As people age, they want the comfort of being in their own home, while keeping up with their health and managing their symptoms. With the help of assistive technology, the elderly and sickly population are given the opportunity to stay safe and independent in their own home. Assistive technology is a variety of equipment that assists with everyday activities which may have become difficult due to a decline in health. Telecare, which is monitored 24 hours a day, 7 days a week, is electronic equipment which provides assistance at the press of a button. Telecare is described as care where the care receiver and caregiver are at a distance from each other. Telecare can help individuals who have recently been discharged from the hospital, have a disability, at risk for or suffer from falls, have no local family or support, have memory loss or dementia, or who have been victims of crime or violence.
Telehealth uses telecommuting technology to provide all medical aspects, including medical services and medical information, at a distance. This is achieved by joining patients and their providers, with the use of telephone, fax, electric email technology, and interactive full-motion video and audio (Shafqat, et al.) Assistive technology is being used to keep up with the aging population and the increase in long-term care. Telecare increases the access to care. Some patients do not have access to reliable transportation or live in rural areas, where it can be difficult to get to their health care provider. Telecare overcomes any geographic barriers to healthcare, especially with specialty providers. Telecare can improve the quality of care for patients. A recent study showed that patients have had 38% fewer hospital admissions, 31% fewer hospital re-admissions, 63% more likely to spend fewer days in the hospital, and more engaged in their health (Davis). Telecare reduces healthcare costs by eliminating the cost of transportation and inpatient hospital cost. One major goal for telecare is to keep patients as independent as possible. Telecare improves patient engagement, which helps patients stay healthy.
There are many African American adults with diabetes, who live in rural communities and have poor access to specialized care. The use of technology can help with educating patients on diabetes self-management. There was a study conducted to evaluate diabetes self-management education (DSME) intervention to improve the adherence to American Diabetes Association (ADA) guidelines (Davis). This intervention included interactive videoconferencing, telephone, fax line, and a telehealth enabled retinal camera, which was used in a community health center. The videoconferencing gave patients access to a dietician and a nurse diabetes educator. Diabetes TeleCare, a 12-month intervention, that was conducted in northeast South Carolina. The patients were recruited from three community health centers, which were over 100 miles away from CareSouth Carolina. The intervention consisted of 12 sessions, three of them being held in person, and the remaining nine were transmitted by interactive videoconferencing by the self-management education team. The purpose of this study was to educate individuals on how to self-manage their Type 2 Diabetes Mellitus, by using interactive videoconferencing in undeserved areas. After 12 months, it was reported that there was an improvement of glucose and LDL cholesterol (Davis). The use of videoconferencing was deemed as the most helpful factor when providing education to patients on how to manage their diabetic symptoms. Diabetes Telecare is considered to be effective in rural and undeserved areas.
Telecare is also effective for oncology patients receiving care in rural areas. With the help of a telephone, cancer patients can participate in a telephone-based care management and home-based automated symptom monitoring to monitor and improve pain and depression. Kurt Kroenke, M.D. and his colleagues conducted a study in the rural areas of Indianapolis, Indiana. They used a collaborative care approach to manage pain and depression associated with cancer. Patients received care by a nurse-physician team using an automated home-based system monitoring by using interactive voice recordings (Mavandadi). The nurse is trained in assessing symptoms and medication adherence, and in making treatment adjustments. After 12 months, patients reported less pain and depression after receiving telephone-based management of their symptoms.
Immediate access to physicians is proven to have better clinical outcomes for stroke patients. Stroke specialists can be readily available to assist in the evaluation of patients with acute stroke by interactive telemedicine. Acute ischemic strokes require immediate care, because of critical time windows for therapeutic interventions. Therapeutic interventions include a thrombolytic agent, which must be administered within 3-6 hours (Shafqat, et al.). It is important to act quickly and not delay treatment due to physician travel time. Therefore, having the assessment done beforehand can assure for a quick transfer to stroke facilities. Neurological deficits are measured during an acute ischemic stroke evaluation; therefore, telemedicine can be quite beneficial. Telemedicine for stroke patients utilize audio-video data transmission, with enough clarity and speed for a neurological evaluation. Physicians use the National Institutes of Health Stroke Scale (NIHSS) as a 13-element measuring tool for stroke deficit. There was a study done on 20 patients with following an acute ischemic stroke. The NIH Stroke Scale (NIHSS) was measured two ways, at the bedside and remotely, by a stroke neurologist (Shafqat, et al.). The remote session was through interactive high-speed audio-video, with the assistance of a nurse. Both patients received two NIHSS scores, one at the bedside and one remotely. When comparing the two NISHH scores, they were relatively similar, with a difference of <4 points (Shafqat, et al.). The advantage of using telehealth in acute ischemic stroke intervention is the timely manner, in which a neurological assessment can be completed, to determine the need for a thrombolytic agent. Telehealth provides the physician with necessary data to make a decision for the patient, prior to going to a stroke facility.
Telehealth seems like something that would only be beneficial to developed countries, however, it is the most beneficial to developing countries. Countries like Uzbekistan and Cambodia have satellite stations, which give off wireless connections for internet in remote areas. The internet access allows citizens to access emails, websites, chats, and videoconferencing, which allows for the opportunity for medical interventions (Edworthy). Physicians who travel to developing countries take their laptops with them. Telehealth is beginning to make a huge impact on developing countries. Practitioners are able to provide medical advice to their patients, without making them leave their homes, which can sometimes be dangerous in certain countries. In addition, patients can receive medical advice from doctors as near as the country they reside in, or as far as a neighboring country (Edworthy).
Although telecare is becoming widely accepted and implemented by many health professionals, nurses and ethicists worry about caring for patients at a distance. The fear is telecare is encouraging healthcare professionals to neglect their patients and inhibit personal relationships between the nurse and patient (Pols). Nurses reported it is difficult to sense if something is wrong by using a webcam to care for patients, as patients on telecare can decline, without noticing it. For example, a patient with heart failure will have a monitoring device. Patients weigh themselves and measure their blood pressure daily. The device sends measurements to a server, where they are coded and sent to nurses (Pols). The nurses must be trained to interpret results, such as weight gain, which can indicate heart failure. The second device that the patient will have is a screen that has question prompts on it. The questions are related to the patient’s physical appearance, as it asks to the patient to observe their body for symptoms related to their disease (Pols). Nurses believe the devices can cause false alarms. For example, if a patient answers “no” to certain questions, it can send an alarm to the nurse. Nurses must follow up via a phone call. Because the questions are not personalized, a “no” response to a question for one patient may not be as alarming as it can be to another patient. Nurses also claim that they have a 6th sense, which has been vital to patient care and good nursing. There are clinical symptoms that can arise, which will warrant face-to-face contact. Seeing a patient face-to-face can warrant different symptoms, which determines the diagnosis, tests, and additional physical examinations that need to be done. Nurses and physicians report visits are too important to be switched to telecare (Pols).
Telecare is a great benefit to the elderly population, because it helps them remain independent and care for themselves in their own home. However, there are some ethical concerns, especially in regards to cognitively impaired patients. There are four medical ethics that are of concern when implementing telecare. The first ethical concern is autonomy, which is being reliant on profession for their care or safety (“Ethical Issues in the use of Telecare”). Telecare can either promote or completely restrict autonomy. The second ethical concern is beneficence. Telecare can reduce unwanted dependence on professional state to increase comfort through environmental sensors (“Ethical Issues in the use of Telecare”). The third ethical concern is non-maleficence, where a balance must be achieved for ensuring safety and invading privacy (“Ethical Issues in the use of Telecare”). Lastly, telecare can interfere with justice, wee resources should balance the needs of individuals, and not disadvantage one group at the expensive of another (“Ethical Issues in the use of Telecare”). During pre-installation, an assessment should be done to evaluate the independence, social well-being, privacy, and protection of each patient. This is particularly important for patients with a disability, because telecare should only be installed with the user’s fully informed consent (“Ethical Issues in the use of Telecare”). Additionally, telecare users should be informed on what information will be collected, and how it will be used, prior to installation (“Ethical Issues in the use of Telecare”). Data should be secured and transferred only between agencies.
Telecare promotes independence, even for individuals with chronic health conditions. IT can improve safety, maximize autonomy, and prolong independence of an individual. There are many advantages to telecare, such as reliability, easy access, face-to-face communication from the comfort of your own home. additionally, telecare can reduce the cost of medical expenses, by keeping individuals out of the hospital. However, there are some ethical concerns that come with telecare. Providers are worried about individuals with cognitive disabilities, since they may not be fully aware of the use of telecare. Additionally, the patient’s privacy can be affected. Nurses and other healthcare providers have mentioned that telecare can be detrimental to the healthcare community. They believe telecare takes away from “good, patient-focused care”, since you are communicated via videoconference and telephone. Some healthcare providers believe face-to-face contact and having the ability to use your 6th sense is important when caring for individuals and preventing any further complications. I think telecare is an interesting concept, especially if it can be utilized for patients who live far away from healthcare communities. There is a lot of studies still being done to determine the effectiveness of telecare and how much it will be used in the future of medicine.
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