Current Telehealth Issues and Upcoming External Challenges

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Introduction

It is safe to say that today is the time of advances in digital technologies. They affect all vital areas of people’s lives, one of which is healthcare. Telehealth is one of the manifestations of the use of modern high and widely available technologies in the care and treatment of patients. However, there is one more influencing factor that influenced the leap in the development of mobile technologies. This is the coming demographic shift in the population of the United States. It is expected that “older adults will outnumber children for the first time in U.S. history” (Vespa et al., 2018, p. 1). Simply put, “one in every five Americans is projected to be retirement age” (Vespa et al., 2018, p. 1). Therefore, health care providers should expect an increased need for chronic care services, as older adults are more prone to chronic diseases than other age groups. It can be concluded that the current external and internal conditions create a unique opportunity to study the telehealth impact for the elderly. It is because current technologies and percentages within the population provide ample time and resources for research.

Topic area

The topic area of this research is directly related to telehealth, specifically CCM and RPM. Experts note that “chronic care management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient” (Chronic care management, 2021, para. 1). In this study, CCM is about patient education about self-management of chronic illness, identification of complications, and proper medication to avoid hospitalization. In RPM, “a team of Remote Patient Monitoring nurses regularly monitors the data and contacts patients to assess health and progress toward health goals” via special medical devices sent to patients (Remote patient monitoring, 2021, para. 2). The research also includes daily vital signs monitoring as part of the intervention.

Population, INTERVENTION, Comparison, outcome, time frame (PICOT) question statement

The PICOT question is, will the number of hospitalizations in elderly patients aged 65 to 99 with multiple chronic conditions such as heart failure, diabetes, stroke, cancer, hypertension, depression, renal failure and receiving Medicare services (P) decrease (O) during and after a month-long (T) RPM program (I) that includes chronic disease self-management training, medication training, and complication identification training compared to their peers who were not remotely monitored and did not have Medicare insurance (C)?

Significance of the study

This study answers current telehealth issues and upcoming external challenges from a changing US society. Telehealth encompasses many methodologies, techniques and models of PRM effectiveness, many of which are poorly or insufficiently studied. This study proves the effectiveness, preventive potential, and safety of some of the telehealth programs for elderly patients with multiple chronic conditions. Moreover, this work contributes to the evidence of telehealth that many still consider controversial or questionable. According to Shigekawa et al. (2018), “it is therefore difficult to draw broad conclusions about telehealth’s efficacy” (p. 1975). It is also worth noting that this research is part of the theoretical basis for an adequate response to future health challenges associated with demographic changes in the US population. It also provides an intervention model and necessary data for other researchers.

Analysis of evidence

In this presentation, only those articles used in the course that are not older than five years will be discussed. The analysis of the recent papers showed that the opinions of the scientific community regarding the effectiveness of PRM are contradictory. However, the researchers agree that new technologies are improving PRM technologies and innovating PRM methodology. Those researchers who have dealt with the issue of the effectiveness of PRM argue that there are internal and external factors that prevent the achievement of a long-term positive PRM result.

At the moment, the effectiveness of PRM interventions seems questionable, and researchers give different answers to this question. For example, Iyngkaran et al. (2016) argue that chronic disease self-management programs are poorly effective and their success depends on many factors. These are environmental, demographic factors, and the burden of treatment and disease (Sheehan et al., 2018). In contrast, Lee et al. (2018) say that PRM via mobile devices is promising and effective, especially in terms of self-management. Moreover, evidence from the work of Iyngkaran et al. could be undermined by Australia’s unique and harsh climate. Therefore, more research is needed on PRM efficacy.

Another important topic within the supporting evidence of this study that should be mentioned is the nature of PRM effectiveness. The truth is, the impact of these interventions and programs is short-lived (Geramita et al., 2020). Their effect cannot be sustained for a long time. In addition, ongoing interaction and trusted relationship between the caregiver and the patient is required for the PRM and self-management programs to be effective. Research by Phelps and Sutton (2018) also supports this claim. The degree of positive impact also depends on the provider’s theoretical knowledge and understanding of the principles of telehealth, CCM, and PRM (Ferrua et al., 2020). One of the few studies that support the long-term positive impact of PRM is the work by Peterson (2018).

Modern technologies directly influence the development of CCM and RPM methodology and techniques (Donati et al., 2019). It is safe to say that every technical innovation in healthcare finds its place in CCM and PRM (Punj & Kumar, 2019). Moreover, new technologies also contribute to the development of new approaches in PRM. Here, the positive effect of technical progress and the dependence of CCM and PRM as health disciplines on innovative technologies is undeniable (McGregor et al., 2020).

The current analysis of the evidence showed what research aspects should be considered and what errors should be avoided in the upcoming study.

Next Steps

One of the following significant steps will be to conduct an experiment within the setting of the chosen practicum site described in one of the previous course assignments.

Other majors include standard steps after completing an advanced education program.

References

Chronic care management. (2021). AAFP. Web.

Donati, M., Celli, A., Ruiu, A., Saponara, S., & Fanucci, L. (2019). A telemedicine service system exploiting bt/ble wireless sensors for remote management of chronic patients. Technologies, 7(1), 13. Web.

Ferrua, M., Minvielle, E., Fourcade, A., Lalloué, B., Sicotte, C., Di Palma, M., & Mir, O. (2020). How to Design a Remote Patient Monitoring System? A French Case Study. BMC Health Services Research, 20, 1-16. Web.

Geramita, E. M., Dabbs, A. J. D., DiMartini, A. F., Pilewski, J. M., Switzer, G. E., Posluszny, D. M., Myaskovsky, L., & Dew, M. A. (2020). Impact of a mobile health intervention on long-term nonadherence after lung transplantation: Follow-up after a randomized controlled trial. Transplantation, 104(3), 640-651.

Iyngkaran, P., R Toukhsati, S., Harris, M., Connors, C., Kangaharan, N., Ilton, M., Nagel, T., Moser, D. K., & Battersby, M. (2016). Self managing heart failure in remote Australia-translating concepts into clinical practice. Current Cardiology Reviews, 12(4), 270-284.

Lee, J. A., Choi, M., Lee, S. A., & Jiang, N. (2018). Effective behavioral intervention strategies using mobile health applications for chronic disease management: A systematic review. BMC Medical Informatics and Decision Making, 18(1), 1-18.

McGregor, B. A., Vidal, G. A., Shah, S. A., Mitchell, J. D., & Hendifar, A. E. (2020). Remote oncology care: Review of current technology and future directions. Cureus, 12(8), 1-15.

Peterson, S. (2018). Telerehabilitation booster sessions and remote patient monitoring in the management of chronic low back pain: A case series. Physiotherapy Theory and Practice, 34(5), 393-402. Web.

Phelps, P., & Sutton, K. (2018). Structured telephonic consultation to decrease heart failure readmissions. MedSurg Nursing, 27(3), 153-158. Web.

Piras, E. M., & Miele, F. (2019). On digital intimacy: Redefining provider–patient relationships in remote monitoring. Sociology of Health & Illness, 41, 116-131. Web.

Punj, R., & Kumar, R. (2019). Technological aspects of WBANs for health monitoring: A comprehensive review. Wireless Networks, 25(3), 1125-1157. Web.

Remote patient monitoring: Comprehensive care at home. (2021). Mayo Clinic Health System. Web.

Sheehan, O. C., Leff, B., Ritchie, C. S., Garrigues, S. K., Li, L., Saliba, D., Fathi, R., & Boyd, C. M. (2019). A systematic literature review of the assessment of treatment burden experienced by patients and their caregivers. BMC Geriatrics, 19(1), 1-11. Web.

Shigekawa, E., Fix, M., Corbett, G., Roby, D. H., & Coffman, J. (2018). The current state of telehealth evidence: A rapid review. Health Affairs, 37(12), 1975-1982.

Vespa, J., Armstrong, D. M., & Medina, L. (2018). Demographic turning points for the United States: Population projections for 2020 to 2060.

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