Phase 4 is all about results, this part of the paper will be based on the hypothetical analysis. Meaning since we will not be actually implementing the process, the results described will be based on

Running head: TELEMEDICINE IN TRANSITIONAL CARE 1

Telemedicine in Transitional Care

Nursing Research

Telemedicine in Transitional Care

Results

The study collected data using the structured interview that involved 25 physicians and nurses as well as 27 older adult patients with cardiovascular conditions, getting care in the primary care facility located in Houston, Texas. The researcher analyzed the acquired information utilizing computer-assisted qualitative data analysis software (CAQDAS). As a result of analysis, the expert has identified different themes that concern the patients and caregivers the most. The main ones are the reconciliation of medication, ensuring access to vital services after discharge, communication of healthcare information, follow-up telephone calls, as well as post-discharge home visits.

Themes Identified in the Study

Reconciliation of Medication

The first topic of concern identified in research is medication reconciliation. It is a crucial component of the transition process that involves developing a list of drugs that the patients take (names of prescribed medicines, routes of administration, frequency of dosing, and strength of dosage) and comparing them against a prescriber’s admission, transfer, as well as discharge. The main goal pursued by the healthcare providers is to offer a correct medication to a person, hence getting vital care in medical facility. Discrepancies (unclear information, contraindications, duplications, and omissions) are linked to rehospitalization, delays in receiving necessary drugs, and medication errors. As a result of a study, it has been revealed that a half of all medication errors occurs during the provision of transitional care, and therefore, both the medical providers and patients are concerned with this issue.

Ensuring Access to Vital Services after Discharge

The second topic of concern identified in the study is ensuring access to vital services after discharge. In addition to reconciling a client’s medications, other factors play a crucial role in optimizing treatment after the care transition. Such factors include access to the relevant equipment (mobility assistive devices, nebulizers, and home oxygen) and medications on the side of the patients. The nurses and physicians recognize the importance of filling, picking up, and consuming medications in an appropriate way to achieve the favorable health outcome. Pharmacy access is another crucial factor that helps ensure the adherence to medication after the hospital discharge. As a result of a study, a researcher has detected that fewer patients obtain prescription medications in comparison with those individuals who receive drugs during a hospital visit. The healthcare professionals participated in research have mentioned that the delivery of medicines at bedside before discharge would help address medication or insurance discrepancies emerging before a client’s release as well as eliminate barriers to drug access. Despite the fact that the bedside provision of medication has been effective in improving the initial access to treatment, the interaction with nurses, physicians, and social workers as well as resolving the long-term financial problems have a direct impact on access to necessary medicines.

Communication of Healthcare Information

The third topic of concern identified in research is the communication of healthcare information. As a result of a study, the researcher has revealed that the provision of medical data to both patients and their family members is limited by poor health literacy and physical deficits (cognitive, vision, and hearing impairments) experienced by these stakeholders. After the interaction with participants, the expert has estimated that 14 out of 27 older adult patients have a high level of health literacy, 10 individuals have reported difficulties in completing common tasks and following the directions on the prescription drug labels, and three individuals have low health literacy. Due to cognitive impairments, the clients cannot properly read and understand health information. As a result, they are not able to precisely adhere to discharge instructions and prescribed drugs. Therefore, they fail to follow up with nurses and physicians after hospital discharge. To improve communication with clients with cognitive deficits and poor health literacy, the nurses and physicians require sufficient time for cooperation, identification of barriers, as well as determination of ways to overcome them (National Institute on Aging, 2015).

Follow-up Telephone Calls

The fourth topic of concern identified in the study is follow-up telephone calls. In addition to the reconciliation of medication, the researcher has implemented follow-up telephone calls to ensure the smoothness of care transition. In these telephone calls, the expert has paid significant attention to the barriers of filling prescriptions, patients’ concerns, negative effects of treatment, as well as discharge drug list. Depending on the severity of a medical condition, the nurses and physicians call clients after discharge, and this process has shown a great potential to address their needs, properly assess self-management, and resolve issues in care transition. However, Crocker, Crocker, and Greenwald (2012) reveal that follow-up telephone calls do not significantly affect the rate of readmission.

Post-discharge Home Visits

The fifth topic of concern is post-discharge home visits to the patients. The nurses and physicians implement post-discharge home visits to precisely monitor a client’s laboratory test values and vital signs, manage drug use, identify issues, as well as provide additional healthcare education. As a result of a study, the researcher has revealed the decreased rate of readmission when a nurse and pharmacists visit patients with cardiovascular conditions at home. In addition, telehealth services help remotely monitor a client’s health status at home and deliver this information to both nurses and physicians, thus facilitating the adjustment of drug regimen. Ben-Assa et al. (2014) consider that such an approach prevents rehospitalization in both short- and long-term perspectives.

Discussion of Findings

The study reveals that the poor transition of care produces considerable health expenses, frequent rehospitalization, overuse of emergency room departments, as well as unfavorable patient outcomes and experiences. Overall, the respondents find telemedicine intervention to be valuable, and they would continue utilizing telehealth to manage their concerns as well as demands. The individuals living in the remote areas also consider patient monitoring technology useful for them. In general, telehealth facilitates the care transition and ensures its smoothness and timeliness after hospital discharge, hence improving adherence to drugs and patient engagement. Telemedicine also has a great potential to enhance the connection between clients, family members, and medical professionals during a vulnerable period (Kash, Baek, Davis, Champagne-Langabeer, & Langabeer II, 2017). In this way, to ensure the favorable outcome in this regard, the nurses and physicians engage in care coordination to ensure the timely implementation, proper management, and accurate evaluation of a client’s treatment plan. The transfer and receipt of information between various levels of care and locations foster successful treatment and guarantee continuity of treatment. As a result of the study, the researcher has detected that the health information provides a more seamless and timely delivery of data between the medical professionals and settings in comparison with the traditional paper form.

In general, the provision of effective transitional care to older adults with cardiovascular conditions, including the reconciliation of medication, is crucial for improving patient care delivery, decreasing expenses and hospital readmission, improving treatment outcomes, and promoting patient satisfaction during their transfer from acute care to home or post-care settings (Keeys et al. 2014). Consequently, comprehensive and clear communication through post-discharge telephone calls, telehealth services, and home visits between clients and healthcare professionals, including nurses and physicians, is a key to success and achievement of optimal care transition.

It is worth to note that one of the main challenges highlighted in research is the effective communication between institutions and caregivers to ensure continuity of care across different healthcare settings. It involves counseling about a patient’s home medications upon the admission to the new facility, reconciliation of medication after discharge, as well as making sure that a patient has access to medications at home. The use of Health Information Technology (HIT) guarantees that the medical professionals have access to a comprehensive care plan and deliver appropriate education to the clients through telehealth. A failure in these areas produces negative outcomes and disrupts a patient’s healthcare. Effective handoff and improved communication between different stakeholders can positively influence hospital readmissions, client satisfaction, quality of care, and reduce overall medical costs, hence avoiding penalties for excessive rate of rehospitalization. In this way, direct communication with healthcare providers is also crucial for a person’s proper transition between healthcare facilities.

Limitations of a Study

Telehealth improves patient engagement, adherence to prescribed drugs, and care transition after hospital discharge. Due to the fact that this study does not demonstrate the effect of telehealth on decreased use of healthcare services, additional research is needed to better understand the genuine impact of telemedicine on preventing emergency department visits and hospital readmission. In Westin Houston Medical Center, where research was performed, telehealth training is provided to the resident physicians and nurses. Small institutions that do not have a sufficient number of trainees may require additional efforts for attracting the medical professionals to fulfill the patients’ needs. In this way, further research is required to validate whether telehealth interventions utilizing remote video visits and patient monitoring can decrease hospital readmissions and emergency department use.

Conclusion

All in all, the study focused on the knowledge, concerns, as well as issues of patients and healthcare providers in regard to medication, access to care, and communication of information through telehealth during the care transition. The implications of a study is crucial for the nursing practice, as it provides a great insight into telemedicine and its role in facilitating care transition from hospital to home. Further large clinical trials in collaboration with health systems would be required to ensure the return on investment for telehealth applied during the care transition. Telemedicine has a great value in ensuring the smooth and safe transfer from hospital to home, client satisfaction, and adherence to medication. Hence, more research is needed to evaluate the genuine impact of telehealth on preventing rehospitalization.

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