Telehealth on Any Nursing Topic

Scholarly Research Article Review: “Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review”

Introduction

The study in the article “Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review” was carried out by Sarah L. Gorst, Christopher J. Armitage, Simon Brownsell, and Mark S. Hawley. These are highly informed authors who are knowledgeable in their different academic areas of specialization. They are all based at the University of Sheffield, in the United Kingdom.

Gorst is a senior researcher. She has a Master of Science in Research Methods in Psychology from the University of Liverpool. Her population research interests include patient utilization of telehealth, facilitators and barriers to telehealth, and self-management of various long-term health conditions.

Armitage is a professor of health psychology. He was the supervisor of Gorst’s thesis entitled “What predicts end users’ (patients’) acceptance of telehealth?” Armitage has a PhD in psychology. His research interests include telemedicine, telehealth, human behavior change, and relationship between behaviors and attitudes.

Brownsell is a senior research fellow in the University of Sheffield’s School of Health and Related Research. He is a PhD holder who has written more than fifty scholarly journal articles. He has also written some books and book chapters. Brownsell has a longtime experience in telehealth and telecare. He is particularly interested in coming up with evidence-based healthcare practice for older populations.

On his part, Hawley is a senior professor in the area of Health Services Research. He also serves as a hospital honorary consultant clinical scientist. Hawley has a PhD in the field of clinical psychology. Some of his research interests include telecare and telehealth products, assistive technology, and services for the older and disabled persons.

The article was published in the Annals of Behavioral Medicine journal. This is a scholarly peer-reviewed medical journal of the Society of Behavioral Medicine. Springer publishes it on behalf of the society. The journal covers various empirical studies and reviews in the area of behavioral medicine. Its editor-in-chief is called Dr. Christopher France who is based at the Ohio University.

Background and Purpose of the Study

Chronic obstructive pulmonary disease (COPD) and Heart failure (HF) are serious chronic health conditions. They are a burden to both healthcare systems and patients. People suffering from these diseases visit healthcare facilities on a regular basis. Some get admitted to the facilities for long-term care. The cost of treating COPD and HF is high. In the year 2012, it is estimated that the United States used more than $ 50 billion to treat the illnesses (Gorst et al., 2014). Despite this huge cost, it needs to be pointed out that the incidence of the conditions keeps on increasing every year. It tends to escalate with the aging of the population.

Both HF and COPD cause serious impairments in the social and physical functioning of patients. It lowers the quality of life of the patients. This makes it difficult for them to continue with their normal daily life activities. In order to avoid the challenges associated with the treatment of COPD and HF, it has been established that telehealth can help a lot. Telehealth refers to the use of telecommunication and electronic technologies in the delivery of healthcare information and services (Gorst et al., 2014). It is a cost-defective strategy of promoting and maintaining quality care among people who are living with various chronic conditions.

Home telehealth allows remote delivery of health information and services. Healthcare providers can use it to manage and monitor the health condition of a patient who is at home. This is what HF and COPD patients need. Doctors can use telehealth to warn the patients about their health deterioration (Gorst et al., 2014). This can help to prevent the achievement of negative healthcare outcomes. Unlike the ordinary care, telehealth reduces visits to hospital emergency departments and hospital admissions. It also helps to enhance the quality of life and lower mortality rates. The technique as well helps to improve self-care and patient knowledge.

Although some recent researches do not show the benefit of telehealth, policy push for the introduction of the practice in the United Kingdom and Europe is in place. It is thought that the technique can help to improve the lives of people living with long-term health conditions and those who have social care needs (Gorst et al., 2014). The future implementation of telehealth can be influenced by patient acceptance. It is believed that although some patients accept to use the technique, others either refuse or abandon it quickly.

The purpose of the systematic review was to examine the uptake, abandonment, and refusal rates of home telehealth by COPD and HF patients. The review also sought to understand various factors which influence whether the patients do or don’t accept the technique and use it.

Methodology (Research Design, Sample, Data Collection)

The systematic review is in form of a mixed research. It combines both quantitative and qualitative methods of data collection, analysis and interpretations. Quantitative research is concerned with the generation of numerical data which can be used to provide important statistics. It is used to quantify behaviors and attitudes (Sansnee, Johnson & Welch, 2014). In the study, quantitative research is evident in the understanding of the rate of refusal, abandonment and uptake of telehealth among HF and COPD patients. The rate can be presented using numbers. On its part, qualitative research involves understanding underlying motivations and reasons for a given behavior. It seeks to answer questions on “how” and “why” (Sansnee, Johnson & Welch, 2014). In the review, qualitative research is evidence in the study of factors that influence the patients’ acceptance and use or rejection and abandonment of telehealth.

The research design of the study was non-experimental. This is due to the fact that the researchers did not use empirically generated evidence. They only conducted a review of other studies by other authors. During the study, the researchers used Cochrane guidelines. The researchers used various databases to look for relevant literature for their study. The databases used included Cochrane CENTRAL Register of Controlled Trials, PsycInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature. “Chronic Obstructive Pulmonary Disease” and “Heart Failure” were applied as population search terms (Gorst et al., 2014). The intervention terms used included “telehealth,” “telecare,” “telemedicine,” “telehomecare,” “telemanagement,” and “telemonitoring.” The outcome terms applied included “uptake,” “adoption,” “abandon,” “decline,” “refusal,” “reject,” “perceptions,” “beliefs,” “facilitators,” “challenges” and “obstacles.”

During the database search, no date limits were applied. All studies published in any year up the date of the current study were considered. The eligibility for inclusion and exclusion required studies that contained technological interventions in the delivery of healthcare to COPD or HF patients in homes or residential care centers. Telehealth was the basic element of this intervention (Gorst et al., 2014). Observational research, correlation survey research, and randomized controlled trials were included. The same case applied to published conference papers that contained enough data on intervention, population and outcomes. The participants for the study were to be 18 years old and above. However, hospitalized patients were excluded. The same was done to technology based mobile phone interventions.

The review of the literature involved screening of the abstracts and titles of the selected studies. Different pieces of data were extracted from the studies. After this, the collected data was synthesized by taking into consideration the study design, study population, intervention type, uptake, abandonment and refusal rates of telehealth, and facilitators and barriers of the acceptance and sustained use of the intervention (Gorst et al., 2014). The researchers used thematic analysis in order to point out recurrent and important themes in the study. In this case, two themes were identified: The aspects that acted as telehealth facilitators and those ones that served as barriers to the technique.

Results/Findings

The results of the study showed that from the initial database search, a total of 824 articles were collected. 169 articles were excluded as a result of being editorials and dissertations. The abstracts and titles of the remaining articles were subjected to screening (Gorst et al., 2014). This led to the exclusion of 556 articles that failed to meet the inclusion criteria. After obtaining full articles for the remaining articles, 58 more were excluded on the grounds that they did not meet the inclusion criteria pertaining to the study population and the study variables. This led to the selection of 41 final articles that described 37 studies (Gorst et al., 2014). The studies comprised 13 randomized controlled trials, 9 mixed research methods, 8 qualitative researches, and 7 cohort studies.

From the 37 selected studies, 22 involved HF patients, 11 included COPD patients, while 4 entailed patients with both COPD and HF. Study participants’ number ranged between 4 and 420 with a median of 50 and a mean of 78. The participants who were given telehealth were between 4 and 195 with a median of 37 and a mean of 51 (Gorst et al., 2014). The 37 studies contained information about an intervention (a telehealth device) or interviews in which patients shared their perceptions about the telehealth intervention. The interventions in this case included remote transmission of physiological information, assessment of various types of health symptoms, and provision of information about disease.

Participants for the study were recruited form medical centers, hospitals, healthcare databases, and clinics. The recruitments were done through announcements made through emails. From the findings of the study, it was established that 32% of the participants rejected or refused telehealth (Gorst et al., 2014). The reasons for refusal included lack of interests and the feeling that monitoring was not necessary. 20% of the participants withdrew after the commencement of the study (Gorst et al., 2014). The reasons for withdrawal included technical problems, health deterioration, and objection of participants to make use of telehealth devices. 17 studies reported patient barriers to the telehealth intervention. These included preference of in-person care, technical problems, technology anxiety, and the repetitive nature of the intervention. 29 studies reported patient facilitators of the telehealth. These included improved self-care, convenience, increased healthcare access, and promotion of health knowledge.

This study is an important systematic review which examines the rate of the abandonment and uptake of telehealth, and factors that influence patients’ decision to refuse, accept or sustain the use of the intervention. However, it has some limitations that are likely to interfere with the external validity of its findings. For instance, high-quality studies recorded high participant refusal rates (Gorst et al., 2014). This suggests that the selected studies were not of high quality. It is also important to note that the review is based on generalizations. It cannot help one to understand how telehealth would be beneficial to patients who have not been screened for HF, COPD or other chronic diseases.

Application to Clinical Setting and Future Practice (General and Individual)

From the findings of the study, it can be pointed out that the refusal to use telehealth intervention is not dependent on the gender or age of COPD and HF patients. It is rather influenced by other factors and barriers that are applicable to the general population. These include technical problems, lack of interests in the intervention, and technology anxiety (Gorst et al., 2014). There is need for people to be sensitized on the importance of the telehealth mode of delivery of the healthcare services and information. This can help to improve their uptake and sustained use of the intervention for the achievement of positive health outcomes.

            Telehealth is an important intervention in the modern healthcare system. It has helped to transform the nursing practice by making the delivery of healthcare information and services easy. For example, patients suffering from various chronic health conditions can now use telehealth to get health instructions from their healthcare providers. Their conditions can also be monitored using the intervention (Calvo et al., 2014). Despite its importance, telehealth is yet to be fully embraced in the modern nursing practice. This is due to the fact that many people are not informed on the benefits of the intervention. Some nurses also have a negative attitude towards telehealth (Calvo et al., 2014). This contributes to the low uptake and acceptance of the health intervention.

It is important for the future nursing practice to ensure that telehealth is effectively incorporated in the delivery of the healthcare services. The healthcare stakeholders should ensure that they address the barriers to the uptake of the intervention (Calvo et al., 2014). In order to achieve this, there is need to support the facilitators of telehealth. This can help to reduce the abandonment and rejection of the intervention. The findings of the study can help to change the practice of a nursing student. They can enable him to understand the benefits of telehealth (Susskind & Susskind, 2015). From the findings, the student will come to understand the perceptions that people hold about this intervention. This can help him to change his or her negative attitude towards the intervention.

Conclusion

This study demonstrates that telehealth is an important health intervention. It is a technique which makes the delivery of healthcare services and information to chronically ill patients easy. People suffering from HF, COPD, and other chronic diseases can use home telehealth to access health care from their homes and care centers. Their healthcare providers can easily reach them and continuously monitor their conditions. Thus telehealth helps to reduce the cost of healthcare delivery, and it enables patients to achieve positive healthcare outcomes.

Despite being an important intervention in nursing practice, telehealth is yet to be fully embraced. This is due to the fact that the rate of its rejection and abandonment is high. This is mainly due to technical problems, lack of interest, and other barriers. There is need to create awareness about how telehealth promotes the delivery of healthcare information and services. This effort can help to improve the uptake of the intervention and foster its sustained use in the future.

 

 

 

 

 

References:

Calvo, G. S., Gomez-Suarez, C., Soriano, J. B., Zamora, E. et al. (2014). A home telehealth program for patients with severe COPD: The PROMETE study. Respiratory Medicine, 108 (3): 453-462.

Gorst, S. L., Armitage, C. J., Brownsell, S., & Hawley, M. S. (2014). Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review. Ann. behav. Med. 48: 323–336. DOI 10.1007/s12160-014-9607-x

Sansnee, J., Johnson, M., & Welch, A. (2014). Research methods in nursing and midwifery: Pathways to evidence-based practice. South Melbourne, Victoria, Australia: Oxford University Press.

Susskind, R. E., & Susskind, D. (2015). The future of the professions: How technology will transform the work of human experts. Oxford, United Kingdom : Oxford University Press.

 

 

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