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Student #37– Client Satisfaction with Telehealth in Assisted Living and Homecare 

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Student #37– Client Satisfaction with Telehealth in Assisted Living and Homecare 

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This article discussed the importance of client satisfaction with the increasing telehealth services in assisted living and home health care facilities. Public policies increasingly supporting aging in place by allowing the older population with greater levels of impairment the opportunity to avoid the delay of their placement in nursing homes, and replacing it with assisted living facilities and home health care facilities. Senior citizens were recruited for a randomized trial where telehealth services were provided. They then rated their care in different implements of time. First, they rated their care upon delivery, then after 6 months, and then after 12 months. These services were provided to 820 clients, and was evaluated by a research team from The University of Minnesota.

The research team tested three types of telehealth devices. The first was sensors, (motion detectors, bed sensors, and humidity sensors) which sent wireless signals to detect sleeping patterns, motion, bathing, toileting, cooking, and other activities of daily living. The second was emergency response systems. These were used to enhance client safety using a pendant with a button that can be pressed to summon help. The pendant has a built in accelerometer that automatically sends a signal if a person may fall or become unconscious. Lastly, the third teledevice is a biometric monitor. The use of this was to conduct physiologic evaluations (heart rate, blood pressure, weight). These devices were connected to a data management system that is monitored by a team composed of registered nurses and trained unlicensed staff.

There were no significant differences in the experimental and control groups of those who were residents of assisted living facili ties. The clients that reported good service at 6 months also reported high satisfaction at 12 months. There is the challenge of trying to market telehealth medicine to those living in assisted living facilities compared to those living in a home.

References
Grant, L., Rockwood, T. & Stennes, L. (2015). Division of Health Policy and Management. Client Satisfaction with Telehealth in Assisted Living and Homehealth.

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Diabetics who suffer from diabetic foot ulcers are just one example of a population in health care who need regular check ups to monitor their health status. Telehealth has made it easier for these patients to reach care by making follow up appointments more convenient, and requiring less hospital visits for patients. Telehealth is emerging because there is a growing need for patients to receive care from home. Hope, Gjengedal, Graue, Iversen, Thorne, and Kirkevold (2017) explore what will bring telemedicine more popularity in the future. They came to the conclusion that four key things are needed; training in the technology that is easily understood or learned, applying telemedicine in a work setting, frontrunners who will back it up, and making sure that communication is efficient and professionally arranged.

With technology forever expanding, it is very important to make sure the users of telehealth understand the technology behind it. Telehealth may frighten healthcare workers at first because of all the technology used in the process. I think if guidelines on how to use the equipment are clear, healthcare workers will feel less intimidated. Telehealth should also be just like a typical appointment with a patient. Conducted just how you would manage your hands on job at a hospital or clinical setting. Although technology seems to becoming less and less informal, technology in healthcare should always be held to a professional standard.

Most importantly, in order for telehealth to grow into a success, professionals in healthcare need to promote it. Backing telehealth up and spreading word of how successful it can be will help tremendously with it’s popularity. It will show people that are hesitant that new technology in healthcare can be a good thing, and it should be imbraced. Finally, making sure that good communication is key in telehealth. Telehealth doesn’t always allow for many professional to be involved like they would in a hospital. Health care workers will have to use effective communication not only to work with the patient, but also other professionals in the team.

Hope Kolltveit, B., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2017). Conditions for success in introducing telemedicine in diabetes foot care: a qualitative inquiry. BMC Nursing, 161-10. doi:10.1186/s12912-017-0201-y

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The article talked about the DTC (direct to consumer) method of laboratory testing. This where a person can log onto a website and decide which lab test they would like to have done, pay, and then print the order off without the need of a physician to approve or order the tests. These tests have been controversial due to the process in which they are obtained and what the patient does with the results.

Patients using DTC laboratory testing enjoy the convenience of ordering the tests they would like done from the comfort of their home, without an appointment. This saves time, money, and hassle of going to the doctor. Another argument for the continuation of DTC testing is that it can be done without insurance, as the cost is paid out of pocket. This means that people without health insurance can afford to get tests done without a hefty appointment cost as well.

Some can argue that early diagnosis would be a pro for DTC testing, however with DTC testing, results are provided to the individual without an interpretation. Medical advice is usually added on when having a lab test done at a doctors office. If the doctor orders a cholesterol test, the results will come back, and the physician will offer advice to what the patient can do to help lower their level if needed. Without the medical interpretation, individuals can be left in the dark without knowing what to do with the results they were just given. What is currently being encouraged is that the results are faxed or brought physically to the doctor's office where they can be put on record and reviewed by the physician. An appointment still may not be needed as a message through a portal may be able to give the information needed to a patient regarding the results.

Chung, R. (2012). Telehealth Physician Oversight over Direct to Consumer Testing: Doctors Working with Patients Towards Patient Empowerment. Telemedicine and e-Health. DOI: 10.1089/tmj.2011.0196

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Student 26- The socio-economic impact of telehealth: a systematic review

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Student 26- The socio-economic impact of telehealth: a systematic review

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The article sought to review the socio-economic impact of telehealth based on different areas within the field and how they impact different populations. The determination was that overall there was a great benefit to underserved populations and those that lack in education, have limited access, and impoverished areas. The article analyzed 306 studies and concluded that telehealth has an overall positive socio-economic impact on all population taken into consideration.

The areas taken into consideration include Pediatrics, First Nations, Home care, Geriatric, Mental health, Radiology, Rural/remote health services and most show evidence of positive socio-economic impact. The article included Renal dialysis which had no results.

I have personally had face-to-face interaction with healthcare professionals which seemed more like a telehealth situation because of the reliance on their computer. I think telehealth has a very positive socio-economic impact on most populations and with some procedures but there are many procedures that telehealth makes little to no sense in implementing or needs to be rethought.

Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of  telehealth: A systematic review. Journal of Telemedicine and Telecare. 2003;9(6):311–320. doi:10.1258/135763303771005207.

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Student 25 - Automated telehealth for managing psychotic instability

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Student 25 - Automated telehealth for managing psychotic instability

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Serious mental illness with psychiatric instability accounts for a high percentage of emergency room visits and hospitalizations. In this article there aim was to evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management. With automated telehealth, the health care would help improve psychiatric illness management and reduce acute service use among the individuals with SMI. This article had a lot background that seemed to be effective in the health field.

In the study of SMI there were thirty-eight individuals with SMI who received the automated telehealth intervention for about six months. The psychiatric symptoms, illness self-management, and self-reported service results were all collected and examined. Also in the study the measures of quality of life, health indicators, and subjective health status were collected. The results of the participants showed improvements in self-reported psychiatric symptoms and illness self-management skills. In total there was an eight-two percent decrease in hospital admissions and a seventy-five percent decrease in emergency room visits.

In this study there was dramatic improvements all around. Studies also should improvements in quality of life, severity of depressive symptoms, and mental health status. Concluding that automated telehealth has promising findings and potential for cost savings. Telehealth truly has a bright future in healthcare.

Pratt, S. I., Bartels, S. J., Mueser, K. T., Naslund, J. A., Wolfe, R., Pixley, H. S., & Josephson, L. (2013). Feasibility and Effectiveness of an Automated Telehealth Intervention to Improve Illness Self-Management in People With Serious Psychiatric and Medical Disorders. Psychiatric Rehabilitation Journal, 36(4), 297-305. doi:10.1037/prj0000022

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Student #29: The Role of Tele-Mental Health in Therapy for Couples in Long-Distance Relationships

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Student #29: The Role of Tele-Mental Health in Therapy for Couples in Long-Distance Relationships

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The article that I read was about long distance relationships and what it tele-Mental health has been doing to help these relationships. According to the article 66% of just college students are in long distance relationships with the odds of these said couples staying together increase and increasing. The reason for this is because of technologies advancements such as Skype and Tele- Mental health. These two things alone help keep the highs and lows of these long distance relationships in balance.

In the first part of the article it talks about those lows of being in a long distance relationship and how it can be emotionally tolling on a couple. Just the Physical distance between them can really put a sense of distrust or uncertainty that my not occur if they were not long distance. It also states that people in these relationships have too extreme highs and lows in a short burst of time. This is because when the significant other comes into town they get an extreme high of excitement and joy but is usually fallowed with the low of them leaving shortly after. The growing solutions for these problems are the in Tele- Mental Health.

Tele-Mental health is helping long distance in a big way by conference calls. The calls are very important because the relationship can get the help and time with a consular and otherwise they would not have access to. Another type is online therapy were one can contact a therapist through a website. During this study they viewed if the therapy online was more or less effective than face to face and at the end it showed no real comparable difference on with would help a couple more. With these technologies that more and more people are having access to long distance relationship are become more successful. I predict that it will continue to grow and help with Mental Health patents in more than just this one way.

McCoy, M. Hjelmstad,L.R., & Stinson, M. (2013). The Role of Tele-Mental Health in Therapy for Couples in Long-Distance Relationships. Journal Of Couple & Relationship Therapy, 12(4), 339-359

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Student #2: Efficacy of Telehealth Treatments for Post traumatic Stress related symptoms 

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Student #2: Efficacy of Telehealth Treatments for Post traumatic Stress related symptoms 

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Psychological treatment can be very important to patients that suffer from Post-traumatic Stress disorders. Whether they suffered a traumatic accident or were a war veteran, PTSD is associated with severe symptoms that can not only affect the person affected but can also play a role in the life of those surrounding them. Through this article, the authors explain how the importance of the treatment can be inhibited by various obstacles. Whether it be that the patient lives far away from a medical center, the time and cost associated with the treatments needed, and the stigma that accompanies receiving such services (Sloan, Gallagher, Feinstein, Lee, & Pruneau, 2011).

Through the telehealth services, patients are able to learn various management teqniques. Telehealth is able to teach individuals how to manage reactions to trauma cues and how to cope when exposed to certain triggers. The telecommunication also allows for management of anxiety disorders while the patient is at home, as well as follow-ups with the patient as often as each patient needs them.

Results of the study demonstrated that those patients participating in the telehealth project had significant reductions to PTSD symptoms as well as a reduction in depression symtpoms. When they evaluated treatments as the cognitive-behavioral intervention, patients outcomes did show that there was a reduction in these symptoms as well. The authors came to the conclusion that this significant change was due to the fact that patients were in a familiar environment when receiving treatment. Treatment was accessible to them and individualized. And patients also demonstrated that it was less intimidating than walking into a clinic and receiving treatments.

Reference:
Sloan, D.M., Gallagher, M.W., Feinstein, B.A., Lee, D.J., & Pruneau, G.M.(2011). Efficacy of telehealth treatments for Posttraumatic Stress-related symptoms: A meta-analysis, Cognitive Behaviour Therapy, 40(2), 111-125, doi:10.1080/16506073.2010.550058

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Student #16 - Imitation Intervention for ASD Via Telehealth Parent Training Program

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Student #16 - Imitation Intervention for ASD Via Telehealth Parent Training Program

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The article that I read was about increasing access to an ASD imitation intervention via a telehealth parent training program. It explained how difficult it is for families to have tests done for their children because of the difficult access for this type service. There's limited financial resources and transportation, geographic isolation, lengthy waitlists, and lack of childcare and trained professionals. Telehealth and other technological applications are going to help the access to evidence-based for ASD Intervention services at a distance for parent training programs. These telehealth services are continuing to grow more popular and have been used as an alternative delivery method.

There are many benefits to using telehealth in this situation. It can can reduce patient and provider costs and it can increase provider system coverage. Patients can be interacted with by video, animation, and active learning tasks, and teleconferencing mechanisms. These training programs for parents are giving them adapting parenting and behavior management techniques through this mechanism. ASD training sessions are acceptable, feasible, useable, and effective when it comes to them gaining new knowledge on how to help their child with Autism. Parents are able to provide their children with more language opportunities, parental interaction, and parents are able to be pivotal response training to help cope with fidelities. A large thing for this program is that clinicians are able to respond to children and parents quickly with this telehealth service, and that has been proven to be successful and very helpful to the parents.

I personally think this type of telehealth can do a lot of good to better the future of health care. It gives us quick hope on how to work with children with autism and how to cope with hard situations as well. Autism is unfortunately a very common mental health condition. To me, I feel as though it tends to be overlooked and underrated. A lot of families are connected to someone with autism and it is hard to understand their mental disability. These programs can send awareness of the illness, knowledge on how to cope and ways to help understand the illness, and bring together a parental bond. I believe it will do a lot of good in the world and will make a lot of lives a lot less restrictive on information.

Wainer, A., & Ingersoll, B. (2015). Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program. Journal Of Autism & Developmental Disorders, 45(12), 3877-3890. doi:10.1007/s10803-014-2186-7

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Student #42- Benefits of Home-Based Telemental Health 

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Student #42- Benefits of Home-Based Telemental Health 

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A home-based Telemental Health is a system that delivers care to patients, while they are in the comfort of their home by using telecommunication technology. Some of these technologies include synchronous modalities, such as telephones and internet-based video conferencing so that the patient and provider can discuss treatments and effects while the patient is at home and the provider is in the office. Some of the disorders that can be discussed, monitored and treated through Telemental Health are; bipolar disorder, substance abuse, depression, OCD, PTSD and many more.

Telemental Health has many clinical benefits, which include improvement in attendance, and patient satisfaction in turn leads to positive treatment outcomes. Telemental Health is a preferred method for patients who suffer from anxiety disorders, or patients who have a fear of the doctor’s office. Patient safety is another benefit of Telemental Health. It reduces travel for elderly patients who may have trouble with mobility. Also for patients who live in areas with harsh winter environments may benefit from avoiding trips.

All in all I think that implementing Telemental Health as an option for care in every health care facility will ultimately benefit patients and caregivers a like. By being able to speak to patients when they are at their homes may make them feel more comfortable in answering questions about pain and other personal questions. Telemental Health would be a great option for not only patients with any mental disorder but for patients who are elderly and may struggle getting around, they would be able to speak to a care provider without having to worry about how to get there, or any of the hazards of travel.

Reference:

Pruitt, L. D., Luxton, D. D., & Shore, P. (2014). Additional Clinical Benefits of Home-Based Telemental Health Treatments. Professional Psychology: Research & Practice, 45(5), 340-346. doi:10.1037/a0035461

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Student #18- Outcomes of a Home Telehealth Intervention for Patients with Diabetes and Hypertension.

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Student #18- Outcomes of a Home Telehealth Intervention for Patients with Diabetes and Hypertension.

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Ever since depression has been a diagnosis, it has also been a major complicating factor in many other bodily processes. A study conducted by Wakefield et al (2012) was about measuring the knowledge, self-efficacy, adherence, and patient perception of the telehealth technology of home telehealth with individuals with co-morbid disorders (diabetes and hypertension). The participants of this study were separated into three randomly assigned groups in which the three groups had either no telehealth present (usual care), some telehealth present (low-intensity), and a large majority of their healthcare was delivered through telehealth (high-intensity). Over 75% of the sample population were invested in this measure for a 12-month period.

The results from this study were quite interesting and thought provoking. According to the authors, there was no statistical significance in any real measure, which included knowledge, self-efficacy, adherence, and the patient perception of the telehealth technology. There was a slight increase in the knowledge of the symptomatology and of how the diseases interactive with another, yet the correlates are very weak and not able to be expanded upon. I think there are a couple of reasons why this study struggled to find a major benefit from telehealth. The first reason is that the mean age of participants in this study was in the 60’s. While some technology is great for decreased cognitive decline in some geriatrics, in others it can be another stressor that they may have to get over. Another reason is that the aging baby-boomer population already has a hard enough time going to the doctor and taking order, let alone taking orders from piece of technology.

Even though this study does not back prove much positive for telehealth, it does not disqualify it as a great way to deliver medical advice and provide services for every age. Seeing that this study is mainly about the existence and treatment for comorbid disorders, it may be harder to track results or keep the patient knowledgeable on both disorders, especially when the patient is older in age. A positive can also be seen that there is no negative consequence of telehealth in this study. There may be no statistical significance in the difference between regular care and telehealth, but that also means for individuals who may be farther away or who may not be seen regularly, telehealth is just as good. This could then save physicians and caregivers time for travel, and it could save the patient money for transportation costs.

References

Wakefield, B.J., John, Holman, J.E., Ray, A., Scherubel, M., Adams, M.R., Hills, S.L. & Rosenthal, G.E  (2012). Outcomes of a Home Telehealth Intervention for Patients with Diabetes and Hypertension. Telemedicine and e-Health 18(8): 575-579. doi:10.1089/tmj.2011.0237

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Student #22- Massive potential or safety risk? Health worker views on telehealth in the care of older people and implications for successful normalization

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Student #22- Massive potential or safety risk? Health worker views on telehealth in the care of older people and implications for successful normalization

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Telehealth is a modern way to provide medical assistance to patients in need of convenient and affordable health care. By utilizing modern technology health care providers are able to check up on patients from a distance instead of having the patients come to the hospital. However, this has raised a few questions such as will the quality of care be the same if the patient is not in direct contact with the health care provider. In the article “Massive potential or safety risk? Health worker views on telehealth in the care of older people and implications for successful normalization” Maggie Killington, Maria Crotty, and Wendy Shulver conduct a study on 44 health care providers to determine these health care providers view on telehealth as a viable option in health care. In the study, they look at both telehealth experienced and inexperienced health care providers.

Maggie, Maria, and Wendy describe these benefits that telehealth will provide elderly people in need of health care, “Reduction of potentially distressing travel for people such as palliative care patients, better outreach of specialist services, and increased dosage of exercise for older people undergoing rehabilitation.” (Shulver, Killington, & Crotty, 2016, p. 1) With all these benefits it is not hard to see why this is an appealing option for people who are looking for health care but don’t want to have the hassle of going to a clinic or hospital. However, some health professionals in the study had their concerns with the potential negatives. In the study, Maggie, Maria, and Wendy found that “Urban clinicians with no exposure to telehealth generally felt that telehealth should be reserved for people who are more autonomous rather than rehabilitation patients with complex issues.” (Shulver, Killington, & Crotty, 2016, p. 8) Another issue found in the study was that health care providers though the change to telehealth centered care would disrupt their more traditional approach to health care also that the need for technicians for the technology might be detrimental to someone’s health if the technology was not functioning properly and needed to be fixed. Overall the study had mixed results with some health professionals saying the telehealth care system was good while others had their concerns with it.

In my opinion telehealth can only improve the quality and convenience of care that our health professionals are able to provide. Not every patient that comes into a clinic is in dire need of direct assistance and telehealth would make it far more convenient for those patients who are only going in to get exercise instructions or just going in for routine checkups. Especially with the elderly population who may not have access to vehicles to get to the hospital every day or money to pay the increasing hospital bills. The concern raised in the study on the potential for the technology to break and need repair I believe to be the biggest concern for the future of telehealth. All technology systems break or become in need of repair at some point in their life cycle which yes could result in a patient not getting the proper care they need. However, in those instances health providers could ask the patient to come into the hospital for that day while the technology is being repaired. Alternatively, they could keep back up devices on hand in the event that one should break. Hiccups like these will always happen when implementing a new technology or way of providing care however I believe the positives of telehealth outweigh the potential negatives. With the great convenience and lower cost potential I believe more patients would choose telehealth if given the option.

Shulver, W, Killington, M & Crotty, M. (2016). “Massive potential’ or ‘safety risk? Health worker views on telehealth in the care of older people and implications for successful normalization. BMC Medical Informatics & Decision Making, 161-15.

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Student #23- Automated Telehealth Intervention

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Student #23- Automated Telehealth Intervention

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This article was about how effective and realistic is it to use an automated telehealth interventions with those who have severe psychiatric as well as medical disorders. The study was about 6 months and was paired with a nurse care manager during that period of time. Each intervention was altered to that persons specific diagnosis. Some of the things that were included were how to take care of themselves and health behaviors. The sessions would last roughly 5 to 10 minutes.

Overall, it had included how most who were in the study were more open-minded to continue using this intervention. I had found it very interesting that someone had come up with the idea of using a landline telephone type thing to use it to benefit others with severe conditions. In my opinion, I don't think that mental disorders have been a popular thing to talk about. It is mainly physical conditions or disorders that are in the focus. So I had found this journal to be very intriguing.

The intervention also covered problems with physical and mental disorders. That would be difficult in my opinion to find a way that would measure the data that they needed in relatively the same way. It had later mentioned how the intervention would have to become cost effective. It included how costs of prescriptions and the cost of care is variable in the states of health the people in this study were in. That too I found interesting. Then it brings up another topic of where they found something that could potentially help people but how would they be able to make it affordable for those who need it.

Pratt, S. I., Bartels, S. J., Mueser, K. T., Naslund, J. A., Wolfe, R., Pixley, H. S., & Josephson, L. (2013). Feasibility and Effectiveness of an Automated Telehealth Intervention to Improve Illness Self-Management in People With Serious Psychiatric and Medical Disorders. Psychiatric Rehabilitation Journal, 36(4), 297-305. doi:10.1037/prj0000022

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The purpose of this article was to if telehealth would benefit people that have had strokes. There was a study conducted to see if the patients improved over the 18 sessions. The program was called Moving on after Stroke (MOST). It is a self-management program for people that have had strokes. It was also for the family members so they could help take care of their loved ones.

The results of the study showed that after the 9 weeks of 18 sessions, the patients and their care partners were meeting the expectations that they had about the program. Many of the patients had increased physical activity after the program was over. Some were also becoming more social and becoming more knowledgeable about strokes and how to prevent them. Some of the care partners mentioned that it was more beneficial for the stroke patient to learn how to take care of themselves because that would help them to “move on” from the stroke and regain normal functions.

At the end of the article, there were a lot of stories from the patient and the caregivers about their experience with the program and what their life was like before. It was interesting to read their responses and understand what they were hoping to achieve from the program. Both the patients and caregivers thought that the program was well worth it. One of the caregivers said, “I do find that he’s a little bit easier to live since he’s been coming here, and he realizes that he’s not the only one in the world that’s had a stroke (Huijbregts et al., 2009).

Huijbregts, M., McEwen, S., & Taylor, D. (2009). Exploring the feasibility and efficacy of a telehealth stroke self-management programme: a pilot study. Physiotherapy Canada, 61(4), 210-220. doi:10.3138/physio.61.4.210

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Student 31-Delivering Occupational Therapy Services Though Telehealth to Older Adults: Current Considerations

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Student 31-Delivering Occupational Therapy Services Though Telehealth to Older Adults: Current Considerations

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Telehealth is becoming a common way to deliver health care services to a variety of individuals. OT Practice, a journal pertaining to occupational therapy, provided an in-depth article addressing the pros and cons of OT telehealth being provided to older adults. The article discussed many considerations that must be addressed to deliver effective therapy through technology.

OT services including: evaluations, interventions, remote monitoring, supervision, and consultation all can be performed through audio and video conference systems (Nissen, 20). There are many factors that must be considered when utilizing OT telehealth. The first factor that the article addresses is user acceptance. The equipment that is being utilize for the therapy must be cost friendly along with the set-up of the system. Another important factor is that the system must be user friendly and as simple as possible for the client to utilize. The article shares that there are many benefits for older adults to partake in telehealth therapy. Some benefits include access to therapy in the home for those who travel from a far. It also is convenient for the caregiver of the client as well for the same purposes.

Before an OT can provide telehealth services to a client there are many stipulations. The OT must evaluate the “considerations” created by the American Occupational Therapy Associations (AOTA). There are many ethical considerations that go into providing telehealth services as well. The OT must be licensed to deliver OT services via telehealth and they must follow state regulations. Another factor that is addressed in this article is reimbursement. States throughout the U.S. do not provide detail on reimbursement for a face-to-face session verse telehealth session. The OT practitioners must identify the various Medicaid and Medicare regulations for proper reimbursement.

I personally believe that this could be a great way to deliver therapy services to elderly individuals. I do think that evaluations should be done face-to-face. It would be hard to identify various skills and their limitations via video. I personally believe that the pros out weight the cons. Video appointments will also give the OT the opportunity to evaluate the home of the individual as well. If the system was wireless, they could look at the set-up of the bathroom, bedroom, and steps throughout the house. This would provide helpful tips for the client to live as independently as possible. I think that telehealth services would benefit many elderly individuals especially those in rural communities that commute for therapy services.

Nissen, R (2016). Delivering Occupational Therapy Services Through Telehealth to Older Adults: Current Considerations. OT Practice, (20-22).

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Student 32-Theory-Based Telehealth and Patient Empowerment.

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Student 32-Theory-Based Telehealth and Patient Empowerment.

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The focus of this article was to explain telehealth and provide data on how it has been beneficial in health care. Due to a growing population, an aging population, and chronic diseases more hospital/emergency room visits are taking place. This is a concern because of the cost of health care. Remote patient monitoring allows for needs to be met before or after a hospital stay, so that hospitalization does not have to take place again. Telehealth is helping to make a difference in all of these factors. Suter et al in 2011 defined telehealth as, “remote health care that may or may not involve clinical services.” Health care agencies that use telehealth machines reported a 75% reduction in unplanned hospitalizations and a reduction in emergency room visits. Telehealth monitors are comprised of a monitoring screen, vital sign collection devices. (e.g. blood pressure cuff, pulse oximeter, blood glucose meter, weight scale). These are helpful because the monitors collect vital signs and then stores it as data. From here it forwards the information/data to secure website by telephone lines or networks.

Telehealth has come very useful because of this monitoring system. The monitoring system sends the data it collects to a health care professional, who then analyzes the data that was collected. Depending on the data the health care professional will make the choice to intervene if necessary for the health of the patient. This kind of health benefits many populations: elderly with limited mobility, chronically ill with low functional ability, undeserved, and those who live in rural areas. The benefits of this kind of technology is to help find early signs of certain diseases, the hope is to intervene and fix the problem before hand so then hospitalization does not have to take place.

My first impression of telehealth was not the greatest. I believe strongly in face to face communication, especially when it comes to the health of an individual. After reading this article and seeing the data that was collected, my opinion changed. The fact that telehealth can help monitor a persons health and detected change early on is very important today. I think telehealth will play a vital role in some individuals lives. And is helpful to detect change so that unplanned hospital visits do not have to take place. And will allow for patients to live a regular life when they just have to check in once a day on how their health is. Also know that someone is monitoring them and will intervene if necessary.

Suter, P., Suter, W. N., & Johnston, D. (2011). "Theory-Based Telehealth and Patient Empowerment". Population Health Management, 14(2), 87-92. doi:10.1089/pop.2010.0013

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Student 33 Clinical outcomes resulting from Telemedicine interventions: A systematic review 

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Student 33 Clinical outcomes resulting from Telemedicine interventions: A systematic review 

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This focus of this article is to evaluate the efficacy of telemedicine intervention for health outcomes in two different aspects: home-based and office/hospital-based. Studies with services with no face to face encounters such radiology or pathology diagnosis were excluded in the research. A total of 25 articles met inclusion criteria and were taken further into research. Results concluded the the efficacy of telemedicine in clinical outcomes comes from home based telemedicine. Telemedicine in home based settings is most successful in areas of chronic disease management, hypertension, and AIDS.

There are over 450 telemedicine programs worldwide with 360 of them in the US. These programs most commonly serve those who live in rural areas, the elderly and veterans. There is a growing call for telemedicine services to be covered as part of health insurance. One reason for the lack of telemedicine is the questioning of its cost and efficacy. The goal of this research that was conducted waassess whether telemedicine interventions result in comparable health outcomes  to in-person care.

I think that telemedicine is very convenient and is and will be very successful in the future. I think that telehealth gives people an opportunity to experience new things and get different opinions. I think that it has the opportunity to open peoples eyes to different things out there instead of worrying about how they are going to get to the doctors and when they are going to have time. i think that telehelth broadens many horizans for people out there who cant always make time to see a doctor or even those who have to wait months just to get in to see a doctor. i think that overall telehealth is and will be very successful in the future and wil continue to grow.

"Clinical Outcomes Resulting from Telemedicine Interventions: A Systematic Review." BMC Medical Informatics and Decision Making. N.p., n.d. Web. 29 Jan. 2017.

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Student 34The Premier Monthly Forum about the use of Psychotropic Medications in the Young

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Student 34The Premier Monthly Forum about the use of Psychotropic Medications in the Young

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This article focuses on how the use of telehealth for children who have ADHD, is beneficial for the treatment of their disorder. Because many children with mental health problems do not receive the appropriate care that they need, due to the fact that some pediatricians are not comfortable with diagnosing mental health conditions, a project called "TEACH" was created. This project was designed to help pediatricians learn how to treat different mental health conditions. A group of 176 PCPs had volunteered for TEACH training.This group of volunteers was compared to 200 pediatricians who did not get any training.

Telehealth programs have developed very quickly with many different studies showing that mental health that is given to children is achievable and accepted by parents of those children and pediatricians. According to studies, this Telemental Health Service can be used to establish diagnoses. One of the telehealth programs that were used was a random control trial with 223 children and 88 PCP's. The children had received six sessions over 22 weeks by therapists who were remotely supervised. Children from the telehealth and control group had both improved.

Many times there might only be a few available child psychiatrists, so treatment is usually done by a pediatrician.  Now, there is a move to pay for this telemedicine so that child psychiatrists can broaden their practices to areas that specialists could be lacking.  The trial showed that telehealth can be used successfully in treatment for children who have ADHD. I think that this was an interesting project to do and believe that this will be very helpful for health care in the future when children who might have ADHD need to get prescribed medication. It was concluded that pediatricians who volunteer for this telehealth training became more comfortable in diagnosing children with different mental health conditions. As a result to this project, they had increased their prescribing of mental health medications.

References:
Myers K, Vander Stoep A, Zhou C, et al. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: A community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015 Apr; 54(4) :263-274. doi: 10.1016/j.jaac.2015.01.009.

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Student 35-Efficiency  of Nurse Telehealth and Peer Support in Augmenting Treatment of Depression in Primary Care

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Student 35-Efficiency  of Nurse Telehealth and Peer Support in Augmenting Treatment of Depression in Primary Care

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This study was done to compare how phone calls of from nurses after being diagnosed with depression from a primary care physician. 302 individuals participated in this study. Patients were selected after being diagnosed as having a major depression disorder and given a prescription for a selective serotonin reuptake inhibitor. These patients where then divided into several categories usual physician care, nurse telehealth care, and telehealth care and peer support.

Patients who were involved with the telehealth categories were given a total of 12-14 phone calls after 16 weeks. 1-2 calls per week for the first two weeks, one call per week for three to eight weeks, and then 1 call every two weeks up to 16 weeks. More calls were allowed in emergency situations and patients could leave phone messages. Phone calls lasted 10 minutes and a series of question were asked by the nurse and all questions were answered from the patient. The nurses also offered emotional support and talked about things that were bothering the patient.

After the study was conducted, the hypothesis that the nurse assisted telehealth was superior to normal physician care was confirmed. Patients with the telehealth had a much better adherence to their medication regimen and better overall mood. Patients that had telehealth and peer support had even better results than those with just telehealth monitoring.

Hunkler, Enid M., Meresman, Joel F. (2000). Efficiency of Nurse Telehealth and Peer Support in Augmenting Treatment of Depression in Primary Care. Arch Fam Med. 2000; 9:700-708. retrieved from https://triggered.clockss.org/ServeContent?url=http://archfami.ama-assn.org%2Fcgi%2Fcontent%2Ffull%2F9%2F8%2F700

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Student 36-Client Satisfaction with Telehealth in Assisted Living and Homecare

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Student 36-Client Satisfaction with Telehealth in Assisted Living and Homecare

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This article discussed the importance of client satisfaction with the increasing telehealth services in assisted living homes and home healthcare agencies. Polices continue to increase the support of aging in a place that allows older adults to avoid the delay of nursing home placement by using assisted living or home health services and aid them in this process. Seniors were recruited in a randomized trial, telehealth services were provided, and the clients rated their care at three points in time postimplementation. The first point in time was first delivery, then 6 months, and 12 months. Telehealth services were provided to 820 clients, a research team from the University of Minnesota evaluated the efficacy of these services.

This research team evaluated three types of telehealth medicine, first were sensors that send wireless signals to detect motion, bathing and toileting. Emergency response systems that can be used to ensure safety as a pendant to summon help. Then biometric monitors to conduct physiologic evaluations like blood pressure heart rate and weight. When measuring their satisfaction, clients were asked to rate their providers on 25 items assessing their satisfaction on quality of care, responsiveness, and competency. The results showed high satisfaction for homecare clients and assisted living facility residents.

Clients that reported high satisfaction at 6 months, also reported high at 12 months. There were no significant differences in the experimental and control subjects among the residents of assisted living facilities. Some assisted living managers saw a greater value in on-site staff compared to information collected remotely using telehealth services. Potential challenges in marketing telehealth services to aging individuals are apparent. Although some believe that telehealth services will be easier to market to seniors living in a home than those already in assisted living.

References
Grant, L., Rockwood, T. & Stennes, L. (2015). Division of Health Policy and Management. Client Satisfaction with Telehealth in Assisted Living and Homehealth. Retrieved from  http://online.liebertpub.com.ez proxy.usd.edu/doi/pdfplus/10.1089/tmj.2014.0218

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This article was written by Lynne McFarland and took place in 2012.  They basically trained and watched dermatologist and other doctors in telehealth.  The training went over very well, and then the researchers gave a survey out to the physicians.  When the results came back, they saw that the doctors enjoyed the telehealth technology for the most part.  The percentages were good for dermatologists and they liked how convenient it was for them.   Although they enjoyed it, they also did not like the fact that they had to have a larger workload, since more people were visiting the dermatologist.

I think this is a wonderful thing that is happening.  It is difficult to get into the dermatologist, many people have to schedule appointments six months in advance.  After looking at the study it seems like it is easy to help patients and easy for the patients to get the help they need.  It makes sense that the con of teledermatology is that the dermatologists cannot get all the work done.  I assume it is difficult to get a good diagnosis of someone quickly just from a picture or video.  This might cause more problems in the future.

Within the years to come they hope to fix some of the bugs and figure out a way for the dermatologists to not have such a large workload.  Since the doctors now have so much work to do, there might be some job openings for more.  This would help the people who are looking for jobs and those who need help from a dermatologist.  Many more people can be helped in the future.  Overall I think teledermatology is a great idea, it can save time, money, and increase jobs.

References:

McFarland, L. V., Raugi, G. J., & Reiber, G. E. (2013). Primary Care          Provider and Imaging Technician Satisfaction with a Teledermatology Project in Rural Veterans Health Administration Clinics. Telemedicine & E-Health, 19(11), 815-825. doi:10.1089/tmj.2012.0327

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Student 38- Ethical Considerations Regarding the Use of Technology for Older Adults

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Student 38- Ethical Considerations Regarding the Use of Technology for Older Adults

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This article, written by, George Demitris questions the ethical considerations that come along with the use of Telehealth. Specifically, Demitiris talks about the key factors of privacy and confidentiality that can easily be broken while using the technology of Telehealth. George Demiris believes that, equal access, usability, and the impact of technology on the patient-provider relationship are the most important things that have the potential to be lost in the new phenomenon of Telehealth. The article goes on, to talk about HIPAA, and how Telehealth is not completely secure yet, to be up to the standards of appropriate safeguard to protect patient health information that may be exchanged during Telehealth.

Although this article talks about some challenges that Telehealth faces, it has an overall positive tone toward the technology of Telehealth in general. George Demitis highlights the advantages of Telehealth. The first example he talks about is the American Indian and Alaskan Native populations that are in many cases, located in rural locations. These populations have extremely high rates of cancer disparities, and low rates of access to high quality continuous care. Telehealth seems like the best solution to this ongoing problem. Not having access to good health care is a very real problem for many Americas.

Lastly, The article touches on the fact that every person in the United States deserves equal access to health care. George Demitis believes that the future if Telehealth will give more people equal access to higher quality care than what they have been receiving in the past. This is very important to the large population of aging adults in the United States as well. Since people are living longer, the need for health care for older adults is increasing. The older adults can benefit from at-home Telehealth services since many are disables and unable to access their health care providers.  Overall this article is saying, that Telehealth has an extremely bright future in the health care industry. There are still some problems with privacy issues but the Telehealth technology has the potential to solve a lot of problems in the United States.

References:

Demiris, George, Ardith Z. Doorenbos, and Cara Towle. "Ethical Considerations Regarding the Use of Technology for Older Adults." Research in Gerontological Nursing 2.2 (2009): 128-36. EbscoHost. Web. 25 Jan. 2017.

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Student 39 Telehealth Cognitive Behavioral InterventionTh article, “Telehealth delivery of cognitive behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study” discusses the efficacy and feasibility of delivering a cognitive behavioral intervention via telehealth (2016). 16 families from rural Colorado were a part of the group study. The study analyzed how effective the teleconferencing was and how accessible it was for the participants. The cost of teleconferencing was also taken into consideration while completing the study. This study hopes to help expand telehealth to the mental health patients. The study showed that it was an effective way of delivering a cognitive behavioral intervention through teleconferencing. The study brought to light some improvements and adjustments that need to be put into place. Glitches with the teleconferencing was not much of an issue if it happened patients just called in. Another issues is that the healthcare provider missed the face to face interaction that helps build a better relationship. The last problem is that the parent and provider had to plan out each session carefully. All of these are improvements that can be made. The result of the study shows that delivering a cognitive behavioral intervention is feasible and can be accomplished. It just needs continuous improvement to better assist the patient and provider for a better experience for both parties.I think that teleconferencing can be a great help to the patients that have anxiety. They don’t have to be worried about meeting a new person face to face and it could make them feel more comfortable. The ease of access is a big part of this study. It is very common for people to have access to a computer with teleconferencing capabilities. I see expansion for this kind of telehealth communication in the future.ReferencesHepburn, S. L., Blakeley-Smith, A., Wolff, B., & Reaven, J. A. (2016). Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism: The International Journal Of Research & Practice, 20(2), 207-218. doi:10.1177/1362361315575164

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Student 39 Telehealth Cognitive Behavioral InterventionTh article, “Telehealth delivery of cognitive behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study” discusses the efficacy and feasibility of delivering a cognitive behavioral intervention via telehealth (2016). 16 families from rural Colorado were a part of the group study. The study analyzed how effective the teleconferencing was and how accessible it was for the participants. The cost of teleconferencing was also taken into consideration while completing the study. This study hopes to help expand telehealth to the mental health patients. The study showed that it was an effective way of delivering a cognitive behavioral intervention through teleconferencing. The study brought to light some improvements and adjustments that need to be put into place. Glitches with the teleconferencing was not much of an issue if it happened patients just called in. Another issues is that the healthcare provider missed the face to face interaction that helps build a better relationship. The last problem is that the parent and provider had to plan out each session carefully. All of these are improvements that can be made. The result of the study shows that delivering a cognitive behavioral intervention is feasible and can be accomplished. It just needs continuous improvement to better assist the patient and provider for a better experience for both parties.I think that teleconferencing can be a great help to the patients that have anxiety. They don’t have to be worried about meeting a new person face to face and it could make them feel more comfortable. The ease of access is a big part of this study. It is very common for people to have access to a computer with teleconferencing capabilities. I see expansion for this kind of telehealth communication in the future.ReferencesHepburn, S. L., Blakeley-Smith, A., Wolff, B., & Reaven, J. A. (2016). Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism: The International Journal Of Research & Practice, 20(2), 207-218. doi:10.1177/1362361315575164

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The article, “Usability, satisfaction, and clinical usefulness in an urban community health center” (2015) examined a group of patients over a 3- month period for an intervention of Telehealth diabetes in the urban communities. Type 2 diabetes (T2D) was one of the most common diseases that affected millions in the US. The studies of T2D had shown an increase amount of clinical benefit of blood glucose, blood lipids, and blood pressure. Unfortunately, there is not a lot of care being delivered or evidence-based recommendations for T2D patients in urban communities. The purpose of the study was to make blood glucose readings more accessible for both the patient and health care providers in these communities.

The study's method consisted of placing an electronic pillbox into a diabetic’s remote home monitoring (RHM), which gave the blood glucose meter a Bluetooth inside the device. The Bluetooth automatically had blood glucose, blood lipids, and blood pressure results sent to a clinician on their devices. This program of Telehealth involved little training to know how it operated, and increases the availability of clinicians. Once the Telehealth clinicians received data from the meters of their patients, the systems made an alert about the patient’s sugar levels, and the nurses could make calls to the patient if needed. The clinicians could then accommodate and schedule appointments when needed after the 3- month clinic visit.

Results had shown increased ratings of use and satisfaction with both clinicians and patients. Both users thoroughly enjoyed the program because it’s accessible, hands on, and very easy to use. It is very user friendly for both users, and increased the improvement of communication between the clinician and patient. Over the 3-months of this study, the program showed improvement of blood glucose control with all patients. These findings supported the use of a Telehealth diabetes program that is user friendly, and can potentially change future outcomes of T2D in urban communities. (Welch, G., Balder, A., Zagarins, S., 2015)

References:
Welch, G., Balder, A., Zagarins, S. (2015). Telehealth program for type 2 diabetes: Usability, satisfaction, and clinical usefulness in an urban community health center. Telemedicine & e-Health, 21(5), 395-403. doi:10.1089/tmj.2014.0069

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Student 50: Theory-Based Telehealth and Patient Empowerment

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Student 50: Theory-Based Telehealth and Patient Empowerment

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Paul Suter, Newton Suter, and Johnston (2011) explain that telehealth has high potential to improve the quality of healthcare that we can provide. Telemedicine is also a subject brought up, which is the  use of medical data and information, from one site to another, through electronic communications for the purpose of improving individuals health. Telehealth and telemedicine revolve around home health which is greatly convenient. Granted, patients and individuals will have to be educated on telehealth to know its full potential. The patient is the one who will be using telehealth and the providers will be monitoring. The individual will have to have the knowledge of how to work the technology they will be using. It is emphasized that self- management is important. A problem arose when the patients became dependent on their home devices, when the end goal was to gain the self knowledge of themselves so they may "graduate" from the devices that are given to them.

Telehealth in my eyes, is a well thought out plan that can work greatly. Especially in the future, maybe we could create a device that gives doctors information about their past and present vitals and what not before the patient even sets foot in the room. Problems have potential to rise, in just about all technology but for the most part and more specifically the future, we can save alot less time for providers if the information is already present. Also, telehealth would help greatly for the elderly population to show current updates of the individuals health status. I feel that telehealth is a good thing and can be very beneficial. Like is said, I am sure problems have the potential to arise in some situations but overall I think telehealth is a positive step towards something great.

References
Suter, P., Suter, W. N., & Johnston, D. (2011). Theory-Based      Telehealthand Patient Empowerment. Population Health Management, 14(2), 87-92. doi:10.1089/pop.2010.0013

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Keri Kamphoff: PTSD and Depression Symptoms Alleviated Through Telehealth

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Keri Kamphoff: PTSD and Depression Symptoms Alleviated Through Telehealth

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A large majority of the adult population has suffered from a traumatizing experience. Many people are able to recover from events of this nature without emotional deficits; however, around seven percent will develop a form of depression or Post-Traumatic Stress Disorder (PTSD: National center for PTSD). Although both of these impairments may result in substantial epidemiological setbacks, very few of those living with the aforementioned emotional disorders seek treatment. Often, people do not seek help due to lack of access to care, insufficient funds or time to spend at treatment sessions, and the stigma surrounding those with a mental abnormality (Sloan, Gallagher, Feinstein, Lee, & Pruneau, 2011, p. 111). Thankfully, technological innovations have been created to eliminate these barriers to healthcare.

Traditionally, therapists have used “cognitive-behavioral” approaches when treating trauma victims. Two primary modes of telehealth that use a similar approach have been implemented into treatment plans for those living with depression or PTSD. The first involves using an internet program to individually manage one’s own case. The site contains tips and coping strategies for the consumer to practice. An example would be a cue to write down feelings about the experience one went through as a mode of self-reflection. The other plan takes advantage of systems such as Skype to allow video conferences between those affected and professional guidance. Often, patients use a combination of the two methods to achieve optimal results as both have proven to produce the same positive effects (Sloan, Gallagher, Feinstein, Lee, & Pruneau, 2011, p. 112).

As noted by Cognitive Behavior Therapy, “Telehealth interventions produce a large reduction in PTSD [and depression] symptoms from pre- to posttreatment” (Sloan, Gallagher, Feinstein, Lee, & Pruneau, 2011, p. 119). After comparing the results from those treated with telehealth versus face-to-face interaction, researchers discovered that in person sessions yield the same effect as telehealth for those living with depression. On the other hand, those living with PTSD benefitted more from face-to-face interaction. There is no information cited in regard to the reason behind this difference. (Sloan, Gallagher, Feinstein, Lee, & Pruneau, 2011, p. 121).

The three main focuses of healthcare systems around the world are cost, quality, and access. The pillar of providing access to all is achieved through telehealth because these systems allow consumers to receive care in their own home. The recipient of care would not have to worry about judgmental eyes of others and could complete the treatment on their own time. However, if one wanted to achieve optimal quality, he or she would choose in-person treatment as it has been proven to be the most consistently successful mode of therapy. I believe the reason why in-person interactions generally have more success is because effective communication cannot be completely achieved through technology. Some parts of nonverbal communication are lost through video conferences and technological malfunctions could hinder important conversations. Humans are comforted by the presence of others, and face-to-face interactions are always more personable than through a screen. So, I believe that if patients utilized both forms of health care in the future, many more people could lead healthier lives.

PTSD: National Center for PTSD. (2016) How common is PTSD. U.S. department of veteran
affairs. Retrieved from <http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp>

Sloan, D., Gallagher, M., Feinstein, B., Lee, D., & Pruneau, G. (2011) Efficacy of telehealth
treatments for posttraumatic stress-related symptoms: A meta-analysis. Cognitive behavior therapy, 40 (2), 111-125. doi: 10.1080/16506073.2010.550058.

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Maggie Schmidt- Sustainability of Telehealth in a Public Health District

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Maggie Schmidt- Sustainability of Telehealth in a Public Health District

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Telehealth has become the most recent way to connect physicians to their patients. These patients are being seen to receive basic diagnoses, therapies, and continuous monitoring when a physical examination or clinic visit is deemed unnecessary. This rapid expansion is significant in the vast modifications our healthcare system is continually experiencing. The purpose of these changes is to make healthcare delivery easier and more accessible for patients and physicians alike. A research study was conducted to evaluate if rural telehealth was sustainable. The objective was to assess if the integration of telehealth in a rural public health district was successful and how the improvement became sustainable. (2010)

The study was conducted in the largest rural public health district in Georgia. Semi-structured interviews were conducted 25 times with 19 professionals. The study concluded that telehealth integration strengthened collaboration within the public health district. Sustainable rural telehealth can be enabled by collaboration, a push towards technology, and opportunistic exploitation. Telehealth in this study was partially federally funded. However, it increasingly began to pay for itself through the offering of new services and the savings from decreased travel time and expenses. This study only confirms that telehealth is self-sustainable and a new way for patients to receive healthcare services.

The future of telehealth is very broad and continuously expanding. It has become a more widely accepted form of healthcare by both patient and physicians. While some may still be skeptical, there seem to be numerous benefits for patient, physicians, clinics, and society as a whole. Some of these benefits include, but are not limited to: convenience, satisfaction, rural healthcare options, infection control, and environmentally friendly. Some negatives that were found were: less personal, licensure requirements, and increased use of technology in healthcare is sometimes frowned upon. The positives greatly outweigh the negative in this scenario and telehealth is well on the up rise in the healthcare world. The benefits of utilizing teleheath are quite substantial and readily evident to the hospitals and physicians who have chosen to use telehealth services.

Singh, R., Mathiassen, L., Stachura, M., & Astapova, E. (2010). Sustainable rural telehealth innovation: a public health case study. Health Services Research, 45(4), 985-1004. doi:10.1111/j.1475-6773.2010.01116.x

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A review of Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations

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A review of Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations

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What is the general perception of telehealth and telemedicine amongst primary care providers working in long term care facilities? A survey based review of professionals across the country was conducted last year to see if an increase in remotely provided care, known as Telehealth, has won over the hearts and minds of those whose work is in nursing homes. The results were interesting, as it gave a glimpse into what the future could hold for telemedicine.  Overall, respondents to the survey found that when it is well implemented, telehealth is a valuable asset to reach more patients and provide care for many who would otherwise be neglected. 89% of the respondents to the survey were physicians, with the remainder identifying as advance practice providers (Nurse Practitioners).

Overall, the survey responses by these physicians and other clinicians were positive about their experience and opinion of telehealth.  The survey is believed to be the first time providers had been questioned regarding their opinions and consisted of 22 questions regarding the efficiency, quality, and various concerns that have previously been voiced regarding telehealth, such as question number 20, “Telemedicine takes too much information technology expertise to implement” which was generally disagreed with by participants. In its namesake question, the survey asked if telemedicine would help avoid resident transfers to the ED/Hospital, with the overall response showing relative agreement to the statement. While the survey respondents were generally positive about the efficacy of telemedicine for reducing potentially avoidable hospitalizations amongst long term care residents, many went on to say that those outcomes are entirely dependent on both quality equipment and trained telehealth equipment operators.

While the opinion amongst many primary care providers is that there is a significant benefit to the implementation of telehealth in nursing home facilities, their caveats focused on the need for high quality audio, video and diagnostic tools such as a digital stethoscope.  Without these, it seems, there is a belief that there would be some degradation of care. Supporting these requirements, often easily accomplished in an urban setting, become more challenging in locations where telemedicine could have the most benefit, such as rural nursing facilities in small communities.  A concern raised in the article regarding insufficient broadband internet services in these communities is not without merit. Many rural communities exist behind an infrastructure gap that may keep them from receiving the care of their more urban peers. Additionally, physician reimbursement for telehealth services is often not well known, however there are some CPT codes that allow for telehealth visits every 30 days for nonurban nursing home patients.  Overall, although providers may be onboard with the implementation of telehealth in these facilities, there still exist numerous hurdles to see its maximum value obtained.

Driessen, Julia et al. (2016). Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations. Journal of the American Medical Directors Association, Vol. 17(6), 519-524.
http://dx.doi.org/10.1016/j.jamda.2016.02.004

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 Telehealth Behavioral Treatment for Medication Non-adherence.

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 Telehealth Behavioral Treatment for Medication Non-adherence.

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Medication non-adherence, or people simply not taking their required medications or following through with their treatment requirements, poses a great risk on our healthcare industry as a whole. According to this article, published through the National Library of Medicine and the National Institutes of Health, medication non-adherence can lead to: increased morbidity and mortality, additional complexity of clinical decisions by clinicians, and increasing the burden on our healthcare system by around $300 million. These figures are due to wasted resources, re-admittance for the same issue, and increased medical damage to the patient.
This study was focused on using Telehealth techniques to monitor and treat medication adherence among adolescents with inflammatory bowel disease. This study was small and focused, using 9 participants that attempted to complete their treatment over Skype, a video conferencing app. Results of the study found that Telehealth treatment could substantially increase adherence and actually save and average of $100 and 4 hours of travel time for each patient.
For me, this study highlighted one of the less talked about usages for Telehealth that could actually have an incredible impact on the entire healthcare industry. For these patients, just having somebody to hold them accountable and answer questions along the way, was all they needed to be more involved in their own treatment processes. Also having the ease of not having to disrupt their daily lives was a motivator for these patients, especially at their adolescent age.

Source:
Hommel, K. A., Hente, E., Herzer, M., Ingerski, L. M., & Denson, L. A. (2013). Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study. European Journal of Gastroenterology & Hepatology, 25(4), 469–473.

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Because I am going into to Physical Therapy, I instantly swayed to look for an article on telerehabilitation. The scholarly article, “A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation” explains how a group of highly educated individuals took roughly 28 studies about telerehabilitation to analyze how effective and positive it is to the patient and therapist. They also attempted to develop results on if telerehabilitaiton is costly or not. The conclusion may surprise some.

There is little known about telerehabilitation. However, a conclusion has been made. The results show that telerehabilitation is just as effective compared to traditional practices. Also, individuals with a physical disability receive longer consultations with their therapists so that they do not miss any information regarding the client. However, cost is another story. There is not sufficient evidence allowing the health care field to conclude that telerehabilitation is costly or not.

I am at a standstill about telerehabilitation and the impact it will have on the future. I may not be informed enough, but I do appreciate the fact that individuals who have a hard time being mobile can receive information in the comfort of their own home. Every week, I go to Dakota City to clean for a woman who had a stroke. She has partial paralysis in both her legs and left arm and has to drive 2 hours to physical therapy because of insurance issues. If she had the ability to receive telerehabilitation, she would not have the burden of being lifted into a van and home every other day. On the other hand, I do not like the lack of face to face contact. Relationships in health care are so important to keep, and I believe without that, health care will not be the same.

Kairy, D., Lehoux, P., Vincent, C., & Visintin, M. (2009). A Systematic Review of Clinical Outcomes, Clinical Process, Healthcare Utilization and Costs Associated with Telerehabilitation. Disability & Rehabilitation, 31(6), 427-447.

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Student 51 The Delivery of Early Intervention (Idea Part C) Services

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Student 51 The Delivery of Early Intervention (Idea Part C) Services

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Cason, Behl, and Ringwalt (2012) discuss the utilization of telehealth in Early Intervention (EI) Services for children birth to two who display signs of a developmental delay. The purpose of providing intervention services early in life is to meet those developmental milestones and prevent future delays in children. A majority of these children who qualify for services live in rural parts of their state and are usually limited from receiving health-related services. Health care providers involved with these services (i.e. occupational therapist, physical therapist, etc.) looked at utilizing telehealth to reach out to children in rural areas to still provide rehabilitation services. After observing the effectiveness of telehealth in early intervention services, researchers wanted to know if other states throughout the nation were utilizing this form of health care delivery for children as well.

Researchers concluded that the utilization of telehealth was beneficial for this specific population. Children living in rural areas who may not have access to their health care providers were able to continue rehabilitation services through telehealth delivery. Another benefit was that telehealth “demonstrated savings of time and resources” (Cason, Behl, & Ringwalt, 2012, p. 40). Overall, families were very satisfied with telehealth delivery for evaluations and services. Even though telehealth has been effective here, only 20% of 26 states are using telehealth for early intervention services (Cason, Behl, & Ringwalk, 2012, p. 41). The effectiveness of telehealth for rehabilitation services should be emphasized across the nation to benefit more children in need of these services.

Since the utilization of telehealth was shown to be effective and beneficial in early intervention services for children, more health care providers should consider this form of health care delivery. For the 26 states that were mentioned, 10% will be utilizing telehealth within the next one to two years (Cason, Behl, and Ringwalt, 2012, p. 41). In the future, the utilization of telehealth will continue to grow with the increase in technology and evidence of efficacy. Travel time will decrease for both patients and health care providers, which gives them both more time to deliver services online. Telehealth used for early intervention services will continue to be convenient and beneficial to children who qualify for services and live in rural populations.

References
Cason, J., Behl, D., & Ringwalt, S. (2012). Overview of states' use of telehealth for the delivery of early intervention (IDEA part C) services. International Journal of Telerehabilitation, 4(2) doi:http://dx.doi.org.ezproxy.usd.edu/10.5195/ijt.2012.6105

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Student 52 - Nursing Telehealth Example 

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Student 52 - Nursing Telehealth Example 

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The article "Sustained Effects of a Nurse Coaching Intervention via Telehealth to Improve Health Behavior Change in Diabetes" is from 2014. The purpose of their study was to recognize the need for diabetes-related healthcare in rural communities, and use Telehealth as an avenue for nurses to coach patients with diabetes through a person-centered approach. Their approach is called the motivational interviewing technique. They measured the benefits of the coaching by using a Telehealth group and a usual care group. Measuring success came from evaluating through the Diabetes Empowerment Scale and satisfaction surveys. They also had a 9-month follow up survey to measure long-term success.
They found that the Telehealth model was effective in diabetes coaching and could even be an effective intervention for long-term behavioral change. I think that this is an interesting model for care. I had not previously thought about the long-term care needs of an individual with diabetes. Healthy choices and frequent nurse coaching can lead to better lifestyle changes and if someone lives in a rural area they may not have access to that important continuous care. I think that this is a good option for people who do not have that access. I also think that privacy and technological abilities should be taken into consideration so that the patient has low risk in participating and understands how to communicate through Telehealth. Overall I think that this intervention program is successful and should be utilized by rural areas.
While the diabetes coaching method is successful, I am not sure that this is a universal success across all aspects of Telehealth. Telehealth is incredibly broad and can be very useful for rural communities that need to consult with physicians long-term, but some conditions need to be dealt with face to face. There are some negatives that should not be forgotten like communication, technology, and reimbursement issues. I think that Telehealth will be a prominent force in the future of healthcare and that everyone involved should be aware of the risks but also of the benefits and see if their individual situation would call for Telehealth as an easier alternative. Telehealth has the potential to be a great avenue for healthcare delivery as long as the system is not abused.

Young, H., Miyamoto, S., Ward, D., Dharmar, M., Tang-Feldman, Y., &
Berglund, L. (2014). Sustained Effects of a Nurse Coaching
Intervention via Telehealth to Improve Health Behavior Change in
Diabetes. Telemedicine Journal and e-Health, 20(9), 828-834.
doi:10.1089/tmj.2013.0326

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Student 53- Physical Therapy Telehealth example

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Student 53- Physical Therapy Telehealth example

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The article, “Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington,” goes over a case study, done in 2009, at Infinity Rehab. The test conducts whether telehealth meets the needs of a physical therapist in a Skilled Nursing Facilities. To conduct the test, they took 51 resident samples from people who were admitted for rehabilitation and tested for patient satisfaction and clinical outcomes.  Patients got assigned alternately to a telehealth session or an in-person session. The clinical portion was taken from the Short Physical Performance battery and six-minute walk test. The patient satisfaction portion a survey was given out to the patient and the physical therapist. This tailored to both portions of the case study to make it complete and accurate for what they wanted to find.

After the study conducted from September 2014 to March 2015, telehealth was deemed reliable for meeting the needs of a physical therapist and the patient. The study showed that telehealth was equivalent to non-telehealth groups in clinical outcomes and patient satisfaction. This shows that by using telehealth in comparison to non-telehealth, the patient will get a similar outcome and should be equally satisfied with the process, which is great for determining whether to use telehealth.  From the case study, not only was clinical outcomes and patient satisfaction reviewed but cost savings came out of the study as well. Clinical outcomes scored similar in telehealth vs in person. In patient satisfaction, the patient and the physical therapist were both highly satisfied. Finally, cost savings was a total of $5,000 from the whole trial. This combined the $4,000 of hours of payment and $1,000 of travel time to make a total of $5,000 savings.

I think this study helped to show that telehealth is comparable when it comes to face to face visits. Telehealth in physical therapy could be a turn-of-the-century type of thing when it comes to rehab. Travel would not be an issue and would be less expensive for the patient and the therapist. Telehealth in physical therapy not only benefits the patient but also benefits the therapist as well. They can see more patients in a day because some of their patients will be online patients. Overall, I think telehealth is great and is comparable to in-person visits. This could be the new thing, where people go online and “skype” their doctor for a diagnosis rather than travel to the doctor.

Lee, A. W., & Billings, M. (2016). Telehealth Implementation in a Skilled Nursing Facility: Case  Report for Physical Therapist Practice in Washington. Physical Therapy, 96(2), 252-259.

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Review one scholarly, peer-reviewed journal article about the efficacy of telehealth. Summarize the article and write your thoughts regarding how this might impact health care delivery in the future. Post at least three full paragraphs by Sunday at 11:59 p.m. (A paragraph must be at least five sentences). Be sure to include your reference in APA style at the bottom of your initial post. We will discuss these posts in class. This assignment is worth 10 points. See the grading rubric for more specific instructions. 

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Review one scholarly, peer-reviewed journal article about the efficacy of telehealth. Summarize the article and write your thoughts regarding how this might impact health care delivery in the future. Post at least three full paragraphs by Sunday at 11:59 p.m. (A paragraph must be at least five sentences). Be sure to include your reference in APA style at the bottom of your initial post. We will discuss these posts in class. This assignment is worth 10 points. See the grading rubric for more specific instructions. 