Telehomecare and home care services: Goals and Impacts in the Healthcare Delivery

by: admin Health Theories‚ Healthcare Research‚ Patient Care‚ Quality of Care‚ Social Change Comment off

Article Reviews

  1. Telehomecare and Remote Monitoring: An Outcomes Overview, Stachura M, Khasanshina E, October 31st, 2007, Partners Healthcare: Center For Connected Health; Retrieved September 23, 2013 from http://www.connected-health.org/programs/diabetes/research-materials–external-resources/telehomecare-and-remote-monitoring-an-outcomes-overview.aspx

      Telehomecare involves the checking of vital signs from remoteness via telecommunications equipment and the replacement of home nursing visits with video conferences. The field of telemedicine and telehomecare is growing at a rapid rate. The use of Telemedicine makes medical care available to anyone in an urban or rural region regardless of distance from medical centers and physicians. According to the presented article, telehomecare and remote monitoring technologies have the potentiality of playing a vital role in the management of cost and weakening of chronic diseases. According to article, based on the report released by the AdvaMed, the advanced Medical Technology Association, “it describes how such technologies—which convey real-time, physiological information on a patient’s condition over the internet or phone lines enable physicians to adjust and tailor therapy to meet a patient’s changing needs in between visits to a health care provider.”

      The report of this article, according to a studied review on telehomecare and remote monitoring, focused on “how these technologies have impacted the care of patients with diabetes, congestive heart failure and chronic obstructive pulmonary disease.” Based on the findings:-

“● A study of 281 congestive heart failure patients who received telehomecare found that they experienced a 60 percent reduction in hospital admissions, a 66 percent decline in emergency room visits and a 59 percent reduction in pharmacy utilization. In contrast, the control group experienced increases in all of these areas.

● When patients with severe respiratory illness requiring long-term oxygen therapy were remotely-monitored, hospital admissions decreased by 50 percent, acute clinical problems decreased 55 percent and hospitalization costs went down by 17 percent.

● A study of 400 diabetes patients found that those monitored by in-home glucose meters and video conferencing showed significantly greater improvement in reducing average blood sugar levels than those who did not receive such monitoring.”

        As positive reports of patient and provider acceptance of telehomecare began to shallow, so did the adoption of the prospective payment system, changing reimbursement from fee-for-service to prospective payment for an episode of care. Because of this change, home care agencies are financially at risk, and therefore are seeking new methods of providing cost-effective and quality care. Simultaneously, the home health industry is managing with challenges, including a nursing shortage, increased concern over quality of care, decreasing reimbursements, and an aging population with intricate chronic illnesses. These challenges require new and inventive ways to deliver efficient, high-quality care. telehomecare is believed to be an effective and ground-breaking way to deliver services, under these demanding conditions. The home care industry is progressively integrating this technology. The study also suggests that home care using communication and monitoring technology is feasible and suitable to patients, caregivers, and providers. The addition of telehomecare technology seems to improve care outcomes among patients with chronic illness, most often HF, diabetes, and chronic wounds. Additionally, but eventually, over the long term, management costs of chronic illness will decrease, with the use of telehomecare.

         This article supported that notion that “telehomecare has the potential to be cost-effective way of delivery health services. Three larger studies showed that although initially, care delivery costs were increased due to the cost of equipment, overall costs of care were decreased due to decreased hospital charges and travel costs. In most studies, small sample sizes and lack of robust economic analyses preclude generalization of financial results. Further, most of the studies that evaluated telehomecare costs were conducted before the change to a prospective payment system. Patients in these studies received telehomecare in addition to in-person visits. This additional care may have influenced the achievement of positive outcomes and is important to note. The extra care also equates to extra costs. New evaluations of the cost and effectiveness of this technology are needed to understand new reimbursement structure.”

        Telehomecare is a new technological intervention, so the body of evidence is scant. There is much more to learn in order to enhance the use of telehomecare technology. Although the end result of the study provided positive outcomes. However, the study also affirmed that, “little is known about the mechanism behind those outcomes. It is not known how changes in therapy are made based on data provided by telehomecare technology. More studies are needed that use methods described by Dansky et al.They videotaped telehomecare interactions to analyze nursing activities. Such studies can inform us about how information and knowledge are transferred during a telehomecare visit.”

       It was found that there was a positive effect of using telehomecare on providers.  Researchers also have studied the effects of telehomecare on nurses. Nurses reported that using telehomecare technology added dimensions to caring by creating new types of bonds with patients. Patient who received telehomecare were more focused and more comfortable managing their diseases. Nurses also reported it was useful for monitoring vital signs, saved time and money, increased productivity,and gave them the ability to provide better care to patients. However, nurses noted that the complexity of technology can be frustrating and anxiety provoking.

  • Telehomecare Communication and Self-Care in Chronic Conditions: Moving Toward a Shared Understanding, Shea K., and Chamoff B., March, 12, 2012, Wiley Online Library, Retrieved September 23th, 2012, from http://www.telehealth.ca/intrototelehomecare.html

         Technology allows people to perform a variety of functions that otherwise would not be possible. In the health care industry, technology recently has enabled physicians to communicate with patients from remote locations. Doctors, nurses, and health care providers are using telehomecare technology all over the world. This article supported the first article by presenting the ideas that, “communication in remote electronic monitoring differ from those in traditional home health care, the understanding shared by the nurse, patient, and family members remains the same: patients’ self-care behaviors affect exacerbations of chronic health conditions.” It further explained the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses (THN).  Based on the result of study, “There was almost no correlation between patients’ perception of THNs’ communication (frequency [r= 0.05], timeliness [r= 0.09], and understandability [r= 0.03]) and patients’ integration of information into daily health practices. However, significant correlations were found between the THNs’ perception of patients’ communication frequency and timeliness, and integration, (p= 0.02; p < 0.001) respectively.”

        Telemedicine is not a new concept. The Food and Drug Administration (FDA) says telemedicine is “actually an extension of one of the oldest, simplest, and most popular forms of electronic medical consultation: a telephone conversation between doctor and patient or a medical generalist and a specialist.” Lastly, the study concluded that, “frequent phone communication may lead the remote THN to believe patients are integrating blood pressure, weight, and other information into daily self-care behaviors, when in fact the patient reports that they are not. The influence of a halo effect on the THN may cloud an accurate perception of what is actually occurring. Remote communication may require more attention to THNs educating patients about shared understandings when using telemonitoring. Best practices for THN should include explicit goals and intentions for telemonitored homecare with individualized instructions about how to use the information for self-care.”

  •  The demand for home health care has risen steeply in recent years. The aging population and the push for more efficient delivery of hospital services have powered this growing demand. However, health care financing reforms have constrained the industry’s growth. Home health agencies struggle to deliver high-quality services while staying within the financial limitations imposed by reimbursement changes. Telehomecare is one way to provide cost-effective care in the current milieu.  It is my understanding, based on the three articles, to admit that over the last few years, the concern of home care service is an essential factor of the enduring reforms of healthcare systems. However, their full integration into the hospitals and primary care services is still a slow progress. It appears that telehomecare could help in creating networks of services between hospital and primary care providers. Even though their potential to increase access to services and improve quality of care and health outcomes is recognized, their widespread adoption has not yet been attained. Various fences need to be overcome.
  • The advent of telehealth  has seen the rapid growth and application of information and communications technology (ICT) in many areas of healthcare delivery. The benefits of telehomecare are increasing, due to patients preferring to stay in their homes if possible before moving onto a higher level of healthcare service, should it be nursing home or hospice living. Telehomecare involves a link between the patient’s home and a hospital or central office that collects data. The benefits of telehomecare for the health professional will decrease company expense, travel time will be cut out, which means no reimbursement for clinician travel cost. And the nurse gets to see and attend to more patients instead of spending half of their time on the road. It also helps a doctor because, he can tell the person who is in the household on how to treat the injured person until help arrives.