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UCLA Regional Medical Center

Furthering Development Of Telecare

Abstract

Telehealth allows patients to get health and social care from a distance allowing them to keep their independence and improve their quality of life. The increasingly aging has resulted in a significant increase in the prevalence and consequences of chronic diseases, necessitating additional care and welfare. Telecare thus has made the elderly one of their key target populations. Innovative home solutions allow seniors to live in the setting of their choices while also protecting them from incarceration or nursing care placements. It provides a sense of security and comfort to the aging persons as it seems to be amongst the promising techniques facilitating independent living in a communal setting. Telemedicine solutions open up new avenues for diagnosis, treatment, education, and recuperation, as well as the ability to track patients with a variety of chronic illnesses. It also minimizes socioeconomic disparities in access to care and provides patients from urban and rural locations with equal opportunities. Even though with many undeniable advantages, it also has certain drawbacks. Older individuals are typically hesitant to adopt new technologies, especially when learning the requisite knowledge and abilities.

Furthermore, when it comes to establishing trust in Telehealth, privacy and security are critical. Trickling classified info can have devastating and long-term consequences on the patient's life and career. Telehealth elderly care should be tailored to their specific requirements, abilities, and interests, with adjustments made over time. If essential, accessible, appealing, and cost-effective, technology is created to tailor to seniors' lives and plans. Telecare will undoubtedly be a fundamental part of their future lives, enhancing independent functioning.

Table of Contents

1. Introduction ……………………………………………………………………………4

2. Mission, Vision, Values...………………………………………………………………4

3. Statement of Problems………………………………………………………………….5

4. Research purpose……………………………………………………………………….6

5. Hypothesis………………………………………………………………………………6

6. Research Methodology…………………………………………………………………8

7. Models of Analysis………………………………………………………………………8

   1. Evaluation model……………………………………………………………………….8

   2. Descriptive model ………………………………………………………………………9

   3. Action model …………………………………………………………………………….9

8. SWOT Analysis………………………………………………………………………….10

9. Limitations and Delimitations of Study…………………………………………………11

10. Research Findings……………………………………………………………………….11

    1. Can this be cost beneficial and effective………………………………………………11

    2. Will this improve communication and convenience………………………………….13

    3. Will this prevent possible complications and unnecessary hospitalization……………14

11. Recommendation……………………………………………………………………….15

    1. Recommendation for action……………………………………………………15

    2. Recommendation for further study…………………………………………….17

12. Summary and Conclusion………………………………………………………………18

13. Attachments…………………………………………………………………………….19

14. References …………………………………………………………………………….21

Introduction

As the name depicts, Telehealth uses electronic communication technologies such as computers and mobile devices to manage your health care and access health care services remotely. The most contemporary medical service delivery is used when doctors and patients are not in the exact location (Allen, 2016). Telehealth blends the requirements of the people with professional health care services by using modern information and communication technologies to aid, monitor, and care for them. These technologies are always surrendered to be fast, accurate, and cost-effecting in the long term. Telehealth covers four main distinct domains, such as live video (Cascella, 2016). This service gives room for two-way interaction between the patient and the clinician using audiovisual telecommunication technologies. The domain can thus be used for diagnosis, consultation, and maybe treatment services. This is, in fact, a factual lifesaving technic as less cost is involved during the visual meeting.

The next one is mobile health. It involves using mobile phones, computers, and tablets for public awareness, education, and health care through communication. It is also widely used in making national alerts about an outbreak of a disease. Then there is a store and forward domain, and lastly, a remote patient monitoring domain. All this use electronic communication just for the betterment of citizens' lives. The research below thus focuses on the benefits of Telehealth for seniors and primary care providers, most so in implementation strategies, cost-benefit, and its cost-effectiveness. It continues to expound on the problems faced by elderly persons in health care.

Statement of problems

From my observation it was found that many departments are slapped with a massive blow of elderly patients missing physical clinic appointments and discussions (Allan R, 2006). This has led to their life’s deterioration, and most do succumb. In this age bracket, people are known to be more forgetful and maybe cannot cope with the long distances to get treatment due to their less energetic nature. Some are clotted with poverty confining their chances of being admitted to hospitals due to the high fee narrowing their lives to pain and death. It was found that most of these people do live in the up-country sides as they cannot manage the city lifestyle. Their chances of reaching out for high-quality health facilities are also narrowed as high sums will be required only in transportation. Take a look at the previous and recent catastrophic disease that married the whole world by COVID-19.

Poor health practices and education led to the disease haunting most elderly due to their weak immune system. Most governments had no chance but to heavily venture into Telehealth for this group to curb the misfortune. This was primarily witnessed in countries like Spain, Italy, the USA, and many more African and European nations. Well-laid strategies were implemented to isolate the patients in their homerooms, and doctors continuously sent them for check-ups. Before this, the admission fee only in public and private hospitals in Africa was almost thousands of dollars, leading to more people dying. The governments were also saving in ventilators and beds required to admit all these patients. The health care providers, too, got relieved from the overcrowded clinics, which led to most of them also acquiring the disease.

Research purpose

The research was done mainly to expound on the benefits of Telehealth for elderly persons, primary care providers, and reasons to further advance it. This was to be done focusing on three major questions: is Telehealth improving the communication and convenience between the elderly patients and doctors, and how is it doing that? Does Telehealth truly cost beneficial and effective? And lastly, is Telehealth preventing possible complications and unnecessary hospitalization? With those, the purpose of the paper would be met. The data found could then be used in advising more countries to venture into the activity appropriately, putting the benefits of the patients first. The research is also done to equip the young generation with extensive information about the emerging trends globally and the appropriate way to research with a goal-oriented mindset.

Research Hypothesis

Telehealth improves the communication and convenience between doctors and their patients. In case of sickness, Telehealth eliminates the need to drive to the doctor's office or clinic, stroll or wait in a queue. From the comfort of your bed or chair, you can simply consult with your doctor. Virtual visits may be more convenient for you to fit in your hectic daily schedule. Contingent on your work plan, you may not even need to take time off work. It makes communication easy since you can ring the doctor seeking consultation or reporting some new disease symptoms on your body. Telehealth is also applicable for psychiatric and psychological purposes. For example, in Tel Aviv, there has been a program with cardiac patients for years (Berman and Fenaughty, 2005). There is a centralized system where patients' personal, residential, and physician information is stored. The patients wear a portable device that instantly connects them to the centralized system for new disease symptoms. This allows the nurses to dispatch emergency personnel by the physician's prescription or correctly advise the patient. This has undoubtedly increased communication between the two parties making the diseases less deadly as they lack enough time to build on their severances.

Telehealth is generally cost beneficial and effective. As anticipated from the abstract and introduction, Telehealth is a health and money-saving activity for the elderly. Through Telehealth, high hospital admission fee is halved as the patient can get treated from home. For example, it is said that the cost of admission of COVID-19 was thousands of dollars in most countries, especially in Africa (Smith and Anthony, 2020). This was too costly and unaffordable by most patients increasing the countries’ death rates on the disease as people shied off those high charges. The government, too, was overspending on beds, ventilators, and nurses' protective wearing. But with the introduction of Telehealth in most countries, all these treatments and education could be afforded bed seated at home, cutting on all those costs. Transportation costs for the elderly patients who only use private means to the hospitals are also confined. This, too, render this activity money-saving to the patients.

Lastly, Telehealth prevents possible complications and unnecessary hospitalization. With frequent communication between the patient and the doctor about their well-being, patient's hospitalization could be sure a theory. The health status complication will also be diminished as the doctor will track how the patient is dwelling. The patient will have unrestricted access to his doctor explaining his status through phones or even video conferences. With this, hospitalization will only be for patients under critical conditions that need constant physical attendance by the doctor.

Research methodology

To develop relevant findings as per the hypothesis, I used several data/information collection methods. I applied the literature review method. Being that Telehealth is among the trending therapeutic activity carried out globally, I was able to get access to several Telehealth, telecare, and telemedicine journals and books studying their effect on the patients and the health care providers. The journals were like: How the North Texas Telemedicine Revolution began (Goodman, 2016), benefits and Drawbacks of Telemedicine (Hjelm, 2005), and many more. I also used personal observation in data collection, being well-informed theoretical about the activity. The COVID-19 catastrophe gave me background knowledge about the activity since it has been the only disease I witnessed patients under Telehealth in my life. To strengthen my research, I had to pay some random visits to elderly individuals within our society who have been rumored to have undergone the activity to better their lives. I did question them on the limitations and the advantages of Telehealth to them and some advancements that they would like to be done for more effectiveness.

Models of Analysis used

Geographical distribution, telehealth interventions, and patient categories were used to categorize the study. The study's concept and objective measures, including clinical outcomes, patient perceptions, economic factors, and organizational features, were examined, focusing on the lessons gained and the need for further research. The analysis and reporting focus on these four telehealth domains: live video, Store and forward domain, Remote patient monitoring, and mobile health. The specific models that were used were:

Evaluation model

This entails the extraction of meaningful information from the recipients to enable you to provide valuable arguments to the evaluators. This model aims at preliminary details on the activity, and it helped me in enquiring information from the elderlies themselves. Feedback is frequently regarded as beneficial if it aids in decision-making. However, assessment studies may not always have a long-term impact and sometimes fail in short-term scenarios. I chose the model for its numerous benefits, such as. It gains insight about a project or program and its operations, helps in capacity building, improves practice, and lastly, it has assessed effects as one can see whether the objectives have been met.

Descriptive model

It involves figuring out "what" rather than "why" behind an event—the emphasis shifts to what something is based on unbiased data. The model focuses on the understanding of the study topic. To get concrete data by understanding the topic's depth, I flipped through people's journals and books inquest for the content. This was done by first determining the specific books with unlimited content about the topic. This was, in fact, the highly used model within the research as it was a new area to me, plus it was not within my profession. Though the model was tiring as reading through the many books and journals was time-consuming and tiring.

Action model

This is where some of the data were found from new knowledge observations. This model worked as my bedrock in the research, especially the comments from the ongoing COVID-19 pandemic, which I have keenly witnessed and read. It had to put my observation on the field relating the current health activities I saw from the recent severe disease with Telehealth. The model gave me a realistic understanding of the topic connecting my mind with the data from the evaluation model to confirm their correctness.

In business rivalry or project planning, a SWOT analysis can assist a person or organization determine their strengths, weaknesses, opportunities, and threats. For pre-decisional stages, this technique works by 'peeling back layers of the corporation.' It can be used to assess an organization's strategic position. Its goal is to establish the venture's goals and identify the internal and external elements that are helpful and hindering in reaching those goals, as well as possible solutions. A SWOT analysis is commonly used to provide meaningful information for each category and determine a company's competitive advantage by asking and answering questions. The name is an acronym for the four parameters the technique examines:

• Strengths: characteristics of the business or project that give it an advantage over others.

• Weaknesses: characteristics that place the business or project at a disadvantage relative to others.

• Opportunities: elements in the environment that the business or project could exploit to its advantage.

• Threats: elements in the environment that could cause trouble for the business or project

With Telehealth being an emerging issue in the health sector, it carries many advantages and some flaws. The benefits associated with Telehealth include: it reduces the rural barrier to care. This is actually among the most significant advantages of Telehealth as patients can be attended to wherever they are. It decreases strain on the healthcare system as patients no longer stress themselves from limited personal appointments and long traveling time. It supports independence, especially the elderlies, as they don't rely on others for institutionalization. It further delivers costs savings, as shall be seen from the findings as patients save on appointment fees and traveling expenses. It offers extensive telehealth technology options ranging from mobile phones to emails and computers.

Certain apps have been built to estimate the amount of insulin needed, which significantly helps diabetic patients. Lastly, Telehealth expedites timely care. It strives to quickly direct patients to their right health care providers, thus preventing them from much time in queues or clinic visits.

Even with those many strengths associated with Telehealth, it too has the following weaknesses. It is not practical to conduct every form of a visit from a distance. Patients still need to visit the doctor for imaging tests and blood testing, and diagnoses that require more hands-on treatment. The safety of electronic transmissions of personal health information is an issue. During the COVID-19 epidemic, insurance companies are gradually covering the costs of telehealth visits; however, some services may not be fully covered, resulting in out-of-pocket payments.

Furthermore, some of the patients are highly illiterate, thus confining them from effective digital electronic technologies. Lastly, Telehealth is not that readily available in many countries; therefore, patients cannot always depend on it. It may sometimes be interrupted with power or network problems, something that could not have happened in the case of in-person patients' treatment.

Limitations and Delimitations of the study

Every research study cannot lack limitations or flaws during the research period, and sure I too had to face some. Inadequate time: the research duration was not long enough to collect as much data as possible under the study—complications in accessing data. I conducted the research while enduring challenging situations in accessing the possible information that could have detailed the report. Maybe having a research partner could have helped me access more materials and discuss my views before analyzing the report. Inadequate financial resources also blocked me from reaching as many patients as possible to hear their views on the impact of Telehealth. Some relevant journals and books also needed cash to access, which I couldn't meet at all. The data collection method, which was mainly literature review, wasn't an excellent way to assemble primary data. It mainly entails some people's minds, something I wouldn't prefer when the opportunity was given enough to use personal observation.

Some of the delimitations are: the study was limited to only elderly patients and health care providers, which could have been expounded to the general population. The research questions were also strictly three; improve communication, benefits, and unnecessary hospitalization. Lastly, the study couldn't evaluate the negative effect of this Telehealth on the providers and recipients.

Research Findings: Can this be cost beneficial and effective?

Using the literature review method and descriptive model in data hunting, I found that truly Telehealth is a cost beneficial and effective activity (JJMoffat, 2011). It was found that patients can save more than 100 dollars by opting for telehealth sessions, as the average telehealth appointment only costs between 30 to 50 dollars compared to almost 170 dollars for in-person therapy. On individuals diagnosed with preterm delivery, the overall cost of gestation for those who use telehealth services was estimated to be around 7,000 dollars compared to almost 21,000 dollars for those who attended in-person consultations. It was further found that patients who used Telehealth saved an average of roughly 14,000 dollars (Bardsley and Steventon, 2013). Those frequently on elevated plans and footing the majority of the medical bill themselves would greatly benefit from those reductions. This excellent saving plan can help the patients, especially the elderly, remain with enough funds to fine-tune their eating diets and invest in their children instead of medical services alone. The telehealth costs also lighten the challenging economic situations slapping most individuals globally, especially those with the duty to provide to their kinships.

Doctors and clinics with telehealth programs were found to receiving general cost savings. According to the Geisinger Health plan study (Keck and Doarn, 2014), it was found that the telehealth program saved roughly 10% in cost throughout the study period, resulting in a return on investment of $3.30 in cost reductions for every $1 spent on telehealth program implementation. These advantages are directly significant to doctors and hospitals serving rural patients in remote places. According to the University of California, it was further found that the rural emergency sector saved almost $ 4600 on average when patients used pediatric telehealth consultations compared to physical talks (Illove, 2016). Further, according to Davis's study, it was highlighted that telehealth consultations reduce the number of patients being transferred or airlifted to other better hospitals by roughly 31%, thus rendering significant savings to the hospitals from costly air ambulance charges.

The cost reduction from fewer hospitalization was found to be another significant financial gain. From a study of nursing homes that applied Telehealth to provide off-hour care to patients, the nursing homes witnessed their hospitalization drop from 11% to 9% for the institutions under telehealth activities (Shaw, 2009). From another study, the Veterans Health Administration post-cardiac care program used Telehealth to reduce clinic readmissions by almost 50% for heart failure and 45% for other conditions (Novak, 2012). These are considerable reductions in costly hospital readmissions, which save a lot of money in the long run. These benefits were also not restricted to the patients and health care providers but the patients' employers and insurance companies.

Will this improve communication and convenience?

Using personal observation methods and evaluation and action models: it was found that Telehealth has dramatically improved communication and convenience between the patients and the healthcare providers. By visiting some of the elderly patients under the care to explain to me about their communication frequency with their doctors, it was found that the patients enjoy frequent communication, which is always in a switch of a button. The communication costs were also relatives cheap to them compared to traveling costs. Mobile video calls and teleconferencing were among the highly anticipated ways of communication with their doctors. Some also have alerts on their devices reminding them of dosage time, eliminating the forgetting nature. For this, most of the patients were found to have installed internet connections in their homes either with computer desktops or smartphones, enhancing more accessible communication.

According to Massachusetts General hospital data (Wotton and Batch, 2005), it was found that Telehealth is currently considered as a driver of patients’ satisfaction, meeting their expectations for convenient care access and quality. Scholars have long praised Telehealth as a valuable tool for connecting patients to care when they might otherwise encounter significant barriers to care. Patients who live long distances from the hospitals, having busy job schedules, or having a large family do heavily benefit from telehealth care. From the vast anticipated visits on the elderly patients, it is not a surprise that most of them found virtual meetings more convenient and impressed that they could still get quality care and communication better than the ancient and familiar in-person visits. It was easier to book a convenient appointment time for telehealth follow-up than for clinic visits, according to 80% of study participants. Patients also claimed that telehealth sessions were of good quality and their happiness with the scheduling process. Some patients thought telehealth services were just as good as in-person visits, while others argued that telehealth appointments are higher quality than in-person visits.

Even when using video visits, patients experienced meaningful ties with their doctors. 70% of the patients who used Telehealth stated that they had a good personal connection with their doctors. Patient's satisfaction with Telehealth was thus generally high, and on a ten-point scale, 72% of the patients gave their Telehealth a nine out of the possible ten. Some of the low ratings were due to minor technical issues associated with poor networking in some areas. Physicians, on the other hand, still place great importance on in-person appointments. Although almost 60% of telehealth practitioners believed that the technology was accepted for their respective patients' needs and of comparable quality to in-person sessions, some still expressed misgivings. A third of the doctors still vote that in-person visits provide better care than Telehealth. Furthermore, roughly 45% of the doctors felt that in-office visits allowed more patient-provider interaction than telehealth appointments.

Will this prevent possible complications and unnecessary hospitalization?

Lastly, it was found that Telehealth prevents possible complications and unnecessary hospitalization. Using a descriptive statistic on the frequency and examples of telehealth calls in a month based on Massachusetts nursing homes (Paul, 2006), it was found that recently most of their patients have been introduced to in-home care facilities saving for their spaces in hospitals for severe patients' conditions who require constant physical doctor's attendance. The data indicated frequent calls and video conferencing employed by most of the doctors in the department. Patients constantly called seeking consultation on minor sickness or newer symptoms that did not necessarily require in-person visits to the physicians.

Both its treatment and control groups saw a decrease in hospitalization per 100 resident days during the pre-and post-intervention periods. The control group witnessed a 5.5 percent decrease in hospitalization rate, while the treatment group saw roughly a 10 percent decrease. As a result, the treatment group pre-post disparity in hospitalization was almost 4.5 percent lower than the control group pre-post difference. This effect was most noticeable in the most engaged nursing homes, where hospitalization rates dropped by roughly 15 percent. Even with this great witness in the hospitalization of the patients, it was also found that some patients get into critical condition when not admitted. This was found to rise due to poor consultation between the patient and their doctor. Some patients were found to give an inadequate description of their health status as their physical strengths sometimes clotted their faces. The disease could build itself slowly within their bodies without their knowledge, something that could have been detected in case of an in-person visit to the doctor. Overall, it was voted in by almost 85% that Telehealth has genuinely reduced unnecessary hospitalization, giving those patients who do not like the hospital's environs a shiny face.

Recommendations

Recommendation for Action

Telehealth is cost beneficial and effective. With the findings depicting this for us, it still cannot be entirely argued that no more actions can be done to fine-tune it—some flaws associated with this need to be acted upon for Telehealth to be highly cost-effective. The health care providers from respective clinics and hospitals or the department of health agency should recommend less expensive technologies to be used by the patients for easier purchase by the less wealthy individuals (Marengoni, 2011). Take a look at countries slapped with high poverty ratio, when the health department confined their minds to the same technologies used by highly developed countries such as USA and United Kingdom to their countries too; the patients will incur high cost to sustain this. Telehealth will thus be less cost-effective to them cause the same patients do have investments to make. Therefore, every agency or health care provider should encourage their patients to purchase these electronic devices from their hospitals at relatively fair prices without minimizing the quality of the activity.

The charges associated with these online consultations and diagnoses should also be halved after finding out that some providers value telehealth patients as wealthy persons bumping huge charges for their treatments to them. Since the activity is encouraged across every individual, the costs should be standardized relative to the patient's disease. With these changes made instantly in most counties, if not all, Telehealth will surely be the song in the future health sector.

Telehealth improves communication and convenience. This is undoubtedly true as patients can talk with their doctors at a press of a button, but still, advancement ought to be done. Some patients are faced with communication difficulties, and at some points, the doctors, too, do not take a step to check the reason behind it (Pierratos, 1999). As known, human beings may be sluggish on their duty without supervision. Enough and thorough management should be done to the doctors to ensure that they consult with their patients. This can be done by connecting all the communication devices to a central place in the hospital where a doctor is in a call or video with a patient is recorded with the exact things they were discussing. The agency, too, should ensure good networking country-wide to ensure that the connection problems do not hinder rural patients. This, too, must involve rural electrification cause the devices are of electricity usage. The country's networking companies too should be standardized on their charges on these communications rendering it easily affordable for every patient. Lastly, most hospitals are encouraged to apply the centralized data collection program for every patient on communication and convenience. The patients are given specific portable devices that automatically transmit any changes to the central program in the respective hospitals.

Telehealth indeed prevents possible complications and unnecessary hospitalization. The doctors should make random home visits to these patients to advance since not all patients understand their symptoms and explain them virtually. Some symptoms are easily noticed by the experts, something that can be well-seen physically. Some of the patients are also too old that can't be refrained with the telecare thing. Thus, consideration should be given in choosing those to hospitalize and those to continue with Telehealth. Lastly, some patients' home care places aren't hygienically up to the hospital standards to be occupied with a sick person. They should not choose but to admit them to the hospitals until their conditions become debatable to be taken for home care now.

Recommendation for further study

For future research about the topic, the researchers should be given more time to identify the patients under the telehealth activities and verbally communicate with them to get primary effects. Some reading materials do shrub off the negative part of the activity. They, too, should visit the hospitals practicing the act for details. Furthermore, I would like the topic to be expounded to the elderlies and providers and the benefits to the government and society, stressing society's view on enhancing the activity. Future research should emphasize why the exercise is primarily practiced in Western countries and not wide enough in African countries and what they should do to emulate the rapidly developing world. Lastly, specific and pronounced favorable methods and models for the research should be given for extensive data collection and fast mind-making on what direction to take to save the research period and its practical use. All the researchers should avoid and prevent the limitations I incurred here, emphasizing the delimitation and enhancements.

Summary and Conclusion

Telehealth-based care is increasing in popularity. The elderly population has become increasingly involved in the momentum, and innovative telecare solutions are increasingly finding their ally. Technology advancements have made it possible to execute solutions commonly thought to a distant vision in the future. Aside from the fast-developing technology for education, protection, assessment, treatment, and rehabilitation, there are several other advantages. Telehealth opens up new possibilities for chronic disease patients. It improves the quality of life for older patients by reducing socioeconomic inequalities in access to treatment and providing equal opportunities for patients from both urban and rural areas. There has been a substantial shift in well-developed countries from passive monitoring to more active monitoring and having a decent fiscal future in recent years.

As people get older in the United States, their lives quality improves. They put in a lot of effort throughout their careers because older folks are more computer savvy and conscious of the repercussions. Patients are empowered to control their health, activity, and other pro-health behaviors when in charge of their care. Japan and the United Kingdom have not been left behind as they continuously toil to better their telehealth facilities, thus increasing their countries' life expectancies. Some African countries such as Kenya, South Africa, Nigeria, and many more are venturing into this modern health activity, scrapping and nullifying frequent elderly deaths. The report shows that well-laid implementation strategies have been put in place, and the activity is thus cost-effective in the long term. Telehealth is, therefore, the medicine to curb chronic diseases in elders and, hence, the medicinal world's critical action soon.

Attachments

References

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