Due to shortages of physical therapists in skilled nursing facilities, compliance with regulations can become challenging, and the aging population results in an even higher increase in demands for rehabilitation in these facilities (Lee & Billings, 2016, p. 253). The purpose of this study I reviewed is to “(1) describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in a SNF delivered via telehealth.” (Lee & Billings, 2016, p. 252). In the area of Washington that this study occurred, they were experiencing a shortage in physical therapists, which led to the disruptions in the continuity of services to the residents. This study was first proposed at Infinity Rehab in Washington in November 2008, and in March 2009 the Board approved a pilot study. This study continued from March 2009 to June 2009, and in June they presented to the Board a telehealth session. “At this meeting, key issues such as public safety, literature support, and proper therapy via telehealth were discussed.” (Lee & Billings, 2016, p. 254). The telehealth physical therapy was approved in February 2011. (Lee & Billings, 2016, p. 255). 

            Patients in this study were alternately assigned to either a telehealth group or an in-person group. As this system progressed they came out with other ways to utilize telehealth such as tablets or laptops so that it was more portable and easier to interact accordingly (Lee & Billings, 2016, p. 255). It was also critical to residents and practitioners using telehealth for physical therapy to be mindful when considering eye contact. It was also important for the residents to be informed of the chance that the telehealth service could be deemed inappropriate, if their condition was instead calling for an in-person visit. Many of the residents that were supervised via telehealth scored “at least as well as residents seen in person” and “positive feedback with telehealth implementation was reported” (Lee & Billings, 2016, p. 256). This method also seemed to be effective and beneficial because of the cost savings to the skilled nursing facilities.

            When I first found this article, I thought that I would read more about how telehealth was not compatible within the physical therapy field, and was surprised to read about the positive effects and outcomes it did have on patients and practitioners. I think throughout the future as we see an increase in need of practitioners in skilled nursing facilities, with our aging population, telehealth will be very useful. I also think that as we continue using this technology we will be able to find even more efficient and beneficial ways to use and improve this technology.

 

References

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. doi:10.2522/ptj.20150079

 

 

They are furthering telehealth, to talking over the phone or even face-to-face conversations with providers. Because veterans are more likely to live in rural areas, it is important that they are educated on telehealth. They would benefit the most from this technological advancement. Not only do the patients need to be educated on this technology but so the providers. The better the providers know how to operate the telehealth system, the more the patients will benefit from this technology.

 

After learning about telehealth, I believe this will have a large increase over the next decade. This should be encouraged to people when they are visiting clinics now, so people are aware of it. This could be a huge advantage when waiting rooms are packed and can require long wait time. In addition, weather can sometimes leave if difficult and unsafe when traveling to the medical facility. To make this be the most effective, telehealth needs to be expanded to all states.

 

Citation:

Perdew, C., Erickson, K., & Litke, J. (2017). Innovative models for providing clinical pharmacy services to remote locations using clinical video telehealth. American Journal of Health-System Pharmacy, 74(14), 1093-1098. doi:10.2146/ajhp160625

      The study included 51 adolescents, between the ages of 18 months and 7 years, and at-least one of their parents. All children had parents whom wished to seek their child evaluation for ASD (Smith et al., 2017). “Families completed the Naturalistic Observation Diagnostic Assessment (NODA) for ASD, which was compared to an in-person assessment (IPA)” (Smith et al., 2017). NODA is a form of Telehealth technology in which families can share information with different healthcare professionals and receive an evaluation and diagnosis back. The results of the study showed that “NODA has potential to improve the efficiency of the diagnostic process of ASD” (Smith, et al., 2017). 

     I’ve always had my doubts about telehealth within healthcare. I constantly think how can a healthcare professional tell you what’s wrong over a computer/TV screen without ever even touching you.  After looking into different articles, and settling with this one, I have a more open mind about telehealth. If different studies are all showing positive results in relation to telehealth then obviously there are parts to this that can work! The world keeps changing, technology keeps growing. In the future, I see telehealth being huge in the world. 

 

Smith, C., Rozga, A., Matthews, N., Oberleitner, R., Nazneen, N., & Abowd, G. (2017). Investigating the Accuracy of a Novel Telehealth Diagnostic Approach for Autism Spectrum Disorder. Psychological Assessment ,29(3), 245-252. doi:10.1037/pas0000317

On the contrary, there are various barriers to implementing telehealth technology in rural areas and communities who offer or want to offer mental health and substance abuse services.  “Financial instability has been one of the primary barriers to expansion of telehealth services in rural areas” (Benavides-Vaello, Strode, & Sheeran, 2013, p. 113).  This challenge has arisen in rural communities due to initial startup expenses of the service, such as the cost of telecommunication devices/equipment, and the continued costs that result from properly maintaining the new equipment (Benavides-Vaello, Strode, & Sheeran, 2013).  Additionally, availability of space in a healthcare center to store the equipment and insufficient training on how to correctly use the telecommunication modalities are also barriers to implementing telemedicine in rural areas (Benavides-Vaello, Strode, & Sheeran, 2013).  While these are known barriers, active leadership and advocation for telehealth in rural areas are needed to improve mental health and substance abuse services in rural areas.  

In conclusion, further research and evidence-based literature is needed for practitioners and consumers to acknowledge the benefits surrounding telehealth services in the expansion of mental health and substance abuse treatments in rural communities.  I believe telecommunication technology will positively benefit the delivery of mental health and substance abuse services in the future.  For instance, I have confidence that telehealth medicine will allow vast populations, ranging from pediatric to geriatric populations, to receive these two increasingly needed services.  Furthermore, I believe that telehealth technology can decrease mental health or substance abuse disparities that specific populations are susceptible to.  Use of telehealth technology will continue to grow in mental health and substance abuse treatment services.  

Reference:
Benavides-Vaello, S., Strode, A., & Sheeran, B. (2013). Using technology in the delivery of mental health and substance abuse treatment in rural communities: A review. Journal of Behavioral Health Services & Research, 40(1), 111-120. doi: 10.1007/s11414-012- 9299-6

 

 

       In conclusion, telehealth will be very important for the future health of rural populations. The use of telehealth for psychological treatment has proven to be effective for this specific population; therefore, many other populations are likely to benefit from telehealth. The use of telehealth among sexually and domestically abused individuals could help them have better mental health outcomes and improve the mental health of the overall population. This article supports the use of telehealth and provides strong evidence showing its benefits for the mental health of rural populations. Telehealth may become the future for improved mental health and psychological services among rural communities.

References:
Gray, M. J., Hassija, C. M., Jaconis, M., Barrett, C., Zheng, P., Steinmetz, S., & James, T. (2015). Provision of Evidence-Based Therapies to Rural Survivors of Domestic Violence and Sexual Assault via Telehealth: Treatment Outcomes and Clinical Training Benefits. Training & Education in Professional Psychology, 9(3), 235-241. doi:10.1037/tep0000083

One promising application of Telehealth is in neuropsychological assessment. Although test administration must still be done in person, the neuropsychologist can conduct the clinical interview with a client at a remote site using video teleconferencing. It is necessary to examine client and psychologist reactions to Telehealth in neuropsychological assessment, as well as client and provider-borne costs of Telehealth versus in-person services. Psychologists, however, expressed less satisfaction with Telehealth than with the conventional care setting. Costs for Telehealth care were much lower than for other methods of care involving travel to the medical center or to rural outreach sites. A number of factors may have produced.

 

After reading and learning about Telehealth, I believe it is going to keep growing over the next few years. This can help families who don’t have money to go to doctors or when you are busy. I didn’t even know this was a thing until I came to this class, so maybe people need to talk more about it so people know it is something you can do instead of going to the hospital. I don’t think using Telehealth for everything is a good idea, but if you have a small cold it is something I would use. If I had a more serious problem I would rather see the doctor in person then on a computer. 

 

Reference

Schopp, L., Johnstone, B., & Merrell, D. (2000). Telehealth and neuropsychological assessment: New opportunities for psychologists. Professional Psychology: Research and Practice, 31(2), 179-183. doi:10.1037/0735-7028.31.2.179

 

 
The study consists of 106 subjects who have SCD that participated in seeing if telehealth helped them improve their overall health from pressure ulcers and depression. The study had a 6-month duration. The purpose of the study was to see if the telehealth intervention ‘CareCall’ could help on reducing pressure ulcers and depression in patients.   The study showed that the ongoing care to treat secondary conditions such as pressure ulcers and depression in SCD patients was reduced. This is one of the first studies to demonstrate how efficient telehealth can be in helping people with SCD. 

At first I was very skeptical about telehealth. I had a lot of doubts of it not being efficient in today’s society. Personally, I like the one-on-one contact with a doctor. After reading this study, and reviewing the results it showed that telehealth can help people. Society is evolving and technology is becoming a huge part in everything we do, advancing with telehealth I think would be a great opportunity for the healthcare system. 

                                                                                                                                             

 

Houlihan, B. V., Jette, A., Friedman, R. H., Paasche-Orlow, M., Ni, P., Wierbicky, J., . . . Williams, S. (2013). A pilot study of a telehealth intervention for persons with spinal cord dysfunction. Spinal Cord,51(9), 715-720. doi:10.1038/sc.2013.45

 

Telehealth is not a new concept in the world of medicine, but it is at a point of rapid growth within the current system. The recent push hopes to increase the number of patients that can be seen, as well as limit travel and financial hassles for individuals. “Studies of video visits have demonstrated these benefits in specialty settings including wound care, prenatal genetic screening, family planning, cardiovascular care, and home care” (Powell, Henstenburg, Cooper, Hollander, & Rising, 2017, p. 225). Studies though are fairly limited to these practices. Powell and her colleagues expand the research to the field of primary care.    

This article looks to better understand patient feelings about telehealth in the form of video visits with their primary care provider. This study was first implemented in 2015 at Thomas Jefferson University in 2015, where coordinators offered the video option to patients. Participants that were willing to test the new system set up appointments and had virtual visits with their current primary care doctor. After each visit, patients were contacted again and interviewed about their feelings and attitudes towards the video visit. The questions asked prompted discussion about their beliefs of future success of such programs on a widescale basis. A small sample size was used in this study, but the overall consensus was positive for the patients that took part in the trial. Some issues noted were technical difficulties with audio/video lag, internet connection issues, and the log-on process. 

This article interested me because I had posed this question in a previous class meeting. I have a great relationship with my primary care provider, but am unable to see her when it is needed because I am going to school in Vermillion. Seeing doctors here is not really an issue, but I often have to relay messages, have files sent between the 2 locations, and have a follow-up with her when needed. Having the ease of a video appointment with her, limiting the middle person, would be beneficial for me, as well as many other people restricted by distance. I will be interested to see if this aspect of telehealth takes hold within the ever-changing world of health care. 

Powell, R. E., Henstenburg, J. M., Cooper, G., Hollander, J. E., & Rising, K.L. (2017). Patient perceptions of telehealth primary care video visits. Annals of Family Medicine, 15(3), 225-229. doi: 1370/afm.2095

Through three steps telehealth nursing can help patients with their medical needs in their home. The first step is through a method of using a telenursing program for simple or complex patient’s starting with an assessment that identifies the patient, their illness, and the environment around them. The second step is to further identify the illness through primary care in their home setting. The third step is to create a telehealth nursing plan that guides the patient through interventions in their home to improve their illness. Using their telehealth technology, patients can monitor their progress and have home care check-ups (McKnight). The opportunity to use telehealth nursing is a great choice and is hands on keeping patients more satisfied and less worried about their conditions.  All that is needed is a computer with internet and wifi capabilities and a phone to be able to contact nurses, doctors and IT with any issues either medical or technology based. The more time spent learning and using telehealth services the better off patients will recover.  

Reading this article over telehealth nursing was very interesting. I find telehealth nursing a great option for patients to use instead of having to make a visit to a doctor’s offices or hospitals. Being able to stay in my own home to recover while receiving instructions on how to better myself seems like a great advancement and move for the future of healthcare. A problem I feel may occur using telehealth nursing is not understanding how to use a computer to view cares needed and having to call a help service where it still is not clear on how to use this services. Another issue is computers crashing and calls being drop when trying to get information for healthcare services. Older generations of people may have a difficult time us the medical cares over the computer and not understand the technologies. I feel expanding telehealth nursing to get more people familiar with it may help with these issues because then family members and friends can help one another out to use telehealth properly. 

Reference: 

McKnight, S. (2012). Telehealth: Applications for Complex Care. Online Journal of Nursing Informatics. Retrieved from http://ojni.org/issues/?p=2034

The Use of Deployable Telehealth Centers by Military Beneficiaries to Access Behavioral Healthcare: An Exploratory Evaluation in American Samoa 

Jordon Haefs 

            My article regarding telehealth had to do with the behavioral health aspect of the topic. It is about the implementation of relocatable telehealth center (RTeC) which can be used soldiers and beneficiaries for their behavioral health. It was essential a shopping container repurposed to be an office for physiatrists to remotely contact soldiers in areas lacking the proper resources. With everything being contained in a shipping container, it allows the whole office to be moved and attached to any FOB in the middle east or any combat area. This allows soldiers to have contact with a physiatrist within their time on a deployment rather than put more strain on their resources already over there. 

            According to the survey, over 96% of the participants of this system said the would use this again and with over 92% said they were satisfied with the amount of help they received (Mishkind, Martin, Husky, Miyahira, Gahm, 2012). This is great results because it shows how effective it is in providing those who need it with excellent behavioral health solution. In addition to effectiveness, this is a much more cost-effective method that can reach more patients than rather having those doctors travel around to each RTeC location. This could be part of the answer in helping veterans with PTSD and transition back to life back in the states. Though that is pure speculation, it is safe to assume access to behavioral health in remote would be very helpful. 

            While the system is being used in the military, according to the article, this system has used even in the United States. In the US, it is estimated that 89 million people live in a Mental Health Provider Shortage Area. So, with some obvious modifications to the structure, this could be implemented to provide mental health solutions to those in need (Mishkind, Martin, Husky, Miyahira, Gahm, 2012).  This is another great example of telehealth and more specifically for telebehavioral healthcare. It provides a more personal solution to telehealth compared to a hotline. It is not to say these services are bad in any way but there is always room for improvement.

 

Reference: 

Mishkind, M. C., PhD, Martin, S., M.H.A., Husky, G., B.S., Miyahira, S. D., PhD, & Gahm, G. A., PhD. (2012). The Use of Deployable Telehealth Centers by Military Beneficiaries to Access Behavioral Healthcare: An Exploratory Evaluation in American Samoa. TELEMEDICINE and e-HEALTH , 18(10), 729-735. Retrieved January 1, 2018, from http://online.liebertpub.com.ezproxy.usd.edu/doi/pdf/10.1089/tmj.2012.0023 

    Telehealth is definitely on the rise right now as the world keeps successfully advancing in technology.  Soon, we’ll be able to do things with technology that we never thought we’d be able to do and in some cases, have the technology do it for us.  It’s crazy to think about and things to be cautious about but I do believe that the benefits outweigh the drawbacks.  In Washington, the implementation of telehealth was put into place in a Skilled Nursing Facility where in their case, physical therapy plays a huge role in determining the residents’ health. 

 Because there was a shortage of physical therapist services in the Washington area, the residents were not receiving the best care that they possibly could.  It doesn’t only hurt the physical therapy businesses but the patients as well, and patient-centered care is a hard concept to meet when there aren’t enough physical therapists to do so.  Infinity Rehab paid the itinerant physical therapist more than 30% of the salary of a regular employee, which also was less efficient due to travel and time required to become familiar with the facility, staff, and residents of the SNF (Lee, A. W., & Billings, M. 2016).  Frustrations rose and because of the shortage, the facility thought it would be a great idea to look into telehealth pilot program to try to fix their problems. 

     After a successful completion of the pilot, the facility adopted telehealth language for physical therapy.  What does this mean for health care delivery?  Not only did the adoption of the telehealth program help the shortage of physical therapists in the area, but it to helped with cost savings and the patients were quite satisfied.  Telehealth does a lot of positive things for the delivery of health care and some of them include increasing the access to health care, improving health outcomes, reducing healthcare costs and in the case of my article, assisting to reduce the shortages the healthcare workplace.  The impacts of telehealth are almost too good to be true but with the right steps, I believe every facility is going to adapt and use it to their advantages. 

 

Reference: 

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. doi:10.2522/ptj.20150079 

The article described the treatment plan as meeting four times a week for three weeks with a Adobe Connect. The subjects were children with apraxia between the ages of five to eleven. They described the treatment as testing and working on the child’s capability to perform pseudo-words, generalize the skills in real world, and maintain the new skills they had learned. A pseudoword is a fake word or  a string of letters that resemble an actual word. Some examples would be heth, lan, nep, rop, sark, shep, spet, stip, toin, and vun.

The results of this “experiment” with telehealth were actually really good! Of the five children that took place in this study, all five showed significant progress! Also, two of the children actually improved not only with singular words but phrases. Four of the children maintained growth even four months after the study had finished! I think this is a great way of utilizing technology and there is a hige future for this type of telehealth. Imagine being able to work with a speech pathologist from home, or even having pre-recorded lessons to be able to work on their speech more! 

Thomas, D. C. (2016). Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech. . International Journal of Language & Communication Disorders .

 

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., … Nesbitt, T. (2016). Personalized Telehealth in the Future: A Global Research Agenda. Journal of Medical Internet Research, 18(3), e53. http://doi.org/10.2196/jmir.525