Synthesis Essay on Impact of Telehealth on Health Outcomes

Introduction

Since the 19th century, telecommunications techniques have been used to deliver timely and quality care, health education and administrative activities (DelliFraine, & Dansky, 2008). Telehealth is touted to improve access to care, while at the same time it increases expediency to providing patient care and reduces the cost of transportation (Barberan-Garcia, 2014). Through the use of telehealth, patients have been able to access medical care, receive treatment and manage acute conditions before they become critical. Telehealth reduces the cost of providing health care services while it increases opportunities for nurses and improves convenience for patients (DelliFraine, & Dansky, 2008). Patients can seek care closer to their homes, thereby reducing the number of time patients wait for specialty care. Telehealth has also been used to provide educational programs like continuing medical education (DelliFraine, & Dansky, (2008). Such benefits help to improve and support the productivity of healthcare providers. However, significant questions about the effectiveness, efficacy, and value of the use of telehealth remain unanswered. This is because, telemedicine has been linked to patient safety risks associated with lack of face to face care, lack of in-person care and hindrances presented by the telehealth system risk (Sanders et al. 2012). This literature review analyzes how telehealth has impacted patient care in the healthcare field in the United States.

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Berwick and Fox, (2016) believe that there are approaches to assess the quality of healthcare. First, the outcome approach where the lengths of stay, mortality rates, and re-hospitalization rates are used to evaluate the quality of healthcare. Secondly, assessing the sufficiency of medical facilities is an approach that can provide proper instruments and setting which allows for good medical care. Finally, assessing the quality of healthcare is an approach that determines whether good medical care was applied.

According to Dansky, Vasey, and Bowles, (2008) telemedicine not only improves the patient's outcomes but also the quality of care by allowing nurses to be alert allowing faster interventions when there are changes in the conditions of patients. Therefore, the most promising use of telehealth is its importance in improving quality of care. For example, during cardiovascular care, sensor technology is used to monitor patients with heart failure from their homes. The device has been essential in monitoring such patient's thereby preventing re-hospitalization and improving the quality of care.

Wakefield et al. (2009) evaluated the efficacy of videophone and telephone in interventions. Knowledge, satisfaction with care, compliance, and self-efficacy were measured. The sample of the study involved 148 patients, 47 patients received care through the telephone, 52 patients received care through the videophone, and 49 patients received normal care. The study results indicated that there was no significant difference between satisfaction, self-efficacy and medication compliance. The adjustment of videophone and telephone patients showed that symptoms self-monitoring showed better treatment indicating the quality of care.

Self-monitoring is a critical non-clinical effect of telehealth, which can improve quality of care by inspiring patients to care for themselves through adherence. Radhakrishnan and Jacelon (2012) carried out a study to whether home telemonitoring could improve patient outcomes. The study sample included 120 patients who have asthma. Each patient was assigned a virtual or an office-based program. The study measured the following outcomes; symptom control, utilization of services and quality of life. The results of the study indicated that office visits were similar to virtual care and the patients adhered to their medications and therapeutic care, giving evidence of the quality of care.

When evaluating the quality of care using telehealth, measuring patient's perceptions of the type of care, they are getting is important. Darkins, Kendall, Edmonson, Young, and Stressel (2015) conducted a study to determine the perceptions of patients using VHA's CCHT program. The results of the study showed high satisfaction levels for patients who used CCHT program. The patients also appreciated the monitoring, education, and access to the program. However, they were mainly frustrated by the slow response times, care coordination inaccessibility and equipment problems. Despite these frustrations, the patients showed a high level of satisfaction with the use of home telehealth.

Cost saving is an essential factor in the field of telehealth. In Darkins, Kendall, Edmonson, Young, and Stressel (2015), the study used VHA's CCHT program, and the cost was estimated to be around $1600 for every patient annually. Such a considerable lower cost shows that the CCHT model is cost-effective in providing care. Similarly, according to Dang, S., Dimmick, and Kelkar (2009), telehealth leads to the magnitude of savings by reducing the overall cost of hospitalization in the US from $8 billion to 4.2 billion annually.

In a meta-analysis of telemonitoring studies carried out by Kitsiou, Pare, and Jaana, (2015) the study indicated that 12 articles showed cost efficacy with the use of telemonitoring. Therefore, the benefits of using telemonitoring outweighed the cost by reducing the rates of hospitalizations, lengths of stays for patients, and the number of home care visits. Besides, the study found a significant cost saving for Medicaid and Medicare programs. Newman and McMahon (2011) estimate the potential savings if telehealth is fully implemented through California's Medicaid program to be about $408 million annually. Therefore, home telehealth is cost-effective, but the most common problem is to find a way in which the cost efficiency of telehealth can be measured.

According to Brewster, Mountain, Wessels, Kelly, and Hawley, (2014), the change in nature if a clinical setting can lead to patient safety risks associated with the use of telehealth when nurses traditionally perform care in homes. Such risks are due to lack of face to face care, lack of in-person care and hindrances presented by the telehealth system. In their study, they found that there are hindrances based on clinical assessment and good decisions for treatment. The use of telehealth was also found to have a negative influence on staff-patient relationships by reducing and hindering good communication and making it difficult to have good clinical relationships. Therefore, the study concluded that the use of telehealth might be less safe than standard care.

Through the introduction of telehealth, there are daily routine changes regarding work process and workload that negatively impact patient's outcomes. Nurses indicated that the use of telehealth led to an increase in workload through initial patient assessment and installation of equipment (Brewster, Mountain, Wessels, Kelly, and Hawley, 2014). The work process also increases by having to visit the patients and conduct them through the telephone. A study by Sanders et al. (2012) also indicated that the use of telehealth changed the interaction with patients. Telephone calls replaced regular care visits. This led to some staff members missing critical health symptoms. Besides, the lack of patient or staff knowledge and understanding of telehealth system is a patient safety risk. The lack of understanding, skills or expertise can compromise the safety of patients through the inability to use the system in the right way (Sanders et al. 2012).

Conclusion

Overall, the research reviewed found telehealth to have a positive and negative impact on health outcomes of patients. The studies yielded promising results for remote monitoring by focusing on CCHT programs. CCTH showed to be effective in improving health outcomes such as patient adherence using self-monitoring. The use of telehealth was also showed to be effective in improving response times and improving patient adherence leading to increased patient satisfaction. However, significant questions about the effectiveness, efficacy, and value of the use of telehealth remain unanswered. This is because, telehealth has been linked to patient safety risks associated with lack of face to face care, lack of in-person care and hindrances presented by the telehealth system risk. Many studies have shown that the lack of patient or staff knowledge and understanding of telehealth system is a patient safety risk.

References

Barberan-Garcia, A., Vogiatzis, I., Solberg, H. S., Vilaro, J., Rodriguez, D. A., Garasen, H. M., ... & Roca, J. (2014). Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries. Respiratory medicine, 108(4), 628-637.

Berwick, D., & Fox, D. M. (2016). "Evaluating the quality of medical care": Donabedian's classic article 50 years later. The Milbank Quarterly, 94(2), 237-241.

Brewster, L., Mountain, G., Wessels, B., Kelly, C., & Hawley, M. (2014). Factors affecting frontline staff acceptance of telehealth technologies: a mixedmethod systematic review. Journal of advanced nursing, 70(1), 21-33.

Dansky, K. H., Vasey, J., & Bowles, K. (2008). Impact of telehealth on clinical outcomes in patients with heart failure. Clinical Nursing Research, 17(3), 182-199.

Darkins, A., Kendall, S., Edmonson, E., Young, M., & Stressel, P. (2015). Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: a retrospective matched cohort study of 4,999 veteran patients. Telemedicine and e-Health, 21(1), 70-76.

Dang, S., Dimmick, S., & Kelkar, G. (2009). Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. Telemedicine and e-Health, 15(8), 783-796.

DelliFraine, J. L., & Dansky, K. H. (2008). Home-based telehealth: a review and meta-analysis. Journal of telemedicine and telecare, 14(2), 62-66.

Kitsiou, S., Pare, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal of medical Internet research, 17(3).

Newman, M., & McMahon, T. (2011). Fiscal Impact of AB 415: Potential Cost Savings from Expansion of Telehealth. Blue Sky Consulting Group.

Radhakrishnan, K., & Jacelon, C. (2012). Impact of telehealth on patient self-management of heart failure: a review of the literature. Journal of Cardiovascular Nursing, 27(1), 33-43.

Sanders, C., Rogers, A., Bowen, R., Bower, P., Hirani, S., Cartwright, M., ... & Chrysanthaki, T. (2012). Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC health services research, 12(1), 220.

Wakefield, B. J., Holman, J. E., Ray, A., Scherubel, M., Burns, T. L., Kienzle, M. G., & Rosenthal, G. E. (2009). Outcomes of a home telehealth intervention for patients with heart failure. Journal of telemedicine and telecare, 15(1), 46-50.