Telemedicine technology first emerged as a method of care delivery in the 1960s via programs launched by NASA and the Nebraska Psychology Institute, but significant barriers have slowed its adoption since then. Technological, staffing-related, and financial obstacles have certainly influenced the presence of telehealth in national and global healthcare markets, but never have we seen the increased opportunity and need for such programs than we do today. We are beginning to see legislative reform and unprecedented potential to not only expand the applications of telehealth and remote patient monitoring, but to also establish telehealth as an integral piece of balanced and cost-effective care. Telehealth is a key player in achieving positive patient outcomes, engaging patients in their own care management, reducing disparities in access to care, and improving overall public health. But how does this tie to palliative care?
The Aging of Baby Boomers – Implications for Disease Management
One of the largest trends we have seen in recent years is the continued outnumbering of Baby Boomers to children less than 5 years of age, and as a result, the medical field is faced with numerous age-related challenges: resource allocation, importance of addressing comorbidities rather than single-disease diagnoses, provider shortages, and sustainability of federal programs. As life expectancy increases and the leading cause of death in the United States inches further away from chronic noncommunicable diseases, we must stop and ask: what are the implications of the aging population on healthcare?
By 2030, the World Health Organization (WHO) projects that more than 60% of the Baby Boomer population will be managing more than one chronic condition ranging from hypertension and heart disease to dementia and cancer. The management of these conditions, though, puts a significant financial strain on the already expensive healthcare market in the United States and the number of accessible providers will continue to be stretched thin.
Maximizing the Value of Palliative Care with Telehealth
Palliative care aims to provide the highest possible quality of life to both patients nearing end of life and their caregivers and support networks. Traditionally this has been achieved through a comprehensive approach to addressing emotional, physical, psychological, and spiritual needs of the patient with pain management at the center of care delivery. But although palliative care is no stranger to the current healthcare arena, providers still struggle to maximize its clinical value across the care continuum and across patients’ disease progression. When we don't use what may be the best tools for the job, at the right times in the care path, we miss opportunities to optimize patient and family coping, to limit suffering, and to ensure that our care plans are patient centered (Hennessy et al., 2013). The reality is that we must be focusing on providing preventative rather than reactive care and telehealth offers ones means of doing so.
Though telehealth programs have been appearing more frequently in recent years to improve chronic care management and access to care in rural areas, few of these are palliative-centered. In fact, the concept of applying telemedicine in palliative care was only just presented at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, CA.
Empowering Baby Boomers to Engage in Palliative Telehealth
Aside from financial factors, though, one of the largest barriers to the use of telemedicine in palliative care is the concern with technology and technology-related complications for an older population that is often uncomfortable with virtual physician care. This is certainly true for a North Carolina-based program launched by Four Seasons Compassion for Life in 2016.
While initial concerns existed, researchers found that patients readily adopted the technology and often felt a sense of accomplishment in doing so once properly coached. Successful enrollment of an older population requires that during installation the palliative care professional thoroughly engages the patient and caregiver and ensures their confidence and capability with the technology through demonstrated learning. Some other points to consider and program suggestions are listed below:
Video-based conferences between the provider, patient, and caregiver
Virtual case conferences with a patient, caregiver, palliative care provider, primary care clinician, or other necessary specialists
Self-reported assessment tools (e.g., symptom surveys and questionnaires)
Smartphone applications for the patient, caregiver, and provider
Remote activity monitoring and remote patient monitoring of symptoms
Education and medication management, including custom reminders for needed actions
A home-based palliative care program has the potential to reduce hospitalizations and improve care as video communication and symptom monitoring contribute to increased quality of life and survival rates. The initial visit must establish trust between patient and provider so that ongoing care can exist. The virtual video communication associated with palliative care telehealth programs allows providers to care for more patients and increase access to services while eliminating other issues related to strictly in-person visits: provider burnout, long travel times, and the inability to care for many patients in a work day.
Avoiding Re-hospitalization Among Palliative Patients with Telehealth
The need for telehealth-based palliative care programs is particularly needed outside of the hospital setting as very few post-acute care facilities have easy or convenient access to specialists. Consequentially, any change in a patients’ condition often result in re-hospitalizations that can be both stressful and expensive. Not to mention, this ultimately may not be what the patients or their families want. In some more costly cases, hospital transports are delayed while care providers search for any advance care planning directives. With telehealth that enables quick access to palliative care specialists, patients can be treated according to their own individual care plans without the need to visit a facility or wait for a medical emergency to spur required care, all in the hopes of reducing readmission rates for both patient and provider.
What Does the Current Market Look Like?
We have all heard the phrase “healthcare is constantly changing” and in some ways this is truer today than it ever has been before. The influence of technological advancement on the current healthcare market has been exponential in bettering access to treatment, improving disease control methodology, and increasing the efficiency and quality of care itself. Looking back ten years, even, it seems that we are expected to do and accomplish more today with fewer resources: fewer hands in the operating room, less time in the doctor’s office, and less money as widely used technology is no longer reserved based on cost. But patients are coming home sicker and quicker.
Telehealth allows families and patients to feel supported when everything related to a life-limiting diagnosis is unknown. Patients don’t lose contact with their providers even at 2AM when they feel anxious and need to speak with a professional. Caregivers are provided with added resources since a nurse is always on the clock to assist emotionally and clinically. Electronic education allows patients to feel comfortable and safe within the walls of their own homes. As Dan Casey, Direct of Telehealth and Clinical Support Services at NVNA and Hospice notes, “more and more is being done in home settings and telehealth is an added layer of support for the palliative care community. Direct reimbursement of these programs remains a challenge, but the industry standards are changing. More home care agencies need to implement telehealth to build the groundwork for larger market changes, and now is the time to do so.”
“3 Ways Technology Has Changed Healthcare: UIC Health Informatics.” Health Informatics Online Masters | Nursing & Medical Degrees, 30 Oct. 2018, healthinformatics.uic.edu/blog/3-ways-technology-has-changed-healthcare/.
Bashshur, Rashid L. “Guest Editorial: Compelling Issues in Telemedicine.” Mary Ann Liebert, Inc., Publishers, 2013, www.liebertpub.com/doi/abs/10.1089/tmj.2013.9998?journalCode=tmj.
Bull, Janet, and Lindsay Bonsignore. “Telemedicine in Palliative and Supportive Care: A Continuing Conversation.” ASCO Connection, 25 Jan. 2018, connection.asco.org/blogs/telemedicine-palliative-and-supportive-care-continuing-conversation.
Garza, Anyssa. “The Aging Population: The Increasing Effects on Health Care.” The Aging Population: The Increasing Effects on Health Care, 2016, www.pharmacytimes.com/publications/issue/2016/january2016/the-aging-population-the-increasing-effects-on-health-care.
Hennessy, John E, et al. “Practical Issues in Palliative and Quality-of-Life Care.” Journal of Oncology Practice, American Society of Clinical Oncology, Mar. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3595441/.