As the prevalence of chronic diseases continues to rise, healthcare systems will experience added pressure to make efficient use of their resources and treat more patients without compromising quality of care. Telehealth offers a solution to the growing need for healthcare efficiency in primary care settings today.
Optimizing Healthcare With Telehealth
Telemedicine in primary care can limit excessive healthcare resource utilization by allowing clinicians to intervene faster and address disease exacerbations as they arise. As a result, telemonitoring can ensure that patients remain healthy at home and aid in the prevention of unnecessary hospital admissions and emergency department (ED) visits.
A recent study sought to assess these benefits of telehealth by introducing home telemonitoring into a traditional primary care model. The main objective of the study was to understand the influence of the primary care home-based telemonitoring program on the use of healthcare resources. The authors measured healthcare resource utilization according to hospital admissions and ED visits.
Boosting Healthcare Efficiency
They study was designed as a before and after exploratory study without a control group. The telehealth intervention was conducted over two years and it took place within a healthcare organization that included a referral hospital, 25 primary healthcare centers, 230 general practitioners, and 320 nurses.
The participants in the study included home-bound patients with either heart failure or chronic lung disease (primarily COPD) who had experienced at least two hospital admissions during the previous year.
The telemonitoring intervention required the participants to monitor their biometric measurements according to disease state. Participants were also asked to complete a health status questionnaire that assessed their perception of their medical condition and also asked a series of questions that were specific to their disease state.
All patient data was sent daily from the patients’ smartphones to a web platform where it was reviewed by their care providers. Primary care nurses were in charge of the telemonitoring program and they received assistance from general practitioners when necessary.
In order to monitor high risk alerts, pre-established thresholds were set for each patient. When patient data was reported outside the established parameters, alerts were triggered on the web platform.
The primary outcome measured by the researchers was the difference in the number of hospital admissions occurring 12 months prior to the intervention and 12 months after the intervention. Secondary outcomes included length of hospital stay and number of emergency department visits.
Limiting Excessive Resource Utilization
Upon completion of the study, the researchers found statistically significant reductions in hospital admissions and ED visits. Hospital admissions decreased from 2.6 admissions per patient to 1.1 admissions per patient and emergency department visits dropped from 4.2 visits per patient to 2.1 visits per patient.
Though not statistically significant, the length of hospital stay also decreased by 3.5 days after the telemonitoring intervention. Length of stay decreased from 11.4 days to 7.9 days. This result is noteworthy because shortening length of hospital stay can positively influence quality of life for both patients and their families. A shorter length of stay can also lower costs associated with hospitalization.
Also of note is the satisfaction of both the clinicians and their patients with the home telemonitoring program. Satisfaction is important to measure across all telemedicine programs as it can play a major role in the acceptance and success of a telehealth intervention. The patients, relatives, and healthcare professionals all reported high levels of satisfaction, which is consistent with other studies that demonstrate that healthcare providers are generally satisfied with telemedicine programs that facilitate clinician involvement.
Keys To A Successful Telehealth Program
This small exploratory study demonstrated that home telemonitoring in primary care limits the overuse of healthcare resources by decreasing hospital admissions and emergency department visits, as well as potentially shortening the length of hospital stay.
The authors also used the study's results to identify several key factors that facilitate successful implementation of a primary care home based telemonitoring program:
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Acceptance of and adherence to the telemonitoring program by primary care professionals
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Promoting the leading role of nursing
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Institutional support for telehealth initiatives
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Availability of human and material resources to dedicate to telehealth
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Adaptation of care processes to include a telehealth model
Despite the lack of a control group, these outcomes and suggestions can be generalized to primary care settings because the study did closely mimic regular clinical practice by focusing on comorbidities and patient function. Additionally, the researchers recruited professionals who are usually in charge of these patients to lead the telemonitoring efforts.
Overall, the results from this study demonstrate that a home telemonitoring program in primary care is a feasible way to improve the efficiency of healthcare resource utilization. Healthcare systems that embrace telehealth will be able to take a proactive approach to treating the growing population of people living with chronic diseases. As a result, our healthcare organizations will become more efficient without compromising the quality of care they provide.
References:
Martín-Lesende I, Orruño E, Mateos M, et al. Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use. Eur J Gen Pract. 2017 Dec;23(1):135-142.
Chae YM, Heon Lee J, Hee Ho S, et al. Patient satisfaction with telemedicine in home health services for the elderly. Int J Med Inform. 2001;61:167–173.
McFarland LV, Raugi GJ, Reiber GE. Primary care provider and imaging technician satisfaction with a teledermatology project in rural Veterans Health Administration clinics. Telemed J E Health. 2013;19: 815–825.
Glaser M, Winchell T, Plant P, et al. Provider satisfaction and patient outcomes associated with a statewide prison telemedicine program in Louisiana. Telemed J E Health. 2010;16:472–479.