Providing Interventions for Dysphagia (RAPID); telehealth system using a tablet to aid caregiver using the National Early Warning Score (NEWS) as monitoring tool across the board; Using FLO with Skype by live streaming with General Practitioners’ for ward rounds. Promoting communication by fax, android tablet, two-way video links, telecare monitoring equipment with online toolkits for all HCPs. Secure email accounts; shared directory created; standardized documentation with structured messages developed to a national care standard to ensure MDTe engagement and support with each other. Android tablets for monitoring telehealth system alerting staff early to initiate early interventions aiding to avoid admission to hospital. Care homes using secure email to improve the flow of information and communication in and out of care homes; online toolkit for staff; telehealth system to alert changes in patients’ observations, for example, monitoring the risk of falls. Two-way video link between care home and clinicians. | Various implementations of telehealth, telemedicine, and telecare including technology-enabled care services across the United Kingdom between care homes and care providers. New and proactive ways of the delivery of safe, effective care. |
| Study 6: Carlisle & Warren (2013) [30]; Australia | Health practitioners and patients; sample size; 2-arm prospective RCTf; n=210 | Mixed-methods | To explore the implementation of a telehealth service within a coordinated model of care for chronic disease management. | Telehealth using home monitoring and videoconferencing with the diabetes care coordinator and GPg to resolve emerging clinical complications; regular emailed reports; broadband communication; telephone contact as required | Definitive conclusions not possible because of limited sample size. However, results showed that participants were keen to engage in telehealth, interpersonal skills, and operational factors were identified as key enablers. Positive working relationships were identified as important for sustaining engagement with telehealth. Benefits of telehealth such as greater access to health care services, improved health outcomes, and effective service delivery. It also highlighted the complexity of chronic disease management positively influenced by the effective implementation of telehealth. |
| Study 7: Cook et al (2017) [46]; United Kingdom | Residential and nursing home community; GPs and allied health care professionals; sample size (study 1) n=45; (study 2) n=28 | Qualitative using constructionist methodology | Aligning access to GP, practice and older people, nurse specialists with care homes using the whole systems service delivery model approach. | Enhanced health care infrastructure for care home residents using a community-based virtual ward providing regular case management. MDT health professionals are then drawn into the group on a case-by-case basis. | Multiple competencies are required by the HCP to provide preventative care, the complex management of frailty, comorbidity, and end-of-life care can only be achieved through multisector and multi-professional working. The whole systems approach enables practitioners to share information and knowledge, problem solve and deliver coordinated care. |
| Study 8: Brown et al (2016) [47]; United States | NPsh and RNsi caring for the older population of patients with long-standing diabetes; sample size n=52 | Quality improvement project and pilot intervention longitudinal cohort evaluation | New model of diabetes management in chronic care delivery. | Care coordination using telehealth, for education and virtual outreach clinic; Communication between veterans and health care providers using protocols and documentation template; registered nurses provided patient education coaching in addition to protocol-adjusted medications; and transmission of blood glucose management via telephone | RNs use of didactic training, access to NP team leader partnering with patients, the use of a mentor, the use of medication titration using protocols and support from a clinical team to ensure safe, timely, and efficient care. |
| Study 9: Spanakis et al (2012) [48]; Europe | Allied professionals, patients, and specialists; sample: doctors, nurses, social scientists, technical personnel, patients, carers, nutritionists, and lawyers | Qualitative using focus groups | New care models incorporating advanced ICTj to support diabetes management in clinical applications CGM in different health care regimes, to integrate clinical and organizational workflows with external health information systems. | REACTION Platform via the Web to integrate care; insulin pumps; electronic health for integrated care space; closed-loop system aiding management of diabetes using ICT; glucose monitoring system; ICT tools for health care support; feedback provision to the point of care; integrative risk assessments Web-based; and electronic patch sensors | Technology allowing for a more accurate, faster response to crisis as well as better overall management in the prevention of complications of the disease. Advanced ICT and wireless technologies to enable continuous monitoring and automated closed-loop delivery of insulin via an insulin pump. The REACTION platform endeavors to provide integrated, professional, management, and therapy services using new chronic care models for diabetes patients in and across Europe. |
| Study 10: Wild et al (2014) [49]; United Kingdom | Care home community including staff, relatives, residents, and carers attached to the care home; sample care staff: n=20; residents n=10; and relatives n=10 | Qualitative | Views and perceptions of the care home community on the role of technology design and the potential value of using technology for the care of older residents. | Future development of technologies within care homes considering: environment; assistive devices links to the community associated with a therapeutic approach; assessment tools; links to MDT; telecare; wireless sensors; telehealth; and virtual external access; speech recognition | Considerations for the development of design and technology, preparation for the introduction of technology would increase uptake, older people can learn new technological skills. To create technology that recognizes residents’ long-term care needs enabling and empowering residents with the aim of improving the overall quality of life. Lack of research in this area is a limitation. |
| Study 11: Mason (2012) [50]; United Kingdom | Care Home Community; sample workshop participants | Report: Vision of the Care Home of the Future | Central to meeting the needs of older people in care homes, with a focus on the delivery of care using technology to improve the lives of residents. | Technology for staff supporting care delivery in the care home setting. Technology to keep people mentally alert and engaged with the outside world; checking systems for staff and residents; tablets and computers; GPSk trackers; medication reminders; epilepsy monitors; lifestyle and behavioral monitoring; video conferencing; telemedicine; information sharing via the Web; and environmental technologies technology tailored to meet individual needs | Future aspirations and visions for the future of care homes to primarily improve the quality of lives of residents promoting changing the landscape of care homes, workshops, staffing developments, care regulation and environment. A clear vision for the care home setting to be seen as a community hub enabling world-class coordinated leading quality care. |
| Study 12: Brittain et al (2016) [51]; United Kingdom | Care home community; 761 studies mapped | Rapid evidence synthesis | To underpin the spread of new models of care by conducting a rapid synthesis of evidence relating to enhancing health in care homes. | Technology: cost, ease of use, and staff demands; Workforce: interventions promoting positive joint working within the care home; Communication and engagement- tools to structure communication have the potential to enhance clinical outcomes; and Evaluation: insufficient data reported. | Digital technology has multiple potential applications in care homes. The use of SBARl as a standardized tool to structure communication. Cost, ease of use and staff demands identified as both barriers and facilitators to the implementation and use of technology. |
| Study 13: Benhamou et al (2013) [52]; France | Patients living with diabetes; sample: n=163, older diabetic individuals | Mixed-methods review | Current developments of information technology for the management of diabetes | Telemedicine delivery platform involving doctors and nurse educators; telemonitoring; Web-based programs to enable collaborative access to patient medical records. Downloadable capillary glycemic data; feedback with GPs via telephone consultations enabling real-time decision support; blood glucose online diary; secure messaging system; and educational websites | The use of information tools, specific software, and the internet provides support and encourages behavior necessary to prevent clinical inertia and effectively manage diabetes by improvement of therapeutic compliance through motivational support. The development of telemedicine and mobile internet contributes to better diabetes management for the user. |
aVC: video conferencing.
bHCP: health care professional.
cCGM: continuous glucose monitoring
dNHS: National Health Service
eMDT: multidisciplinary team.
fRCT: randomized controlled trial.
gGP: general practitioner.
hNP: nurse practitioner.
iRN: registered nurse.
jICT: Information and Communication Technologies.
kGPS: Global Positioning System.
lSBAR: Situation, Background, Assessment, Recommendation.