Increasing Access with Telehealth
For many patients with chronic illnesses, access to nursing care can be costly and inconsistent, frequently requiring home care nurses to travel great distances for in-home visits. New telehealth devices are using telecommunications technology to ease the burden on both nurses and patients. Dr. Kathryn Dansky, Associate Professor of Health Policy and Administration, is exploring the implications that this technology has for health policy, nursing shortages, and patient empowerment.
"There are many practical aspects to telehealth," Dansky explains. "It is playing an important role in filling in some of the gaps in health care, such as better monitoring of chronic illness. For example, someone who lives in a rural area and has had a heart transplant may be very far from doctors, but this technology can help him keep in touch. It has also proven invaluable for patients with diabetes and congestive heart failure."
New telehealth systems have met with rave reviews from program managers, who cited the technology for making nurses' workloads more manageable, enhancing care for both urban and rural patients, and improving the connection between nurses and patients.
"Telehomecare has enriched the climate," one manager says. "Patients love it!"
Another manager credits the program with improving safety for nurses. "Telehealth enabled the nurses to check patients without going out on the roads this past winter."
Telehealth stations allow nurses to check many symptoms and conditions, such as blood pressure, heart rate, blood sugar, and weight. Nurses monitor changes in the patient's conditions over the course of days and weeks and can even have a face-to-face teleconference over the station's screen. Patients are able to use the station when off-line to check conditions at any given time, but they must be on-line to look at changes across time.
"This can also be very empowering for the patient," Dansky adds. "They can check their pulse and heart rate and if it has changed considerably, they can look at their own behavior for what may have caused the change."
Telehealth technology is continually improving, Dansky says. The products are growing more versatile and affordable and the number of vendors creating and providing new technology has increased tremendously in the past few years.
"The technology is in its second generation now, where it can use the patient's regular phone lines," Dansky says. "The early systems required high-power Internet connections that patients often couldn't afford." Dansky predicts that the next generation of technology will be wireless.
Dansky is also examining the ways that telehealth affects health policy issues such as nursing shortages and job satisfaction for home care nurses.
"There is a nursing shortage worldwide that is severe across the United States and critical in Pennsylvania," Dansky continues. "This is an issue for everyone. Can we use technology to increase efficiency so that nurses can help more patients? It can really impact all areas of health policy, including reimbursement for the home health agency and alternative work arrangements that might lead to greater job satisfaction while helping alleviate the nursing shortage."
The technology also creates new avenues to provide health care in assisted living facilities, prisons and schools, where stations can be set up and used by numerous patients.
"We're planning to expand the program to Adult Day Care, the prison system and retirement homes," one program manager adds.
In partnership with the Pennsylvania Homecare Association, Dansky is examining how telehomecare may be used to increase home care nurses' job satisfaction. "No one has really looked at using this technology to increase job satisfaction, but it might really provide a new twist," Dansky adds. We are hoping that, ultimately, nurses will be more satisfied with their jobs and will remain in the workplace longer.
Future directions for research include investigating how using the technology empowers patients. "On the patient side we're looking at how it empowers patients to take an active role in managing their health care," she adds. "We have 80-year-olds in the program who thought they couldn't deal with this, but as they try it and use it, they love it. Telehomecare lets them be in the driver's seat."