Articulo en Ingles

ten Haken et al.
BMC Public Health (2018) 18:284

https://doi.org/10.1186/s12889-018-5123-4
RESEARCH ARTICLE Open Access
The use of advanced medical technologies

at home: a systematic review of the
literature
Ingrid ten Haken1*, Somaya Ben Allouch1 and Wim H. van Harten2,3
Abstract
Background: The number of medical technologies used in home settings has increased substantially over the last
10–15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical
experiences are important. This paper presents a literature review on types, trends and experiences with the use of
advanced medical technologies at home.
Methods: The study focused on advanced medical technologies that are part of the technical nursing process and
‘hands on’ processes by nurses, excluding information technology such as domotica. The systematic review of
literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000
to 2015 and selected articles containing empirical material.
Results: The review identified 87 relevant articles, 62% was published in the period 2011–2015. Of the included
studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy.
Most research has been conducted on the topic ‘user experiences’ (36%), mainly regarding patients or informal caregivers.
Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with
advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However,
relatively low numbers of articles were found studying nurses perspective.
Conclusions: Research on medical technologies used at home has increased considerably until 2015. Much is already
known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological
development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for
homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses
and human factors by nurses in risk management and patient safety.
Keywords: Home health nursing, Medical technologies, Patient safety, Quality of health care, Systematic review, Trends
Background When ‘an increase’ in the number of medical tech-

As a result of demographic changes and the rapidly in- nologies used at home is mentioned, it is not clear which
creasing number of older patients, there is a need for cost and how many technologies are involved. Today, there
savings and health reforms, which include an increased are an estimated 500,000 different kinds and types of
move from inpatient to outpatient care in most industrial- medical devices available on the world market [8, 9].
ized countries over the last 10–15 years [1, 2]. As a conse- The European Commission (EC) publishes data regard-
quence, the transfer of advanced medical devices into ing legislation and regulations for medical devices, but
home settings was considerable and it is expected that the actual figures for medical technologies in outpatient
there will be a further increase in the near future [1–7]. practice are not available [10]. The U.S. National Center
for Health Statistics (NCHS) stated that technologies
have shifted from hospitals into the home, but it too
* Correspondence: i.tenhaken@saxion.nl
1
Saxion University of Applied Sciences, Research Group Technology, Health &
does not illustrate its findings with statistics [11]. We
Care (TH&C), P.O. Box 70.000, 7500 KB Enschede, The Netherlands searched for data with regard to the actual number of
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
ten Haken et al. BMC Public Health (2018) 18:284 Page 2 of 33
medical technologies used in home settings and it specification for a home use medical device is: ‘A med-
proved difficult to find any systematic data sets available ical device intended for users in any environment
throughout the international landscape. outside of a professional healthcare facility. This includes
An important condition for the application of medical devices intended for use in both professional healthcare
technology in the home setting is that quality of care facilities and homes’ [18].
and patient safety must be guaranteed [6]. From a his- The landscape of medical devices is diverse with tech-
torical perspective medical technologies were designed nologies varying from relatively simple to very complex
for hospital settings [12, 13]. This means that specific devices. Wagner et al. [19] stated that ‘high-tech
factors regarding the implementation and use at home dependency’ (for children) matches with ‘technology-de-
now need to be taken into account [7, 14, 15]. In gen- pendency’ if it concerns ‘a medical device to compensate
eral, risks with medical technologies can be classified re- for the loss of a vital bodily function and substantial and
garding (a) environmental factors; (b) human factors and ongoing nursing care to avert death or further disability’.
(c) technological factors [16]. Human factors, however, ‘The needs of these patients may vary from the continu-
are very important in patient safety in both hospital and ous assistance of a device and highly trained caretaker to
in home settings [1, 6, 12]. For example, a major risk less frequent treatment and intermittent nursing care’
factor is the number of users and handovers in the chain [20]. Although patients dependent of advanced medical
of care. In home settings, a sometimes impressive num- technologies at home are often medically stable, they
ber of different users of medical technology, often with sometimes have high technical needs and may be
various levels of training, instruction or education, are expected to need long-term recovery. They also require
involved. Although patient empowerment moves control skilled nursing [21] and a considerable degree of ad-
to the patient and/or relatives, an important user group vanced decision making, planning, training and oversight
is that of professional nurses. Understanding user expe- [22]. An overall definition of ‘advanced medical technol-
riences and information about adverse events and near ogy’ is: ‘Medical devices and software systems that are
incidents are important aspects for developing know- complex, provide critical patient data, or that directly
ledge regarding implementation and use in home care implement pharmacologic or life-support processes
setting. Sharing this knowledge can support patients and whereby inadvertent misuse or use error could present a
caregivers, and especially nurses in their professional known probability of patient harm’ [23]. Examples of ad-
work and will also contribute to patient safety and qual- vanced medical technologies used at home include venti-
ity of care. lators for respiratory support, systems for haemo- or
Therefore, there is a need to address the question first, peritoneal dialysis and infusion pumps to provide nutri-
which types of technologies are used at home; second, tion or medication.
how frequently are they used and third, what trends can In the Netherlands, the National Institute for Public
be distinguished. Additional research questions are Health and the Environment (RIVM) [24] uses the fol-
whether there are any scientific data regarding particular lowing definition:
user experiences; training, instruction and education; Advanced medical technology or high-tech technology
safety and risks, and finally, what can be concluded in the home setting is defined as technology that is
about the role of nurses in using medical technologies in part of the technical skills in nursing and meets the
the home environment. The objective of this paper following conditions:
therefore is to present a systematic literature search on
the international state of art concerning various aspects technology that is advanced or high-tech, for example
of the use of advanced medical technologies at home. equipment with a plug, an on/off switch, an alarm
button and a pause button;
Definitions technology that had been applied formerly only in
First, we want to clarify some definitions. In general, hospital care, but that is now also often applied in
‘health technology’ refers to the application of organized home settings;
knowledge and skills in the form of devices, medicines, technology that can be categorized as ‘supporting
vaccines, procedures and systems developed to solve a physiological functions’, ‘administration’ or
health problem and improve quality of life [17]. The ‘monitoring’.
World Health Organization [8] uses the definition of
‘medical device’ as ‘An article, instrument, apparatus or Within the Dutch classification of advanced medical
machine that is used in the prevention, diagnosis or technologies 19 different devices are identified (see
treatment of illness or disease, or for detecting, measur- Table 1), which will be used in this review as a basis to
ing, restoring, correcting or modifying the structure or categorize the technologies. It is a classification format
function of the body for some health purpose …….’. A in which specific advanced technologies are defined.
Table 1 Classification of advanced medical technologies in the AND NOT (ehealth OR telecare OR telemedicine).
Netherlands according to the National Institute for Public Health Online databases MEDLINE, Scopus and Cinahl were
and the Environment (RIVM) [24] searched electronically using the search string to
Technologies with regard to: obtain data.
Supporting physiological functions:
1. Respiratory support Inclusion and exclusion criteria
2. Sleep apnea treatment
Criteria for selection were defined prior to the search
process. General criteria for inclusion were:
3. Suction devices
4. Oxygen therapy – Year of publication: 2000–2015.
5. Dialysis – An abstract or an article (with or without abstract)
6. Vacuum assisted wound closure has to be available, containing reference to AMT
7. Decubitus treatment information.
8. External electrostimulation
– The article is published in English, German, French
or Dutch/Flemish language.
9. Continuous passive motion
– If medical technology is cited, it has to conform to
10. Skeletal traction the definition of ‘advanced medical technology’ [24].
11. Patient lifting hoists – The abstract or the article has to contain empirical
Administration: material. For the purpose of this review, ‘empirical
12. Infusion therapy material’ has been defined as: AMT which is designed
13. Insulin pump therapy
for the home setting, or where the design or choices
took into account the setting of the home, or where
14. Parenteral nutrition
the medical technology has been tested for the home
15. Enteral nutrition or if the medical technology is already on the market
16. UV therapy and being used in the home setting.
17. Nebulizer
Monitoring: For further selection, inclusion criteria related to the
18. Fetal cardiotocography
key concepts for title and abstract were applied, such as
‘advanced medical technology’, ‘high-tech medical tech-
19. Respiratory and circulatory monitoring
nology’, ‘home-centred health-enabling technology’ and
‘care at home’. The classification of the RIVM (see Table
Terms as ‘advanced medical technology’ (from now on 1) has been taken as a basis to categorize technologies in
abbreviated as AMT) will be used consistently as syno- this review. Domotica and telemonitoring technologies
nyms for ‘complex medical technology’ and ‘high-tech scored under ‘monitoring’, such as fetal cardiotocogra-
medical technology’. The term ‘technology’ will be used phy, and respiratory and circulatory monitoring, were
in the meaning of ‘device’ or ‘equipment’. The target is left out. If the abstract or article was about electronic
on technologies that are instrumental and ‘hands on’ use health records, ‘smart home’, ambient intelligence, perva-
by nurses in the care for patients. This means that infor- sive computing, software of devices, smartphone or
mation technology (IT) based technologies as domotica surgical robots, the article was also removed from selec-
(automation for a home) are not part of the study. tion. Technologies as ‘VAD (ventricular assist device)’,
‘dental devices’ and ‘AED (automatic external defibrilla-
Methods tor)’ were not seen as part of the technical nursing
Eligibility and search strategy process and these records were left out as well. Studies
The systematic review of the literature was conducted conducted in the hospital, hospice or nursing home set-
early 2016. Key concepts for the review were ‘medical tings were also excluded. An overview of all inclusion
technologies’ or ‘medical devices’, and ‘home settings’. and exclusion criteria can be found in Table 2.
The concept of ‘home settings’ is related to the terms
‘home nursing’ and ‘home care service’, of which the Screening process
stem is ‘home’. Combining the key concepts provided The search in the online databases using the search
the search string: (‘medical technology’ OR ‘medical string, identified a total of 1287 references. After check-
device’). As domotica is not part of the study, the search ing for duplicates, 1070 articles remained. Those articles
string was extended with: AND NOT (eHealth OR were reviewed by a reviewer for titles and abstracts on
telecare OR telemedicine). The exact search string is basis of the inclusion and exclusion criteria. A double
(“medical technology” OR “medical devices”) AND home check was performed by two reviewers, who
Table 2 Inclusion and exclusion criteria for title and abstract Table 2 Inclusion and exclusion criteria for title and abstract
and/or and/or (Continued)
Inclusion Exclusion Inclusion Exclusion
Title Advanced medical eHealth CAPD (Continuous Ambulatory technology that is part of
technology (−ies) Telehealth Peritoneal Dialysis) the technical skills in
Medical technology (−ies) Telenursing APD (Automated nursing and meets the
Medical device(s) Telemedicine Peritoneal Dialysis) following conditions:
High-tech medical Telemedical system Dialysis machine • technology that is
technology (−ies) Telehomecare Sorbent dialysis advanced or high-tech, i.e.
High-tech home care Telecare 6. Vacuum assisted wound equipment with a plug, a
Home Teleconsultation closure (RIVM) switch on/off button, alarm
Homecare Ambient assisted Negative-pressure wound button, pause button etc.;
Home health care environment therapy system • technology that had been
Home-based care iPad technology VAC- therapy applied formerly in hospital
Home-based VAD (ventricular assist NPWT care (‘intramural’), but that
technology (−ies) device) Vacuum assisted wound is applied also often in
Home-centered health- Dental devices closure home settings nowadays;
enabling technology (−ies) ECG (electrocardiogram) 7. Decubitus treatment (RIVM) • technology that can be
Care at home AED (automatic external Pressure ulcer treatment categorized as ‘supporting
Care in the home defibrillator) Decubitus treatment physiological functions’,
AND Hospital Decubitus mattress ‘administration’ or
Inclusion criteria for abstract Hospice Pressure relief mattress ‘monitoring’.
below Nursing home 8. External electrostimulation
(RIVM)
Abstract Year of publication: 2000–2015 - If no abstract and no
(External) electrostimulation
and/or 1. Respiratory support (RIVM) article available
Electrical stimulation
article Respirator - If the title is in English, TENS
Respiratory support but the article is written Nerve stimulation
Respiratory therapy not in English, German,
Transcutaneaous electrical
Ventilator French or Dutch/ Flemish.
stimulation to treat
Ventilator-assisted - If about medical slow-transit constipation
Mechanical ventilation technologies, but not 9. Continuous passive motion
Support ventilation about the application in
(RIVM)
Invasive ventilation the setting of the home.
Continuous passive motion
Non-invasive ventilation - If the abstract or article Motion therapy
Non-invasive mechanical contains no empirical 10.Skeletal traction (RIVM)
ventilation material. For the purpose
(Skeletal) traction
Continuous positive of this review, ‘empirical
Tension
airway pressure (CPAP) material’ is defined as: 11.Patient lifting hoists (RIVM)
Bilevel positive airway • medical technology Patient lift
pressure (BPAP, BiPAP) which is designed for
Patient hoist
Negative pressure the home setting, or
Transfer device
ventilation (NVP) • where the design or 12. Infusion therapy (RIVM)
Mechanical in-exsufflation choices took into Infusion pump
2. Sleep apnea treatment (RIVM) account the setting of
Infusion therapy
Sleep apnea treatment device the home, or
Central venous catheter
(Positive) airway pressure • where the medical Central venous line
device (PAP) technology has been Port a cath
3. Suction devices (RIVM) tested for the home and
PICC (perifally inserted
Suction machine • if the medical
central catheter)
Suction apparatus technology is already on Intravenous medication
Airway suction device the market or being used Intravenous therapy
Digital suction in the home setting.
Intravenous chemotherapy
Mucus removal - If the abstract or article
Analgesia pump
4. Oxygen therapy (RIVM) is about: PCA-pump (patient controlled
Oxygen therapy • electronic health records analgesia pump)
Long-term oxygen cylinder • ‘smart home’
Indwelling venous catheter
Long-term oxygen ventilator • ambient intelligence
13. Insulin pump therapy (RIVM)
Supplemental oxygen • pervasive computing Insulin pump therapy
Oxygen conserver • software of devices Insulin infusion
Oxygen concentrator • smart phone
14. Parenteral nutrition (RIVM)
Oxygen tank • (surgical) robots
Parenteral nutrition
5. Dialysis (RIVM) - If not conform the Parenteral feeding
Haemo dialysis definition of RIVM (2013, Intravenous nutrition
Hemo dialysis page 15) of ‘complex
15. Enteral nutrition (RIVM)
Peritoneal dialysis medical technology’.
Enteral nutrition
Peritoneal catheter Advanced medical Tube feeding / feeding tube
drainage system technology or high-tech Feeding pump
Peritoneal automatic technology in the home
Enteral feeding
delivery system setting is defined as
Table 2 Inclusion and exclusion criteria for title and abstract to categorise the medical technologies in the selected ar-
and/or (Continued) ticles. No methodological conditions of selected studies
Inclusion Exclusion were applied in advance and the quality criterion we
PEG-tube (percutaneous applied was that of the article had to contain empirical
endoscopic gastrostomy) material, as we wanted to obtain an comprehensive over-
PEGJ-tube (percutaneous 18. Fetal cardiotocography
endoscopic gastrostomy, (RIVM)
view of published studies of any design and to get insight
jejeunum) Electronic fetal in a variety of contents.
Percutaneous gastrostomy monitoring
tube Fetal monitoring
Jejeunostomy tube Cardiotocography
Gastrostomy feeding 19. Respiratory and Results
16. UV therapy (RIVM) circulatory monitoring Categorization of included articles
UV therapy (RIVM)
Ultraviolet therapy Capnography
The characteristics of the included articles are outlined
Phototherapy Respiratory monitoring in Table 3. All included articles were categorized by year
17. Nebulizer (RIVM) Circulatory monitoring of publication and the type of research, like the designs,
Nebulizer Pulse oximeter
Electrocardiography
methods and used instruments in the studies. Research
features were synthesized where possible into overarch-
ing categories. For example, ‘systematic review’ and ‘nar-
rative review’ were scored as ‘review’ and instruments as
independently screened random samples of 20% of the ‘semi-structured interview’ and ‘in-depth individual
articles. There was an initial agreement of 88%. In case interview’ were both assigned to the category ‘interview’.
of disagreement about the inclusion of an article, the For each study, the medical technology or technologies
decision was based on a joint discussion by all three re- on which the study was based was scored. The
viewers to an agreement of 100% and the resulting categorization was in accordance with the classification of
screening policy was applied to the rest of the abstracts. AMTs (see Table 1). For example, the devices ‘continuous
Based on the selected titles and/or abstracts, articles positive airway pressure (CPAP)’ and ‘negative pressure
were retrieved or requested in full text and assessed for ventilation (NPV) have both been categorized as ‘respira-
eligibility. Some articles were excluded from further tory support’; and the devices ‘jejeunostomy tube’ and
study, for reasons of ‘full text not available’ or the article ‘gastronomy tube’ as ‘enteral nutrition’. With regard to the
contained no empirical material. Finally, 87 studies category ‘dialysis’, further subdivision was made by using
remained which were included in the analysis (see Table 3). ‘haemo dialysis’ and ‘peritoneal dialysis’. If in an article a
A graphical representation of the screening process medical technology was mentioned as an example, but was
has been included in Fig. 1. no subject of study, then the technology was not scored.
‘Medical diagnosis (or diagnoses)’ as mentioned in the
Appraisal of selected studies studies, was included in the analysis only if it was related to
To conduct the systematic literature search on the inter- the medical technology as the subject of study, not if it has
national state of art concerning various aspects of the been mentioned as an example. In some cases, an under-
use of advanced medical technologies at home, several lying cause of diagnosis was indicated. For example, ‘chronic
sources are consulted. To guarantee a scientific stand- respiratory failure due to congenital myopathy’, in itself a
ard, only articles were retrieved from academic data- neurological disorder, has been scored as ‘neurological
bases. MEDLINE refers to journals for biomedical disorder’. Diseases or disorders have been classified as
literature from around the world; Cinahl contains an much as possible under the overarching name. For example
index of nursing and research journals covering nursing, ‘pneumonia’ and ‘cystic fibrosis’ are categorized under
biomedicine, health sciences librarianship, alternative ‘respiratory failure’, and ‘gastroparesis’ and ‘Crohns
medicine, allied health and more. These databases re- disease’ under ‘gastrointestinal disorder’. The category
lated to discipline have been supplemented with Scopus, ‘other’ contains diagnoses which occur only once, such as
which is considered to be the largest abstract and cit- ‘chromosomal anomaly’, or which are not yet determined,
ation database of peer-reviewed literature. Grey litera- like ‘chronic diseases’ or ‘congenital abnormalities’.
ture, such as national and international reports on In relation to the research questions, articles were
regulations and safety of medical technologies, is also classified regarding one of the following categories and,
used to illustrate the background of the problem state- where appropriate, into subcategories:
ment and describe definitions. The Classification of ad-
vanced medical technologies in the Netherlands 1. User experiences
according to the National Institute for Public Health and 2. Training, instruction and education
the Environment (RIVM) has been used as a framework 3. Safety, risks, incidents and complications
Table 3 Characteristics of included studies
Study Country Study design and sample Medical technologies Medical diagnosis Content
of study
Agar, J.W.M., Perkins, A., Australia Separately metered and serially Hemodialysis No medical diagnosis Evaluation of solar-assisted
Tjipto, A., 2012. [96] measured independent draws of mentioned hemodialysis.
each dialysis machine plus reverse
osmosis pairing.
n = 4 (home dialysis equipment
combinations)
Alsaleh, F.M., Smith, F.J., UK Cross-sectional face-to-face Insulin pump therapy Type 1 diabetes mellitus Examination of the impact
Thompson, R., Al-Saleh, M.A., semi-structured interviews; of switching from multiple
Taylor, K.M., 2014. [32] Qualitative and quantitative daily injections to insulin
approaches for data analysis pumps on the glycaemic
n = 34 (patients, children/young control and daily lives of
people) children/young people and
n = 38 (parents) their families.
ten Haken et al. BMC Public Health (2018) 18:284
Amin, R.S., Fitton, C.M., USA Long-term mechanical Chronic respiratory failure (CRF) An overview of indications
2003. [104] ventilation; as indicated by hypoxemia for use of home mechanical
Tracheostomy and or hypercapnia; ventilation, different
Chronic progressive lung methods and modes of
diseases; mechanical ventilation,
Neuromuscular disorders; ventilator settings and
Congenital muscular dystrophy; outcomes of long-term
Non-progressive chronic mechanical ventilation in
parenchymal lung disease; children.
Congenital central
hypoventilation syndrome
(CCHS);
Multiple genetic syndromes
such as myelomeningocele
with Arnold Chiari malformation,
skeletal dysplasia, Möbius
syndrome, Joubert and Prader-Willi
syndromes, and inborn errors of
metabolism such as pyruvate
dehydrogenase complex
deficiency, Leigh’s disease, and
carnitine deficiency, could be
associated with central
hypoventilation;
Bronchopulmonary dysplasia (BPD);
Chest wall dysfunction such as
asphyxiating thoracic dystrophy,
short limb dwarfism, giant
omphalocele;
Idiopathic scoliosis
Page 6 of 33
Table 3 Characteristics of included studies (Continued)
of study
Ao, P., Sebastianski, M., Canada Retrospective chart review Percutaneous endoscopic Esophageal/gastric cancer; Comparison of complication
Selvarajah, V., n = 560 (patients; n = 64 J-tube; gastrostomy (PEG) tubes; Head and neck cancer; rates, types, and average
Gramlich, L., 2015. [83] n = 496 PEG tube) Jejunostomy tubes Stroke; tube patency between
(J-tubes) Neurologic; jejunostomy tubes and
Other percutaneous gastrostomy
tubes in a Regional Home
Enteral Nutrition Support
Program.
Bezruczko, N., Chen, S.P., USA Functional Caregiving (FC); Tracheostomy; No medical diagnosis mentioned Development of an
Hill, C.D., Chesniak, J.M., Survey methods guided by a Tracheostomy/ ventilator; objective, linear measure of
2009. [45] caregiver content matrix BiPAP/CPAP mothers’ confidence to care
validated by content and for children assisted with
clinical reviews; medical technology in their
Survey forms, questionnaires homes.

n = 53 (mothers)
Bezruczko, N., Chen, S.P., USA Functional Caregiving (FC); Tracheostomy; No medical diagnosis mentioned Development of an
Hill, C.D., Chesniak, J.M., Survey forms, questionnaires Tracheostomy/ ventilator; objective, linear measure of
2011. [46] n = 53 (mothers) BiPAP/CPAP mothers’ confidence to care
for children assisted with
medical technology in their
homes.
Bortolussi, R., Zotti, P., Italy Prospective observational study; Peripherally inserted central Pancreatic cancer; Evaluation of distress and
Conte, M., Marson, R., Questionnaire; venous catheters (PICCs); Stomach cancer; pain perceived by patients
Polesel, J., Colussi, A., Structured interview; Midline catheters Other miscellaneous cancer; during the positioning of a
Piazza, D., Tabaro, G., Monitoring form (filled in by Non-neoplastic diseases PICC or midline catheter,
Spazzapan, S., 2015. [33] a nurse) both in the home and
n = 48 (patients) hospice settings, and the
perceived quality of life.
Bostelman, R., Ryu, J.-C., USA Static stability tests; Home Lift, Position and No medical diagnosis mentioned Evaluation of an advanced
Chang, T., Johnson, J., Dynamic stability tests; Rehabilitation (HLPR) Chair patient lift and transfer
Agrawal, S.K., 2010. [93] Method for autonomous device for the home.
maneuvers tested in simulation
and experiments
Brooks, D., King, A., Canada Study design based on Long-term mechanical Neuromuscular diseases: Identify user perspectives
Tonack, M., Simson, H., grounded theory; ventilation on the issues that impact
Gould, M., Goldstein, R., Semi-structured interviews Polio; the quality of the daily lives
2004. [29] n = 26 (patients) Amyotrophic lateral sclerosis (ALS); of ventilator-assisted
Cerebral palsy (CP); individuals living in the
Duchenne muscular dystrophy community.
(DMD);
Muscular dystrophy (MD);
Spinal cord injury (SCI);
Spinal muscular atrophy (SMA);
Transverse myelitis (TM)
Page 7 of 33
of study
Brown, K. A., Bertolizio, G., Canada Review Noninvasive ventilation Chronic stable respiratory failure; An overview of the
Leone, M., Dain, S.L., (NIV) Obstructive sleep apnea indications for home NIV
2012. [100] therapy, of the medical
devices currently available
to deliver it, and a specific
discussion of the
management conundrums
confronting anesthesiologists.
Buchman, A.L., Opilla, M., USA Retrospective evaluation of Home parenteral nutrition Short bowel syndrome (SBS); Identification of risk factors
Kwasny, M., Diamantidis, T.G., patient records (HPN) Motility disorders; for the development of
Okamoto, R., 2014. [63] n = 143 (patients; n = 125 adults; Other catheter-related
n = 18 children) bloodstream infections
(CRBSI) in patients receiving
home parenteral nutrition.

Chatburn, R.L., 2009. [86] USA Review Noninvasive ventilation Chronic obstructive pulmonary Provision of the basis for a
(NIV) disease (COPD); simple procedure for
Acute cardiogenic pulmonary selecting the most
edema; appropriate NIV technology
Hematologic malignancy; for the patient and the
Bone marrow or solid-organ environment of care.
transplant;
AIDS
Craig, G.M., Scambler, G., UK Qualitative research study; Gastrostomy feeding Severe neuro-developmental A study of parental
Spitz, L., 2003. [44] Semi-structured in-depth disabilities: perceptions of gastrostomy
interview Cerebral palsy; feeding before surgery to
n = 22 (parents of 22 children) Syndrome of chromosomal examine the factors parents
or genetic origin; consider when gastrostomy
Unconfirmed diagnoses feeding is recommended
and to identify the need for
support.
Davenport, A., 2015. [64] UK Review Hemodialysis No medical diagnosis mentioned Complications of hemodialysis
treatments due to dialysate
contamination and
composition errors, and how
to recognize them promptly
to provide appropriate
management and minimize
patient harm.
dos Santos-Fontes, R.L., Brazil Experimental design Repetitive peripheral nerve Stroke A proof-of-principle study:
Ferreiro de Andrade, K.N., Pilot randomized double-blinded stimulation (RPSS) Home-based nerve
Sterr, A., Conforto, A.B., clinical trial, stimulation to enhance
2013. [62] Perform tasks of the Jebsen-Taylor effects of motor training in
Test (JTT), Measurement in time, patients in the chronic
A written log by patients phase after stroke.
n = 20 (patients)
Page 8 of 33
of study
Dubois, P., Bérenger, E., France Review Home artificial ventilation Duchenne muscular dystrophy; An overview of patients to
2009. [95] (HAV) Acute anterior poliomyelitis; be monitored at home, their
Obesity hypo-ventilation etiology, interfaces and
syndrome; specific ventilators
Chronic obstructive pulmonary outstanding developments
disease; and benefits from
Kyphoscoliosis; technological progresses.
Dilatation of the bronchi;
Apnea;
Neuromuscular evolving;
Tuberculosis;
Various other
Egan, G.M., Siskin, G.P., USA Multicenter, prospective Peripherally inserted central Active infection; A study to evaluate the
Weinmann, R., postmarket study catheters (PICCs) for Diabetes; safety and efficacy of a new
Galloway, M.M., 2013. [72] n = 68 (adult patients) intravenous (IV) therapies Cancer; peripherally inserted central
Human immunodeficiency catheter stabilization system.
virus (HIV);
Cystic fibrosis
Faratro, R., Jeffries, J., Canada Home hemodialysis (HD) No medical diagnosis mentioned The article outlines cannulati
Nesrallah, G.E., MacRae, J.M., on options for patients with
2015. [68] arteriovenous access and
describes troubleshooting
techniques for potential
complications; strategies are
suggested to help patients
overcome fear of
cannulation and address
problems associated with
difficult cannulation.
Farrington, K., UK Home haemodialysis End-stage kidney failure. An overview of developments
Greenwood, R., 2011. [87] and trends in technology for
home haemodialysis.
Fayemendy, P., Sourisseau, H., France A descriptive protocol Balloon gastrostomy No medical diagnosis mentioned The proposal of a descriptive
Jesus, P., Desport, J.C., feeding tubes protocol of the required
2014. [58] equipment and the different
steps of the replacement of
a balloon gastrostomy
feeding tube.
Feudtner, C., Villareale, N.L., USA Retrospective cohort study Gastrostomy and Cancer; Assessment of the proportion
Morray, B., Sharp, V., Hays, R.M., A structured hospitalization jejeunostomy tubes; Central Respiratory infections; of children discharged from a
Neff, J.M., 2005. [99] chart review venous catheters; Asthma; children’s hospital who are
n = 100 (patients, children) Nebulizer; Gastroenteritis; judged to be technology-
Ventriculoperitoneal Appendicitis; dependent, and determination
cerebrospinal fluid shunts; Epilepsy or seizures of the most common devices
Tracheotomies and number of prescription
medications at the time of
Page 9 of 33
discharge.
of study
Fex, A., Ek, A.-C., Söderhamn, O., Sweden Qualitative design Long-term oxygen therapy Chronically sick patients with Description of lived
2009. [25] Descriptive phenomenological from a ventilator; respiratory or kidney disorders experiences of self-care
methodology; Long-term oxygen therapy among persons using
Interviews from a oxygen cylinder; advanced medical
n = 10 (patients) Peritoneal and haemodialysis technology at home.
Fex, A., Flensner, G., Ek, A.-C., Sweden Qualitative design; Long-term oxygen; Chronically ill patients with A study to elucidate meanings
Söderhamn, O., 2011a. [26] Phenomenological Ventilator: respiratory or kidney disorders of health–illness transition
hermeneutical method; Haemodialysis; experiences among adult
Interview Peritoneal dialysis persons using advanced
n = 10 (patients) medical technology at home.
Fex, A., Flensner, G., Ek, A.-C., Sweden Qualitative study; Long-term oxygen from Chronic kidney or respiratory Gain a deeper understanding
Söderhamn, O., 2011b. [42] Hermeneutic approach; a cylinder; disorders of the meaning of living with
Interpretive phenomenology; Long-term oxygen from an adult family member using
Interview; a ventilator; advanced medical technology

Gadamerian methodology Peritoneal dialysis; at home.
n = 11 (next of kin) Haemo dialysis
Fex, A., Flensner, G., Ek, A.-C., Sweden Descriptive, comparative, Long-term oxygen; No medical diagnosis mentioned Report of a study of self-care
Söderhamn, O., 2012. [43] cross-sectional, quantitative Ventilator: agency and perceived health
design; Haemodialysis; in a group of people using
Questionnaire; Peritoneal dialysis advanced medical technology
Self-care Agency scale; at home.
Antonovsky’s sense of
coherence scale
n = 180 (patients)
François, K., Faratro, R., Canada Single-center Home hemodialysis Diabetes mellitus; A study in a university
d’Gama, C., Wong, E., retrospective cohort study Ischemic nephropathy; hospital-based home
Fung, S., Chan, C.T., 2015. [69] n = 84 (incident home Glomerulonephritis; hemodialysis program to
hemodialysis patients); Other evaluate the effectiveness
n = 56 (patients surveyed by of a home visit audit tool.
a baseline home visit audit)
Fu, M., Weick-Brady, M., USA Ventilators; No medical diagnosis mentioned The role of the US Food and
Tanno, E., 2012. [14] Oxygen; Drug Administration (FDA)
Intravenous therapy. regarding medical devices
Invasive glucose sensor; in the home and how to
Implantable cardioverter support safety and safe use
defibrillators; in the home environment.
Ventricular (assist) bypass
devices;
Insulin infusion pumps;
Piston Syringes;
Automatic implantable
cardioverter defibrillators
with cardiac resynchronization;
Peritoneal automatic
delivery system;
Mechanical walkers;
Page 10 of 33
Glucose Monitors
of study
Fung, C.H., Igodan, U., USA Descriptive study; Positive Airway Pressure Obstructive sleep apnea (OSA) Exploration in detail of the types
Alessi, C., Martin, J.L., Semi-structured in-depth (PAP) device of difficulties experienced by
Dzierzewski, J.M., Josephson, K., interviews patients with physical/sensory
Kramer, B.J., 2015. [49] n = 19 (patients) impairments who use PAP
devices.
Gavish, L., Barzilay, Y., Koren, C., Israel Prospective, randomised Continuous passive Mild-to-moderate, non-specific, Evaluation of the efficacy
Stern, A., Weinrauch, L., waiting-list-controlled trial (RCT); motion device chronic Lower Back Pain (LBP). of a novel, angular, continuous
Friedman, D.J., 2015. [34] Document daily Numeric rating passive motion device for self-
scale (NRS) pain scores; treatment at home in patients
Oswestry disability index (ODI) with mild-to-moderate, non-
questionnaires in a diary by specific, chronic low back pain.
participants
n = 36 (patients)
Glader, L.J., Palfrey, J.S., USA Nasogastric tubes; An inability to consume Description of children who
2009. [38] Gastronomy tubes; are dependent on technology,
Indwelling venous adequate calories to maintain common indications for and
catheters; reasonable nutritional status; complications of gastronomy
Invasive and noninvasive Short bowel syndrome; tubes, invasive and noninvasive
mechanical ventilation Malabsorptive states; mechanical ventilation and the
Inflammatory bowel disease: psychosocial effects of having a
Severe dysmotility states; child dependent on technology.
Other less common gastrointestinal
disorders;
Pneumonia;
Chronic respiratory failure;
Chronic lung disease;
Neuromuscular disease;
Central hypoventilation;
Upper airway obstruction
Graf, J.M., Montagnino, B.A., USA Retrospective pilot case series Tracheostomies; Congenital abnormalities; Description of an educational
Hueckel, R., McPherson, M.L., (chart review); Positive pressure ventilation Neurologic diagnoses; program and timeline for the
2008. [59] n = 70 (patients, children and Primary lung disease discharge of children with a
adolescents) new tracheostomy and the
identification of common
impediments to the education
and discharge process.
Greenwald, P.W., Rutherford, A.F., USA Retrospective case series Oxygen conservers; No medical diagnosis mentioned During a widespread North
Green, R.A., Giglio, J., 2004. [78] (chart review) Ventilators; American blackout, the authors
n = 23 (patients) Airway suction equipment identified a cluster of patients
presenting to their northern
Manhattan emergency
department (ED) with complaints
related to medical device failure.
The characteristics of this group
are described in an effort to
better understand the resource
needs of this population.
Page 11 of 33
of study
Gregoretti, C., Navalesi, P., Italy Mechanical ventilation Many forms of severe chronic Providing useful information
Ghannadian, S., Carlucci, A., respiratory failure to help and guide the
Pelosi, P., 2013. [85] choice of device for
long-term mechanical
ventilation in the home
setting.
Han, Y.J., Park, J.D., Lee, B., South-Korea Retrospective medical Home mechanical Hereditary neuro-muscular Comparison of the various
Choi, Y.H., Suh, D.I., Lim, B.C., record review ventilation diseases (NMDs): underlying neuromuscular
Chae, J.-H., 2015. [102] n = 57 (patients) Spinal muscular atrophy; diseases and an evaluation
Congenital myopathy; of home mechanical
Congenital muscular dystrophy; ventilation with regard to
GSD type II (Pompe disease); respiratory morbidity, the
End-stage myopathy, unspecified proper indications and
timing for its use, and to

develop a policy to improve
the quality of home
noninvasive ventilation.
Hanada, E., Kudou, T., Japan Medical devices only No medical diagnosis mentioned The paper describes the
2014. [94] mentioned as an example current status of ensuring
electromagnetic compatibility
between medical devices and
wireless communications and
measures against
electromagnetic noise.
Heaton, J., Noyes, J., Sloper, P., UK Qualitative methods; Ventilators; Neuro-disability; Families’ experiences of
Shah, R., 2005. [31] Purposive sampling strategy Feeding pumps; Respiratory disability; caring for a technology-
Face-to-face semi structured Dialysis machines; Oxygen Renal disability; dependent child were
interviews; therapy; Intravenous drug Neuro-degenerative disability; examined, exploring the
n = 36 (families) therapies; Tracheostomies; Gastrointestinal disability; multiple rhythms and routines
Suction machines Cardiac disability; around which the families’
Metabolic disability; lives were variously structured.
Congenital abnormality disability;
Haematological disability
Hendrickson, E., Corrigan, USA Review Home parenteral nutrition No medical diagnosis mentioned Provide nutrition support
M.L., 2013. [106] (HPN) clinicians knowledge on
navigating through the
structured requirements of
diagnosis driven billing to
receive reimbursement for
services related to HPN,
provide information on
coding, provide practical
tips for surviving a Medicare
billing audit, and discuss
challenges of Medicare
guidelines seen in clinical
practice.
Page 12 of 33
of study
Hewitt-Taylor, J., 2004. [56] UK Descriptive study; Long-term assisted ventilation; No medical diagnosis A study of the perceived
Quantitative survey; Continuous Positive Airway mentioned education and training
Initial fact finding; Pressure (CPAP); needs of staff who care for
Questionnaire Bilevel Positive Airway children with complex needs,
n = 21 (staff caring for children Pressure (BiPAP). including assisted ventilation,
requiring assisted ventilation) and their families.
Hilbers, E.S.M., The Nether-lands Document analysis; Infusion pumps; No medical diagnosis mentioned Investigation of the technical
de Vries, C.G.J.C.A., Questionnaire Ventilators; documentation of
Geertsma, R.E., 2013. [75] n = 34 (technical documents; Dialysis systems manufacturers on issues of
n = 18 infusion pumps; n = 8 safe use of their device in a
ventilators; n = 7 dialysis systems) home setting.
Jayanti, A., Wearden, A.J., UK Integrated mixed methodology; Home haemodialysis Chronic kidney disease (CKD) A comprehensive and
Morris, J., Brenchley, P., Convergent, parallel design; (HHD) End stage renal disease (ESRD) systematic study of the
Abma, I., Bayer, S., Quantitative methods; barriers to and enablers of

Barlow, J., Mitra, S., 2013. [55] Qualitative study; successful uptake and
Multicentre prospective maintenance of HHD across
observational cohort study multiple centres with low,
Ethnographic interviews; medium and high prevalence
Clinical and biomarkers; rates of home HD. Care
Psychosocial quantitative assessments; pathways of predialysis,
Neuropsychometric tests incident and prevalent dialysis
Economic evaluation; patients are also investigated
Questionnaire under clinical, psychosocial
In-depth semi-structured and organisational domains.
interviews
Groups/ study arms:
a. patient
b. organization
c. carer
d. economic evaluation
3 Patient study cohorts
n = 500 (patients; n = 200
pre-dialysis; n = hospital
haemodialysis; n = 100 home
haemodialysis)
Kaufman-Rivi, D., Hazlett, A.C., USA Descriptive study; Negative-pressure wound No medical diagnosis mentioned Obtain additional information
Hardy, M.A., Smith, J.M., Exploratory study; therapy (NPWT) systems about device issues that
Seid, H.B., 2013. [70] Semi-structured questionnaire for healthcare professionals face
in-depth interviews and self- in homes settings and in
administration; extended-care facilities, as well
Web-based survey adapted from as challenges that caregivers
semi-structured instrument might encounter using this
Questionnaire: technology at home.
n = 22 (professional healthcare
providers)
Web survey:
n = 342 (professional healthcare
providers)
Page 13 of 33
of study
Kaufman, D., Weick-Brady, M., USA There are no technologies No medical diagnosis mentioned The launch of the Medical
2009. [71] specifically mentioned, but Product Safety Network’s
reference is made to (MedSun) Subnetwork,
complex medical devices HomeNet [a program
in general. sponsored by the U.S. Food
As an example are and Drug Administration
mentioned, e.g. infusion (FDA) Center for Devices
pumps, intravascular and Radiological Health
administration sets, (CDRH)] hopes to learn
continuous ventilators, about and address patient
safety issues as it relates to
expanding medical device
usage in the home setting.
Keilty, K., Cohen, E., Ho, M., Canada Systematic review; Home mechanical Bronchopulmonary Dysplasia The review systematically
Spalding, K., Stremler, R., Qualitative analysis; ventilation; (BPD); examines studies reporting
2015. [39] Results presented as a narrative. Non-invasive ventilation; Cystic fibrosis (CF); on sleep outcomes in family
n = 13 (studies) Insulin pump therapy; Inherited metabolic disorders caregivers of technology
Home enteral (tube) feeds; (IMD); dependent children.
Home oxygen; Neuromuscular (NM)
Tracheostomy;
Gastrostomy
Khirani, S., Louis, B., France Test on a lung bench with Volume targeted pressure No medical diagnosis mentioned Determination of the ability
Leroux, K., Delord, V., different circuit configurations support ventilation (VT-PSV) ofhome ventilators to
Fauroux, B., Lofaso, F., and with different levels of maintain the preset minimal
2013. [89] unintentional leaks. VT during unintentional
n = 7 (ventilators) leaks in a VT-PSV
mode.
Kirk, S., 2010. [27] UK Grounded theory approach; Gastrostomy/ jejunostomy; No medical diagnosis mentioned The study explores how
In-depth interviews (parents Intravenous drug therapies; children who need the
were present) Mechanical ventilation; support of medical
n = 28 (children/young people) Tracheostomy; technology for their survival
Oxygen therapy; and wellbeing experience
Parenteral nutrition; and construct medical
Peritoneal dialysis technology and its influence
on their identity and social
relationships.
Kirk S, Glendinning C, UK Grounded theory techniques; Tracheostomy; Medical diagnoses mentioned in A study exploring parents’
Callery P., 2005. [47] Qualitative research methods; Oxygen therapy; general: pre-term infants, infants experiences of caring for a
In-depth interviews (some Mechanical ventilation; with congenital impairments and childwho is dependent on
individual, some with both Intravenous drugs; children with chronic illnesses and medical technology, and in
parents) Parenteral nutrition; cancer. No medical diagnoses particular of performing
n = 24 (children, parents of them) Peritoneal dialysis; mentioned in the study itself. clinical procedures on their
Others (e.g. gastrostomy) own children.
Page 14 of 33
of study
Kropff, J., Del Favero, S., France, Italy, Multinational randomised Insulin pump treatment Type I diabetes The study assessed the effect
Place, J., Toffanin, C., the Nether-lands crossover trial (open label study) on glucose control with use
Visentin, R., Monaro, M., n = 32 (patients) of an artificial pancreas
Messori, M., Di Palma, F., during the evening and
Lanzola, G., Farret, A., night plus patient-managed
Boscari, F., Galasso, S., sensor-augmented pump
Magni, P., Avogaro, A., therapy (SAP) during the day,
Keith-Hynes, P., versus 24 h use of patient-
Kovatchev, B.P., managed SAP only, in free-
Bruttomesso, D., Cobelli, C., living conditions.
DeVries, J.H., Renard, E.,
Magni, L., 2015. [90]
Lee, A.D.W., Galvao, F.H.F., Brazil Patients were evaluated for a Home parenteral nutrition Intestinal failure: The article profiles a Brazilian
Dias, M.C.G., Cruz, M.E., period of 6 months therapy (HPNT) Mesenteric thrombosis; single-center experience
Marin, M., Pedrol, C.N., n = 128 (patients) Colon cancer; with 128 cases of HTPN
David, A.I., Pecora, R.A.A., Non-hodgkin lymphoma; followed for the last 30
Waitzberg, D.L., Volvulus; years and appraise the
D'Albuquerque, L.A.C., Pseudo-obstruction; referral for potential
2014. [103] Trauma; intestinal and multivisceral
Crohn disease; transplantation.
Gardner’s syndrome;
Apendicitis;
Peritonitis (+ dialisis);
Provoked abortion
Leger, S.S., 2005. [84] France Review Mechanical ventilation Chronical diseases The article aims to examine
the different indications of
a humidification system in
patients with mechanical
ventilation in the home, to
review the literature in
order to identify the
positive results obtained by
humidification and, finally,
to describe the most
efficient types of humidifiers.
Lehoux, P., 2004. [48] Canada Qualitative study, relied on the Intravenous therapy; No medical diagnosis mentioned Documentation, from the
triangulation of three sources Parenteral nutrition; patient’s perspective, of how
of data: Peritoneal dialysis; the level of user-friendliness
1) interviews with patients Oxygen therapy of medical technology
(n = 16); influences its integration into
2) interviews with carers (n = 6); the private and social lives of
3) direct observation of nursing patients. Understanding what
visits of a different set of patients makes a technology user-
(n = 16). friendly should help improve
the design of home care
services.
Page 15 of 33
of study
Lehoux, P., Charland, C., Canada Postal questionnaire Intravenous pump therapy; No medical diagnosis mentioned The article describes various
Richard, L., Pineault, R., n = 97 (local centers) Oxygen therapy; medical technologies that
St-Arnaud, J., 2002. [5] Peritoneal dialysis; are used frequently in the
Haemo dialysis; home and the responsibility
Parenteral nutrition; of local community service
centers in the region of
Quebec, Canada.
Lehoux, P., Saint-Arnaud, J., Canada Biographical interview, interview Intravenous therapy, Patients with recurring infections; Determination of how
Richard, L., 2004. [30] questionnaire; Parenteral nutrition, Chronic obstructive pulmonary specialised medical equipment
Direct observations; Peritoneal dialysis; disease; by patients at home was
Document analysis Oxygen therapy Renal failure supposed to be used versus
(patient manuals, brochures, how it was actually used.
leaflets)
n = 16 (patients)
n = 6 (caregivers)
n = 16 (home visits by nurses)
n = 26 (documents)
Lemke, M.R., USA Dialysis; No medical diagnosis mentioned The article describes several
Mendonca, R.J., Intravenous therapies aspects of accessibility of
2013. [50] medical devices for home
healthcare recipients,
especially lay users.
Lewarski, J.S., Gay, P.C., USA Home mechanical Medical diagnoses only The article explains several
2007. [22] ventilation mentioned as an example. issues in home mechanical
ventilation, such as policies
and practice standards, costs,
reimbursement and coverage
Matsui, K., Kataoka, A., Japan Clinical data review/ charts Suction apparatus; Möbius syndrome Investigation of the outcome
Yamamoto, A., Tanoue, K., review Tube feeding; Gastrostomy; of patients with Möbius
Kurosawa, K., Shibasaki, J., n = 10 (patients) Tracheostomy; syndrome, including the
Ohyama, M., Aida, N., Oxygen therapy; Ventilator mortality rate, rate of neonatal
2014. [98] intensive care unit (NICU)
admission, neurological
findings, developmental
problems, and medical home
care and device needs.
McGoldrick, M., 2010. [67] USA Article presents evidence based Oxygen concentrators, An immune-compromised This article presents
guidelines and recommendations Ventilators; individual with a chronic evidenced based guidelines
on the preferred methods. Continuous positive underlying illness and recommendations on
airway pressure (CPAP); the preferred methods for
Bilevel positive airway managing respiratory
pressure (BiPAP); equipment and supplies
Nasal cannulas; commonly used by patients
Tracheostomy tubes; in the home setting and
Tracheal suction catheter; conducting surveillance
Nebulizers activitiesto ultimately
Page 16 of 33
prevent respiratoryinfections.
of study
Michihata, N., Matsui, H., Japan Database analysis Tracheostomy tube; Chromosomal anomaly; Determination of the clinical
Fushimi, K., Yasunaga, H., (The Japanese Diagnosis Gastrostomy tube; Malignancy; details of adult patients
2015. [101] Procedure Combination Home respirator; Inborn error of metabolism (IEM); admitted to pediatric wards
(DPC) database) Home centralvenous Congenital heart disease (CHD); in Japanese acute-care
n = 4729 (patients) alimentation Immune deficiency; hospitals.
Endocrine diseases;
Cerebral palsy;
Other congenital anomalies;
Epilepsy;
Other diseases
Ischemic heart diseases, including
angina pectoris;
Acute myocardial infarction;
Cerebrovascular diseases;
Lung, gastric, colon, hepatic,

breast, uterus, and prostate cancer
Munck, B., Fridlund, B., Sweden Descriptive design; There are no technologies No medical diagnosis mentioned Description of district nurses’
Mårtensson, J., 2011. [53] Phenomenographic approach; specifically mentioned in conceptions of medical
Qualitative study; the study itself, but reference technology in palliative
Semi-structured interview is made to complex medical homecare.
n = 16 (nurses) devices according to a
definition and examples.
‘Medical technology was
defined and confined to
the more advanced devices
that may be present in the
home, such as ventilators,
suction devices, oxygen and various
ports and pumps’.
Munck, B., Sandgren, A., Sweden Explorative descriptive design; Pain, nutrition and volume No medical diagnosis mentioned Description of next-of-kin’s
Fridlund, B., Phenomenographic approach; pumps; conceptions of medical
Mårtensson, J., 2012a. [36] Qualitative study Oxygen concentrators; technology in palliative
Semi-structured interview Suctions and inhalation devices; homecare.
n = 15 (next-of-kin) Percutaneous endoscopic
gastronomy (PEG);
Subcutaneous vein ports.
Munck, B., Sandgren, A., Sweden Qualitative analysis; Pain pumps; Different types of cancer; Description of the patients’
Fridlund, B., Explorative descriptive design; Nutrition and volume pumps; Amyotrophic lateral sclerosis (ALS); ways of understanding
Mårtensson, J., 2012b. [52] Phenomenographic approach; Intravenous infusion: Disetronic Heart failure; medical technology in
Interview pen for subcutaneous injections; Chronic obstructive disease. palliative home care.
n = 15 (patients) Oxygen concentrators and
cylinders;
Nephrostomy catheters;
Percutaneous endoscopic
gastronomy;
Subcutaneous venous port
implantation.
Page 17 of 33
of study
Nakayama, T., Tanaka, S., Japan Retrospective study; Ventilator; Neurological disorders: Effect of a blackout in
Uematsu, M., Kikuchi, A., Medical records were Peritoneal dialysis; Periparturient disorder; pediatric patients with home
Hino-Fukuyo, N., hand-reviewed to identify Oxygen condenser Mitochondrial disease; medicaldevices during the
Morimoto, T., Sakamoto, O., inpatients Congenital myopathy; 2011 eastern Japan earthquake
Tsuchiya, S., Kure, S., Survey by questionnaire Epilepsy;
2014. [76] n = 24 (patients) Cerebral sequelae of acute
encephalopathy;
Perizeus Merzback disease
Kidney disorders:
Hypoplastic kidney;
Nephrotic syndrome
Others:
Diabetes mellitus type 1;
Long QT syndrome;
Effects from bone marrow

transplantation, chronic
respiratory failure
Paddeu, E.M., Giganti, F., Italy Pittsburgh Sleep Quality Index Mechanical ventilation (via Congenital central hypoventilation The daily challenges
Piumelli, R., De Masi, S., (PSQI) questionnaire; Epworth nasal mask or tracheostomy) syndrome (CCHS) associatedwith caring for
Filippi. L., Viggiano, M.P., Sleepiness Scale (ESS); technology-dependent
Donzelli, G., 2015. [40] Beck Depression Inventory children can place primary
(BDI-II); caregivers under significant
Beck Anxiety Inventory (BAI) stress, especially at night.
n = 23 (parents of 23 children The study investigated how
with CCHS) this condition affects
n = 23 (parents of 23 mothers and fathers by
healthy children) producing poor sleep
quality, high-level diurnal
sleepiness, anxiety, and
depression.
Paul, J., Otvos, T., 2006. [82] Canada Randomized crossover study; Oxygen therapy Ex-smokers with severe chronic Comparison of the
Measurement by oximeter; obstructive pulmonary disease performance of a new
Questionnaire oxygen delivery device, the
n = 25 (patients) OxyArm (OA)
(Southmedic Inc., Canada),
with a standard nasal
cannula (NC)
(Salter-Style 1600, Salter
Labs, USA) for both oxygen
delivery and
patient preference in
patients on long-term
oxygen therapy (LTOT).
Page 18 of 33
of study
Pourrat, M., Neuville, S., 2007. [73] France Survey; Home parenteral nutrition No medical diagnosis mentioned For Home Parenteral
questionnaire Nutrition (HPN), pharmacy
n = 12 (by law authorized centres) had to deliver some medical
n = 6 (service providers) devices and drugs. It comes
n = 0 (custom-made makers) up the following and taking
n = 0 (laboratories) care of incidents that’s
occurring at home with
those products. The article
describes an inventory on
vigilance’s organization,
incident’smanagement and
assessment, about HPN in
France.
Pourtier, J., 2013. [97] France Patient-controlled No medical diagnosis mentioned Technology for improving
pain management in the
analgesia pumps. home; various aspects
related to analgesia pumps.
Prenton, S., Kenney, L.P., UK Feasibility study Functional electrical Unilateral foot-drop of central Investigation of the feasibility
Stapleton, C., Cooper, G., Purposive questionnaires stimulation system neurologic origin (>6mo) of unsupervised community
Reeves, M.L., Heller, B.W., Paper diary use of an array-based
Sobuh, M., Barker, A.T., n = 7 (patients) automated setup functional
Healey, J., Good, T.R., electrical stimulator for
Thies, S.B., Howard, D., current foot-drop functional
Williamson, T., 2014. [92] electrical stimulation (FES)
users.
Rajkomar, A., Farrington, K., UK Qualitative method Home haemodialysis No medical diagnosis mentioned An inventory of patients’
Mayer, A., Walker, D., Ethnographic observations; technology and carers’ experiences of
Blandford, A., 2014. [51] Semi-structured Interviews interacting with home
n = 19 (patients and their carers) haemodialysis (HHD)
technology, in terms of user
experience, how the design
of the technology supports
safety and fits with home
use, and how the broader
context of service provision
impacts on patients’ use of
the technology.
Rajkomar, A., Mayer, A., UK Ethnographic observations; Home hemodialysis Renal patients / kidney failure In this study, Distributed
Blandford, A., 2015. [79] Semi-structured interviews; technology (HHT) Cognition (Dcog) was
Distributed cognition for applied to understand renal
teamwork methodology patients’ interactions with
Home Hemodialysis
Technology (HHT), as an
example of a home medical
device.
Page 19 of 33
of study
Rand, D.A., Mener, D.J., USA Retrospective case series Home respiratory No medical diagnosis mentioned Description of the experience
Lerner, E.B., DeRobertis, N., (medical record review) equipment; of an urban, commercial
2005. [77] n = 83 (medical records) Home nebulizers; ambulance provider during the
Oxygen devices multistate August 2003
electrical power outage (EPO)
and to identify how such an
event can affect an emergency
medical services (EMS) system.
Scala, R., 2004. [88] Italy n = 29 (devices) Bi-level home ventilators Chronic respiratory failure (due to The author describes the
for non invasive positive neuro-muscular disorders); technical aspects, the
pressure ventilation COPD; individual characteristics
Severe chest wall deformity; and the clinical applications
Obesity of the most common used
bi-level ventilators.
Short, D., Norwood, J., UK Phase 1: Parenteral nutrition; Cystic fibrosis; The study addresses
2003. [108] Survey Intravenous antibiotics; Cancer questions: Why is high-tech
(Semi-structured interview); Intravenous chemotherapy; healthcare at home
Phase 2: Continuous ambulatory purchasing underdeveloped
Case study analyses peritoneal dialysis and what could be done to
(in-depth case study analyses improve it
of selected districts)
n = 98 (health authorities)
Siewers, V., Holmøy, T., Norway Qualitative study; Mechanical insufflation – Amyotrophic lateral sclerosis (ALS) The study explores patients’,
Frich, J.C., 2013. [54] Semi-structured in-depth family carers’ and health
interviews exsufflation (MI-E) professionals’ experiences
n = 5 (patients) with using mechanical
insufflation – exsufflation
(MI-E) in amyotrophic lateral
sclerosis (ALS) in the home
setting.
Southey, D., Pullinger, D., UK Observational study; Portable digital suction ‘All patients who underwent a Patients undergoing thoracic
Loggos, S., Kumari, N., Data collected prospectively device thoracic procedure and who surgical procedures who
Lengyel, E., Morgan, I., Yiu, P., on the thoracic database; required suction postoperatively met strict discharge criteria
Nandi, J., Luckraz, H., Data logged in a specific for a persistent air leak and a were allowed to continue
2015. [105] data sheet confirmed air-space within the their treatment at home with
n = 20 (patients) pleural cavity’ the device. They were
monitored in a designated
follow-up clinic. Data were
collected to identify the
impact of this service in relation
to the duration of follow-up
required, bed-days saved, and
potential cost/benefits.
Page 20 of 33
of study
Stieglitz, S., George, S., Germany Case series Invasive and non-invasive COPD; The article describes life-
Priegnitz, C., Hagmeyer, L., n = 3 (patients) ventilators Lung cancer; threatening events in
Randerath, W., 2013. [66] Chronic ventilator failure as a respiratory medicine:
consequence of chronic misconnections of invasive
obstructive pulmonary disease and non-invasive
ventilators and Interfaces
Su, C.-L., Lee, C.-N., Taiwan Retrospective, cross-sectional, Long-term oxygen therapy Chronic respiratory insufficiency; The study compared oxygen
Chen, H.-C., Feng, L.-P., observational survey design; Chronic obstructive pulmonary usage between patients
Lin, H.-W., Chiang, L.-L., Questionnaires; disease (COPD); from a liquid oxygen group
2014. [81] Walking test (patient self score) Restrictive lung disease; (LOG) and an oxygen
n = 42 (patients using LOG) Neuromuscular diseases; concentrator group (OCG).
n = 102 (patients using OCG) Cancer; The authors also assessed the
Interstitial lung diseases physiologic responses of
patients with chronic

obstructive pulmonary
disease (COPD) to ambulatory
oxygen use at home.
Sunwoo, B.Y., Mulholland, M., USA Home noninvasive Neuromuscular disease (including The article provides a
Rosen, I.M., Wolfe, L.F., ventilation technology amyotrophic lateral sclerosis and practice management
2014. [57] Duchenne muscular dystrophy); perspective for clinicians
Scoliosis; providing home noninvasive
Restrictive chest wall disease; ventilation, including
Restrictive thoracic disorders; coverage, coding, and
COPD/severe COPD; reimbursement to optimize
The overlap syndrome or clinical care and minimize
coexisting COPD and OSA; lost revenue.
Sleep-related breathing disorders;
Central or complex sleep apnea;
Obesity hypoventilation syndrome
(OHS);
Hypoventilation syndromes
Szeinbach, S.L., Pauline, J., USA Retrospective chart review Home parenteral nutrition Intestinal obstruction; The article describes catheter
Villa, K.F., Commerford, S.R., Qualitative study (the Acute pancreatitis; complications and outcomes
Collins, A., Seoane-Vazquez, E., interview part) Hyperemesis metabolism; in patients who received
2015. [65] One-on-one interviews Regional enteritis; home parenteral nutrition
n = 163 (patients) Intestinal disorders, ulceration; (HPN) therapy.
Intestinal malabsorption;
Enterocolitis;
Sepsis;
Stomach ulceration with
perforation;
Acute intestinal vascular insufficiency;
Intestinal fistula;
Gastroparesis;
Persistent vomiting, pneumonitis;
Other gastrointestinal issues,
disturbances;
Oncology-related diagnoses
Page 21 of 33
of study
Tanno, E., 2010. [74] USA n = 6 (hospitals) There are no technologies No medical diagnosis mentioned Because patients, who use
specifically mentioned in home medical technologies,
the study itself, but are so dependent on these
reference is made to devices they bring them
complex medical devices into hospitals when they
as an example. seek treatment. Many
hospitals have developed
specific protocols, including
safety inspections by clinical
engineers, to follow when a
home-use device is brought
in. This article summarizes
the policies that 6 hospitals
have developed to address
this situation.
Tearl, D.K., Cox, T.J., USA Demographic data are Respiratory technology; Respiratory failure: Preparation of respiratory-
Hertzog, J.H., 2006. [61] prospectively collected from Ventilator; Airway obstruction; technology-dependent
databases; Continuous positive airway Neuromuscular/ Spinal-cord children for hospital
Surveys conducted over the pressure (CPAP); injury (SCI); discharge presents many
telephone or via facsimile Tracheostomy collar; Bronchopulmonary dysplasia challenges. Adequate
n = 74 (patients) Negative-pressure ventilator (BPD) training and education of
(NVP); parental caregivers,
Bi-level positive airway discharge planning, and
pressure (BiPAP) coordination with the
durable-medical-equipment
and home-nursing companies
must be completed. The role
of a dedicated Respiratory care
discharge coordinator has
been evaluated in this study.
Tennankore, K.K., D’Gama, C., Canada Retrospective cohort study Home hemodialysis End-stage renal disease: The study describes adverse
Faratro, R., Fung, S., Wong, E., (all characteristics collected Diabetes; technical events in a large
Chan, C.T., 2014. [80] based on identification in Glomerulonephritis; cohort of home hemodialysis
electronic records and Polycystic kidney disease patients.
patient charts)
n = 202 (patients)
Thomson, R., Martin, J.L., UK Qualitative study; Transcutaneous electrical Diabetes The article describes the
Sharples, S., 2013. [28] In-depth semi-structured nerve stimulation device; psychosocial impact of home
interview Oxygen concentrator; use medical devices on the
n = 12 (patients) Continuous ambulatory lives of older people and how
peritoneal dialysis; the devices are integrated into
Stair-lift; their lives.
Nebulizer
Page 22 of 33
of study
Toly, V.B., Musil, C.M., Carl, J.C., USA Descriptive, correlational, Mechanical ventilation; Neuromuscular; The study describes various
2012. [37] dross-sectional study; Intravenous nutrition/ Respiratory conditions; issues related to family
Structured interview, face-to-face, medication; Gastrointestinal conditions; functioning and normalization
using the Demographic Respiratory/ nutritional Cardiac conditions; in mothers of children
Characteristics Questionnaire, support; Cystic fybrosis; dependent on medical
the Functional Status II–Revised Apnea monitors; Metabolic disorders; technology following initiation
Scale, the Center for Epidemiological Feeding tube; Renal disorders of home care.
Studies–Depression Scale, a Tracheostomy tube;
Normalization Scale subscale, Supplemental oxygen
and the Feetham Family
Functioning Survey.
n = 103 (mothers)
Toly, V.B., Musil, C.M., USA Longitudinal randomized Mechanical ventilation; Respondents recruited from The purpose of the study
Zauszniewski, J.A., 2014. [41] controlled pilot trial; Intravenous nutrition/ pulmonology and was to determine the feasibility,
Structured interviews; medication; gastroenterology clinics acceptability, and efficacy
Semi-structured exit Interviews Respiratory/ ofresourcefulness training (RT),
n = 22 (mothers) nutritional support. a cognitive–behavioral
intervention, among mothers
of technology-dependent children.
Wang, K.-W.K., Barnard, A., Australia Empirical review Mechanical ventilation; No medical diagnoses mentioned, The paper provides a
2004. [35] Tracheostomy; only as an example. comprehensive literature review
Oxygen therapy; on caring for technology-
Enteral nutrition; dependent children living at
Parenteral nutrition; home to gain an understanding
Intravenous drug therapies; of the development of
Peritoneal dialysis; paediatric home care, and its
Haemodialysis; impact on technology-
Suction devices dependent children and their
families, and social implications.
Weiler-Ravell, D., Israel Respiratory support, Neuromuscular respiratory failure The article describes the
2002. [107] ventilators Chronic obstructive pulmonary quandary of home-care
disease respiratory management.
Wong, J., Eakin, J., Migram, P., Canada Qualitative study; Home hemodialysis End stage renal disease (ESRD). The study explores patient
Cafazzo, J.A., Halifax, N.V.D., Semi-structured interviews; training experiences with
Chan, C.T., 2009. [60] Focusgroup learning a complex medical
n = 23 (patients; 15 interviews; device for the selfadministration
8 focus group) of nocturnal hemodialysis at
home.
Yik, Y.I., Ismail, K.A., Hutson, J.M., Australia Prospective study; Transcutaneous electrical Slow-transit constipation (STC) The article describes the test
Southwell, B.R., 2012. [91] Bowel diaries; stimulation of the effectiveness of home
Questionnaires; transcutaneous electrical
Colonic transit studies stimulation (TES) when
n = 32 (patients) patients with slow-transit
constipation (STC) were
trained by a naive clinician.
Page 23 of 33
considered medical technologies with regard to decubi-

tus treatment, skeletal traction or UV (ultraviolet)
therapy.
Table 4 shows that on the years 2000 and 2001 no
relevant articles on the subject were found. Over the
period 2000–2005, 17 articles were published, the same
number over 2006–2010, and there has been a substan-
tial increase in the number of publications to 54 over
the years 2011–2015. In general, it can be concluded
that more frequent investigated technologies show a
fairly even distribution of publications over the years
2000–2015. Technologies, on which little research had
been done, except for nebulizers, have been mainly in-
vestigated since 2010. An increase of published articles
over the years 2000–2015 is apparent particularly for
haemo dialysis and to a lesser extent, for devices for
enteral- and parenteral nutrition. As mentioned before,
several studies reported on the increase of the number
of medical technologies used in home settings, but
concrete data are not available. However, the number of
studies and the visible trends may be indicative of the
frequency of use.
In 63% of the cases (n = 55), a medical diagnosis (or
diagnoses) was mentioned in the article. Where a
diagnosis has been mentioned, in almost half of the
Fig. 1 PRISMA flowchart
studies (n = 26; 47%) it concerned diagnoses in the field
of respiratory failure (see Fig. 2). This is not surprising,
From an analysis of the articles, additional categories since ‘respiratory support’ is the medical technology
of content emerged: most commonly found in the articles, similarly ‘oxygen
therapy’ has also been considered relatively often. Diag-
4. Design and technological development noses with regard to neurological disorders occurred in
5. Application with regard to certain diseases or 42% of the studies (n = 23). Just over a quarter of the
disorders, indication for and extent of use studies (27%) considered diagnoses ‘other’, such as
6. Policy and management ‘sepsis’, ‘chromosomal anomaly’ or other not specified
medical disorders, nearly a quarter (24%) considered
‘cancer’ and 22% kidney disorders (n = 12).
Types of medical technologies used, frequency of use An analysis of the used research designs identified that
and trends 64% (n = 56) of the studies used an observational (non-
In four of the 87 articles (5%) there were no specific experimental) design and only a small part of the studies
medical technologies mentioned as a subject of study (n = 5; 6%) used an experimental design, such as a
(see Table 4). Almost half of the studies (45%) consid- Randomized Control Trial (RCT). Of the included stud-
ered medical technologies for respiratory support and ies 19 were reviews and 8 were essays. A quantitative
39% devices for dialysis, either haemo- (n = 18), periton- design (n = 37) was used more frequently than a qualita-
eal- (n = 15) or dialysis not specified (n = 1). Of the stud- tive design (n = 25); and only one study applied ‘mixed
ies, 29% reported on devices for oxygen therapy. In methods’ (quantitative and qualitative). Just over one-
addition, there has been relatively more research third of the studies (35%) used a descriptive design, and
conducted on equipment for ‘infusion therapy’ (n = 19; a similar number used a cross-sectional study (36%).
22%), parenteral nutrition and enteral nutrition with a Case series were used in 12% of the articles and a
score of 20% each (n = 17). Relatively little research has cohort-study in 9%. A phenomenological approach was
been carried out on suction devices (8%), external elec- applied in 16% of the records. Research instruments
trostimulation (5%), nebulizer (5%), insulin pump ther- most frequently used were interviews (33%) and survey/
apy (3%), sleep apnea treatment (2%), patient lifting questionnaires (21%). In 10% of the cases other instru-
hoists (2%), vacuum assisted wound closure (1%) and ments were used, including different types of assessments
continuous passive motion (1%). None of de studies or tests.
Table 4 Trends in papers reporting on AMTs (n = 87, multiple answers possible), by year of publication (2000–2015)
No shading n = 0, up till the darkest shading n = 5
With regard to the categories of content, most research an experimental design (randomized controlled trial). The
has been carried out on ‘user experiences’ (see Fig. 3): just research instruments in this content category to collect data
over one-third of the articles (n = 31; 36%) focused on this were interviews, either semi-structured or in-depth, and a
topic. Of these articles almost all studies focused on experi- survey. About two-thirds of the articles regarding ‘user ex-
ences of patients or informal caregivers (n = 29) and only a periences’ were published in the period 2011–2015, with an
small number (n = 2) considered the user experiences of accent on the psychosocial impact of patients or informal
nurses or other professionals (see Table 5). More than half caregivers.
of the studies (n = 19) used a qualitative research design; of Relatively little research was found on ‘training, in-
these 13 used a phenomenological approach. The goal of struction, education’ (n = 7), for the use of AMTs in
these studies was to elicit the essence of human phenom- home settings. It was remarkable that all the studies
ena as experienced by the users. Seven studies used a quan- identified as focusing on this topic, concentrated on one
titative design and one an integrated mixed method. Three category of AMT. Respiratory support was the subject of
of the studies applied a grounded theory approach and two study in four instances and in the other three, the focus
was on technologies for enteral nutrition, haemo dialysis
and external electro-stimulation. Four of the seven
Fig. 2 Number of medical diagnoses mentioned in articles on AMTs

(n = 87, multiple answers possible) Fig. 3 Number of articles on AMTs with main content categories (n = 87)
Table 5 Subcateogories of content in selected articles on AMTs (n = 87) by year of publication (2000–2015)
No shading n = 0, up till the darkest shading n = 4
articles utilized quantitative methods, among which Approximately 20% of the selected articles considered the
three of them used an observational non-experimental content category ‘design and technological development of
design and one was an experimental randomized the medical device’ (n = 17). The studies each focused on
double-blind clinical trial. Another study within the ini- only one type of AMT and treated a relative wide range of
tial seven articles used a qualitative observational non- eight different categories, such as ‘respiratory support’,
experimental design, one was a review and another was ‘oxygen therapy’, ‘haemo dialysis’, ‘infusion therapy’, ‘insulin
in essay format. pump therapy’ and ‘enteral nutrition’, but also ‘external
In total, 22% of the articles discussed topics on safety, electrostimulation’ and ‘patient lifting hoists’. Interestingly,
risks, incidents and complications (n = 19). In the majority in this group of articles, relatively often (n = 6) no medical
of cases (n = 13) general aspects about the subject, for in- diagnosis was mentioned. Around half of the studies (n = 8)
stance safe use, factors affecting safety, a safe transfer of the referring to this topic were in review or essay format. All
equipment and monitoring of assessing safety were consid- other studies used a quantitative research design and
ered. One article described technological factors with re- throughout the search no application of qualitative designs
gard to safety, three articles reported on environmental were found. Two studies used an experimental study design
factors and two explored human factors. Safety aspects (randomized crossover trial) to obtain data and two
were explored over a wide range of medical technologies. described a prospective cohort study. The majority of
Five articles were reviews and one an essay. Quantitative papers (n = 11) were published in the period 2011–2015
methods were used in ten of the cases, particularly for and six in the preceding period up to and including 2010.
monitoring, evaluating and assessing safety, technological Seven articles concerned the application of AMTs, all
and environmental factors. Only three studies used a quali- of them devices with regard to at least respiratory sup-
tative design. Retrospective chart reviews or case series port and/or nutritional support. Five studies used a non-
were used to collect data in some cases of unforeseen experimental quantitative design including the analysis
events. Table 5 shows about a doubling of published articles of clinical data, such as record reviews or cohort studies,
in the period 2011–2015 regarding this content category, and two articles were reviews. Most articles on this sub-
compared to the previous period 2000–2010. ject (n = 5) were published in the period 2012–2015.
Six articles described policy or management systems professional role [25, 26, 47]. Insight into the psycho-
in different countries regarding the use of AMTs at social effects on those involved can be used to assist de-
home. The majority of the articles (n = 4) were in essay signers of medical devices to find strategies to better
or review format. The other papers concerned a qualitative facilitate the integration of these technologies into the
cross-sectional case study analysis and an observational home [28].
quantitative study in which data are collected prospectively Seven articles reported on the usability, barriers and ac-
using a database. The categories of content will now be dis- cessibility experienced by patients or informal caregivers.
cussed in greater detail. Findings in these studies showed that several technologies
were rarely perceived as user-friendly and that home med-
Content description and trends to secondary research ical devices inadequately met the needs of individuals with
questions physical or sensory deficits [48, 49]. An accessible design
User experiences which meets the diversity of individual user needs, charac-
In this category, 22 articles described the psychosocial teristics and features would be better able to help patients
impact on patients or informal caregivers from the use manage their own treatment and so could contribute to
of medical technologies at home. Living at home with the quality of care and safety of patients and lay users [50,
the assistance of medical technology needs a range of 51]. Munck et al. [52] stated that restricted patients were
adjustments. Fex et al. [25, 26] state that self-care is reminded daily of the medical technology and were more
more than mastering the technology, in terms of the dependent on assistance from healthcare professionals
health-illness transition, it requires ‘…. an active learning than masterful patients.
process of accepting, managing, adjusting and improving In contrast to the group of patients or informal care-
technology’. When it comes to children, they have to givers, only two papers in this content category focused
learn to incorporate disability, illness and technology ac- on the user experiences of nurses or other professional
tively within their process of growing up [27]. It seems caregivers. The review demonstrates that to maintain pa-
that the use of medical technologies in the home can tient safety, more education on application of medical
have both a positive and a negative psychosocial impact devices for users is needed together with improved
on patients and their families, which in turn causes am- awareness and understanding of how to use the medical
bivalence in experiences [27, 28]. On the one hand, pa- technology correctly in a patient-safe way [53, 54]. More
tients in general gain more independence, an enhanced collaboration between all involved ‘actors’ in the process
overall health and a better quality of life [29–34]. On the of care is also requisite. Continuity among carers, trust
other hand, for some patients the experience is one of between patient and carers and supportive communica-
dependency on others for executing daily activities, and tion between informal and professional caregivers are
these circumstances, to some extent, a social restricted important factors for the successful implementation of
live and perceived stigmatization [29, 30]. The situation medical technologies in the home environment while
in which patients need to use medical technology at maintaining patient safety [44, 51, 53–55].
home also affects family functioning and requires next
of kin responsibilities [35–37]. As a result, next of kin Training, instruction and education
caregivers are frequently faced with poor sleep quality Three articles regarding this topic focused on nurses or
and quantity, and/−or other significant psychosocial ef- other professionals and four on the patients or informal
fects [38–41]. Nevertheless, family members had a posi- caregivers. The results showed that successful use of ad-
tive attitude to the concept of bringing the technology vanced medical technologies at home requires adequate
into the home [42]. Knowledge of how to use the tech- staff education and training programmes. Although
nology and permanent access to support from healthcare many topics in educational programmes are suitable for
professionals and significant others, enabled next of kin different types of professionals in care provision, the
caregivers to take responsibility for providing necessary focus for the level and application of information can
care and to facilitate patients learning to provide self- vary for Registered Nurses and unregistered care staff. In
care [25, 36, 42–44]. Bezruczko et al. [45, 46] developed addition, for overall learning experiences to be of max-
a measure of mothers’ confidence to care for children imum benefit there is a need for a clear focus on the
assisted with medical technologies in their homes. To specific client groups [56]. According to Sunwoo et al.
provide high quality sustainable care, nurses have to [57], in the case of home non-invasive ventilation the
recognize and understand the psychosocial dimensions degree of clinical support needed is extremely variable
for both patients and family members which arise as a given the mixed indications for this respiratory support.
result of changing role and providing care for the pa- A relatively simple procedure, such as the replacement
tients. The need to provide emotional support and of a feeding tube, can be performed by nurses, the pa-
support with appropriate coping strategies is a key tient and informal caregivers, provided they are trained
well [58]. However, several studies revealed the complex- pay insufficient attention to safety-related items in tech-
ity of the education needed by patients and informal nical documentation for the use in the home setting. For
caregivers for the use of advanced medical technologies instance, the environmental factor of electricity blackout
at home [59, 60]. Nevertheless, the studies revealed that leads to electrically powered medical devices failing.
a structured education programme, specific training, or Studies show that this type of event causes a dramatic
the support of a dedicated discharge coordinator has increase in appeal for access to emergency or hospital fa-
several advantages [59, 61, 62]. It was evident that good cilities, and that disaster preparation needs to include
preparation by patients or informal caregivers may result the specific needs of patients reliant on electrically
in a shorter length of stay in hospital, a better perform- driven devices [76–78]. Regarding human factors
ance with regard to the use of the equipment or less re- impacting on safety aspects, one article assessed the suit-
quests by patients and/or families for assistance. ability of a particular theoretical framework for under-
standing safety-critical interactions of patients using
Safety, risks, incidents and complications medical devices in the home [79], while Tennankore
Most articles regarding this topic (n = 13) reported on et al. [80] described adverse events in home haemodialy-
safety in general, like aspects of safe use, factors affecting sis by the use of patients. It was remarkable that none of
safety, complications and prevention of incidents in the the articles focused on human factors with regard to the
home. Some identified the risk factors and the complica- use of medical technologies at home by nurses or other
tions that may arise [63–65], where Stieglitz et al. [66] professional caregivers.
also emphasize that human error is the main reason for
critical incidents and that regular instruction for medical Design and technological development
staff and patients is necessary. To prevent untoward and Of those articles that focused on this topic, ten reported
adverse events, evidence based guidelines, recommenda- on the comparison between different types of medical
tions on the preferred methods for managing the equip- technologies, or their advantages and disadvantages. The
ment, troubleshooting techniques for potential comparison of different devices for oxygen therapy was
complications and monitoring activities are necessary made by two articles [81, 82] and one reported on the
[67, 68]. Faratro et al. [68] added that key performance comparison of two types of enteral nutrition tubes [83].
and quality indicators are important mechanisms to en- Some studies regarding respiratory support considered
sure patient safety when using a medical device in the the process of making a choice between different types
home. Methods to address or evaluate patient safety of devices [84–86] while one paper considered the con-
issues are for example, a home visit audit tool, a nation- ditions for home-based haemo dialysis [87]. A minority,
wide adverse event reporting system, programs such as explored the individual characteristics and the clinical
the Medical Product Safety Network HomeNet, or, in applications of several devices for respiratory support
the case of peripherally inserted central catheters [88, 89] and one considered devices for insulin pump
(PICCs) a central catheter stabilization system [69–72]. therapy [90]. Seven papers discussed the technological
However, a study conducted by Pourrat and Neuville development or effectiveness of medical technologies.
[73] in France found that there are very few internal The testing of devices for external electro-stimulation
medical devices vigilance reports found within organiza- was described in two papers [91, 92], with the testing of
tions that deliver devices for home parenteral nutrition a new design patient lift was subject of one study [93].
and that safety management could be improved. The Hanada and Kudou [94] explored the current status of
safe transfer of medical devices from a hospital setting electromagnetic interference with medical devices in the
to the home and vice versa, comes with several chal- home setting, an issue of importance as more devices
lenges regarding technological, environmental and hu- are considered for home use. The technological develop-
man factors [14]. While many hospitals have developed ment of respiratory support for home use was part of
policies to control the pathways of home-used devices in one study [95], as were the possibilities of solar-assisted
the hospitals, in case patients take them into the hospital home haemo dialysis [96]. While the study by Pourtier
when they are admitted for treatment [74]. Improvement [97] describes the advantages of analgesia pumps that
of the safety of devices intended for use in home set- can be read remotely by nurses, but also emphasizes the
tings, implies also improvement of safety when their central position of a professional nurse in the transfer of
transfer to the hospital settings is urgently needed. information within a multi-disciplinary team.
One article considered the technological factors, three
the environmental and two the human factors. An ex- Application with regard to certain diseases or disorders,
ample of research on the technological factors of safety indications for and extent of use
related aspects of medical technologies used in home All articles described several aspects that need to be
settings by Hilbers et al. [75] found that manufacturers considered for use, such as clinical characteristics of the
patients, indications for the use in the home setting, the Although the number of studies on technologies is indica-
technical availability of devices, the extent of their use at tive of the extent to which they are used in home settings,
home or eventual complications and morbidity. It was however, no firm conclusions can be drawn about this.
important to note that all but one article (n = 6) were This review also identified that most research is con-
about children or related to adults with what are usually ducted with regard to ‘user experiences’ of medical tech-
regarded as paediatric diseases. Results show that the nologies in the home, ‘safety, risks, incidents and
use of AMTs at home among children after hospital complications’, and ‘design and technological develop-
discharge is common (in 20%–60% of cases), or is stand- ment of medical technologies’. There have been rela-
ard for patients with some disorders [98–101]. The tively few studies which have explored the topic of
timely application of advanced home medical technology training, instruction and education. Content analysis
benefits patients and can help to reduce respiratory showed that the use of AMTs in the home setting can
morbidity [102]. Nevertheless, the rate of death of pa- have both a positive and a negative psychosocial impact
tients with Möbius syndrome using the devices at home on the patients and their families, and that it has be-
was high (30%) [98], as was that of patients with intes- come part of self-management and patient empower-
tinal failure dependent on home parental nutrition ther- ment. Successful use of advanced equipment requires
apy in Brazil (75% for 5 years) [103]. The average adequate education and training programmes for both
cumulative survival of children needing home ventilation patients, informal caregivers and nurses or other profes-
was found to be between 75 and 90%, depending on the sionals. When trying to maximize or assure safety,
medical diagnosis [104]. technological, environmental and human factors have to
be taken into account, and it is evident that human fac-
Policy and management tors are the main reason for critical incidents. Studies on
Three of the papers were concerned with costs and/or the design and technological development of medical
reimbursement. The application of medical technologies technologies emphasize that research is necessary to im-
in the home environment can be cost-effective when prove its possibilities and effectiveness. The research
compared to institutionalized care [22, 105, 106]. Never- found on the application of the technologies focused
theless, successful employment of medical technologies predominantly on children and the results indicate that
in the home necessitates medical guidelines for the indi- the rate of the use of home medical devices among chil-
cators for use, careful identification of patients as well as dren after hospital discharge is common. Also that when
careful planning and attention to details [105–107]. Two compared to institutionalized care, the application of
studies concerned the dilemma’s for implementation of medical technologies in the home environment can be
the technologies in home healthcare and emphasized the cost-effective. Much is known, but information on sev-
importance of cooperation in the chain of key stake- eral key issues is limited or lacking.
holders to maximize efficiency of high-tech healthcare at An important finding was that in almost all the
home, one with regard to the purchasing policy of med- reviewed articles, the study subjects were patients or in-
ical technologies [108] and one with regard to the inter- formal caregivers with very few studies focused on the
ventions of local community service centres and role and activities of nurses or other professionals as
hospitals supporting optimal use of these technologies in users. This was unexpected as nurses are the main group
the home setting [5]. of users of AMTs at home and they have to transfer
knowledge and skills on how to use the devices to pa-
Discussion tients and other caregivers. Nurses also have a key role
The use of medical technologies in the home setting in setting up and maintaining collaboration between all
has drawn increased attention in health care over the actors involved in the process of care with regard to the
last 15 years, as the feasibility of this type of medical use of home medical technologies and in giving support
support has rapidly grown. This article systematically to patients and family members in this respect. There is
reviewed the international literature with regard to the need to initiate further in depth research on AMTs use
state of the art on this subject, in order to provide a at home focusing on the role of specifically nurses.
comprehensive overview. Another interesting result was that, despite the fact
Trend analysis over the period 2000–2015 shows that that most adverse events with AMTs at home are caused
most research has been conducted about respiratory by human factors, hardly any studies conducted on this
support, dialysis and oxygen therapy; relatively little subject were found. None of the articles focused on re-
about vacuum assisted wound closure and continuous lated human factors regarding the use by nurses or other
passive motion, and no about decubitus treatment, professional caregivers, although this is the main user
skeletal traction and UV therapy. A substantial increase group. Research on this area could contribute to im-
in publications was found in the period 2011–2015. proved patient safety and quality of care. The results also
revealed the tension between the advantages and disad- practical and useful framework from which to work to
vantages of medical technologies as experienced by pa- gain an insight and overview of available medical tech-
tients at home. Important aspects needed to promote nologies. Of some of the chosen technologies defined
the benefits include improving the user-friendliness of using the RIVM-classification of AMTs, questions do
the devices and attuning their designs for the use in have to be asked as to whether they really are part of the
home settings. This emphasizes the importance of pro- technical skills in nursing process. For example, ‘external
fessionals (and patient groups) working together with electrostimulation’ and ‘continuous passive motion’ are
the designers with regard to sharing knowledge and user mainly applied by physiotherapists, although with
experiences of the use of AMTs at home in order to im- appropriate training nurses can apply them. Then too,
prove quality of care and patient safety. This collabor- devices regarded as only ‘monitoring’ were excluded
ation emerged as of key importance in the successful use from the review.
of AMTs in the home as well.
Although all included articles were retrieved from aca- Conclusions
demic databases and served our purpose, there was con- This systematic review study was designed to fill a gap in
siderable heterogeneity of quality of the studies. Most of the current research by investigating what is known about
the studies have explicitly described their research de- different aspects of medical technologies used in the
sign, albeit to a greater or lesser extent. On the other home. From the results it is obvious that a wide and grow-
hand, there were a few studies that did not even mention ing range of medical technologies are used at home. Dif-
their methodological approach, though it could be de- ferent types of technologies have been subject of study,
rived from the description. Most included reviews are of increasingly –also in scope- over the period 2011–2015.
moderate quality. Although findings are almost always Professional nurses have a central role in the process
described clearly, the search strategy and selection cri- of homecare which has to be recognized when consider-
teria used are often lacking. The quantitative studies are ing use of AMTs at home. Nurses have to support pa-
generally well described in different methodological as- tients and family caregivers and in consequence have a
pects, such as selection of respondents, research design, key role in providing information for, and as a member
data collection methods and analyses. Studies of qualita- of multi-disciplinary teams. Closer collaboration by all
tive nature show more variation in the depth with which actors involved in the process of care and feedback of
the design is described. However, almost all qualitative user experiences to the designers is essential for the
studies have described the research instruments very provision of high quality of care and patient safety.
well, such as semi-structured interviews or question- This review also identified a lack of research exploring
naires. Despite the varying quality of the studies, we be- the perspectives of nurses in the processes involved in
lieve that the whole of different methodological introducing and maintaining technology in homecare.
approaches and the relatively large number of included Most of the research has been conducted regarding the
studies (n = 87) has yielded a fairly reliable overview on experiences of patient experience and how informal
the international state of art concerning various aspects caregivers perceive their role in using medical technolo-
of the use of advanced medical technologies at home. gies at home. The few studies that were found, demon-
For future research, we recommend to emphasize the strate the need for more research focused on the
development of a more detailed methodological design, experiences of nurses working with advanced technologies
zooming in on specific technologies, using large data- in the home. The same applies to research on training, in-
bases or conducting large surveys, and focusing on spe- struction and education to use medical technologies, as in
cific groups of respondents. Both in quantitative and in these areas too, there was limited available research so
qualitative studies, a good definition of the research here again there is need for further research. Despite the
question(s), selection of respondents, development of in- fact that most adverse events with medical technologies in
struments and analysis of findings, contributes to valid- home settings are caused by human factors, our findings
ity, consistency and neutrality. also identified a lack of research in this area for nurses.
Some limitations do have to be taken into account This study demonstrates that, although there is in-
with this review. Although we used the RIVM-definition creasing attention on and recognition of the need for the
of ‘advanced medical technology’, not all devices are con- use of medical technologies in the environment of the
sidered as ‘complex devices’ by nurses in practice. For home, the research has not kept pace with the advances
example, the use of an anti-decubitus mattress in the in care. Subjects such as user experiences of nurses
context of ‘decubitus treatment’ and ‘patient lifting with different technologies, training, instruction and
hoists’ are considered by nurses as being of less or lower education of nurses and human factors by nurses in
complexity. However, overall the RIVM-classification risk management and patient safety urgently need to
was found to be a good starting point, and provided a be investigated by further research.
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ten Haken et al.

BMC Public Health (2018) 18:284

RESEARCH ARTICLE Open Access

The use of advanced medical technologies

Background When ‘an increase’ in the number of medical tech-

Survey forms, questionnaires homes.

home parenteral nutrition.

Interview; a ventilator; advanced medical technology

timing for its use, and to

Abma, I., Bayer, S., Quantitative methods; barriers to and enablers of

Lung, gastric, colon, hepatic,

Effects from bone marrow

patients with chronic

considered medical technologies with regard to decubi-

No shading n = 0, up till the darkest shading n = 5

Fig. 2 Number of medical diagnoses mentioned in articles on AMTs

No shading n = 0, up till the darkest shading n = 4

Submit your manuscript at

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