Remote Collaboration and Evidence-Based Care
Healthcare advancement is inextricably linked to technological advancement. The evolution and transformation of healthcare are important not only in terms of patient care quality and safety but also in terms of overall healthcare operations. Diabetes mellitus (DM) management has come into focus, particularly with the introduction of telemedical devices that bridge the gap between the patient and the care provider.
However, success with such innovation requires a care team that recognizes the importance of interdisciplinary collaboration in pursuing cost-effective quality and safe patient care (Aldahmash et al., 2019). Taking this into account, this paper aims to propose an evidence-based approach to a patient problem, as well as strategies to mitigate the challenges of interdisciplinary collaboration in the context of remote care.
Evidence-Based Care Plan to Improve Patient Care Quality, Safety, and other Outcomes
It is obvious from an intuition that chronic condition management is costly. The high cost of care may result from the need to purchase and constantly refill medications, the requirement to attend routine clinic visits, the management of complications, transportation to distant primary care clinics, and the expensive tests that are sometimes required. With a focus on type 2 diabetes (T2DM) patients, the following is a proposed telemedical approach to improve glycemic control and reduce complications in the patients.
All T2DM patients on regular follow-up at the primary care facility will be included in the intervention. These patients will be given a gluco-telemeter, a blood pressure (BP) monitor, and a smartphone with free internet access. The intervention will last up to six months to adequately assess the outcomes, with the option of extending it to a year.
Patients will be required to self-monitor their blood glucose (BG) regularly, with the measurement automatically uploaded into the gluco-telemeter and transmitted to the central server at the clinician’s end. At least seven readings per week will be recommended. Similarly, the patient’s BP readings will be automatically transmitted. When the measurements are out of range, the care providers will intervene to make a treatment recommendation. In addition, the assigned care provider will call the patients at least three times per week to educate them on medication adherence, self-monitoring of BG and BP, and lifestyle changes.
Furthermore, a video teleconference will be organized once every two weeks for a real-time live patient-care provider interaction for health education. Patients will visit the clinic every three months for HbA1C measurements, medication refills, and a discussion of their progress. The intervention is expected to improve self-monitoring of BG and BP, glycemia control, and lifestyle, with a significantly lower risk of complications. Moreover, the intervention aims to relieve patients of the exorbitant costs of chronic illness management.
Contribution of an Evidence-Based Model in the Proposal of the Plan
The use of scholarly resources to inform clinical care decisions necessitates knowledge of evidence-based practice models. In a previous assignment, the Ottawa model, an interactive model for translating research knowledge into practice, was proposed. This model provides an easily achievable three major phases of approach implementation, which is why it was chosen.
First, before implementing an evidence-based approach, one must assess the barriers and supports. (Nilsen, 2020). This includes the innovation (telemedical care approach), potential adopters (attitude, awareness, concerns, knowledge, and current practice), and the practice environment (patients, culture, economic situation, structural facilities) (Nilsen, 2020).
Second, with essential steps such as barrier management, follow-up, and actual adoption, the interventions and degree of use are monitored, and the third step includes evaluating the outcomes of the patients, care providers, and the system itself (Nilsen, 2020). The Ottawa model was instrumental in developing the telemedical approach, and all phases will be implemented sequentially without skipping any. The use of a PICO(T) question resulted in a more precise and appropriate finding of articles that informed the proposal of the telemedical approach.
Most Relevant and Useful Evidence in the Research
Following thorough scrutiny of the medical databases and sifting through the sources, the Lee et al. (2020) study on telemonitoring and team-based management of glycemic control in T2DM patients proves to be the most helpful. In its background, the study portrays the effectiveness and usability of telemonitoring among a low-middle income racially diverse population as largely unknown.
This study aims to assess the effects of remote telemonitoring using a team-based approach on low-middle income racially diverse T2DM patients. A 52-week cluster randomized controlled trial was conducted in 11 Malaysian government primary care facilities. The study’s participants were T2DM patients aged 18 and older, residents of Selangor state, and with an HbA1C of HbA1C of ≥7.5%≤11%. The primary outcomes were HbA1C changes at 24 and 52 weeks, while the secondary outcomes included fasting plasma glucose, blood pressure, serum lipids, diabetes self-efficacy, and health-related quality of life.
However, there was no significant difference in the number of patients who achieved HbA1C target levels (<7%) at 24 weeks, at the end of the study (52 weeks), 19.2% (n=23) of the 120 intervention participants and 17.5% (n=21) of the 120-control group achieved target HbA1C levels. The intervention group’s diabetes knowledge, lipid levels, and average fasting plasma glucose were also found to be significantly improved, with the study concluding and advocating for a telemonitoring approach for T2DM patients as an effective and cost-effective method of DM equilibration and management.
Benefits and Strategies to mitigate Challenges of Interdisciplinary Collaboration to plan Care within a Remote Setting
Collaborative practice is essentially a standard feature of modern healthcare operations. It requires professionals from various departments to work in integration to achieve common goals. The advantages are numerous, including improved patient care and outcomes, accelerated system implementation, increased efficiency, and increased staff morale and motivation (Huang et al., 2018).
These advantages are attributed to the collaborative efforts of various professionals, which make goals more achievable. However, achieving an effective interdisciplinary collaborative practice in a remote setting may be difficult. First, it is assumed that network issues will impede the process, yet telemonitoring necessitates the ability to transfer and share data across a telecommunication platform.
Second, patients may lack the knowledge required to operate some telemedical devices, or they may experience power outages, rendering the telemedical devices inoperable (Huang et al., 2018). To address these issues, the primary care facility and interested stakeholders must collaborate on a thorough training on how to use the devices a month before implementation, as well as provide a continuous internet connection and solar rechargeable devices. To successfully implement the proposed care approach, stakeholders must facilitate the process in their capacity to avoid undue strain on patients’ sides in terms of costs and device operations.
Remote care and diagnosis are becoming more popular, particularly among chronically ill patients. The increased demand for remote care stems from the need to promote safety, improve health outcomes, and reduce the financial burden on patients. A prodromal phase of research and locating credible evidence occurs before the implementation of these approaches. This is accomplished through the use of strategies such as the PICO(T) questions and evidence-based practice models such as the Ottawa model. However, all of these system implementation phases are pointless without a strategy for maintaining effective interdisciplinary collaboration.
Aldahmash, A. M., Ahmed, Z., Qadri, F. R., Thapa, S., & AlMuammar, A. M. (2019). Implementing a connected health intervention for remote patient monitoring in Saudi Arabia and Pakistan: explaining “the what” and “the how.” Globalization and Health, 15(1), 20. https://doi.org/10.1186/s12992-019-0462-1
Huang, K.-Y., Kwon, S. C., Cheng, S., Kamboukos, D., Shelley, D., Brotman, L. M., Kaplan, S. A., Olugbenga, O., & Hoagwood, K. (2018). Unpacking partnership, engagement, and collaborative research to inform implementation strategies development: Theoretical frameworks and emerging methodologies. Frontiers in Public Health, 6, 190. https://doi.org/10.3389/fpubh.2018.00190
Lee, J. Y., Chan, C. K. Y., Chua, S. S., Ng, C. J., Paraidathathu, T., Lee, K. K. C., & Lee, S. W. H. (2020). Telemonitoring and team-based management of glycemic control on people with type 2 diabetes: A cluster-randomized controlled trial. Journal of General Internal Medicine, 35(1), 87–94. https://doi.org/10.1007/s11606-019-05316-9
Nilsen, P. (2020). Overview of theories, models, and frameworks in implementation science. In Handbook on Implementation Science (pp. 8–31). Edward Elgar Publishing. https://doi.org/10.4337/9781788975995.00008