Assessing the Problem: Technology Care Coordination and Community Resources Considerations
Current healthcare training incorporates informatics courses or similar programs into the curriculum to equip healthcare practitioners to optimize the use of technology in patient management. In today’s world, when technology adoption is at its peak, the healthcare industry has risen to the challenge of adopting numerous technologies and using them to improve patient care.
As healthcare technology becomes more popular, the responsibility of orchestrating operations, developing an effective care coordination strategy, and leveraging community resources grows. To reduce this load, baccalaureate nursing training should design a comprehensive curriculum that teaches nurses about healthcare technology and correct methods of establishing successful care coordination.
The goal of this paper is to analyze how technology can be used to address a patient’s health problem (hypertension), explain how care coordination and utilization of community resources may be beneficial, and analyze how nursing practice standards and/or organizational or governmental policies may impact the use of healthcare technology in addressing the patient’s problems.
The Impact of Healthcare Technology on the Patient
Technology offers a revolutionary management strategy to people suffering from hypertension, a disease that requires lifetime treatment. Mr. JM, a long-distance truck driver with hypertension for the last three years and compliance concerns with both pharmacological and non-pharmacological therapies, is the patient whose condition necessitates remedy.
The patient, who cites the high cost of his medications as the reason for non-adherence, as well as distance or rather an itinerant lifestyle as the reason for missing outpatient appointments every three months, would benefit from a low-cost technology that ensures non-physical patient-provider interaction. Telemedicine, which integrates different types of technology to provide treatment to patients in remote locations, is unquestionably an evidence-based practical option for the patient.
Telemedicine is perhaps the most researched healthcare technology as a feasible approach for chronic illness management. This strategy has various benefits as an approach to hypertension management. Telemedicine provides a long-term and lasting connection and engagement between the patient and healthcare practitioners, circumventing all of the difficulties that may come from the requirement for in-person encounters (Omboni et al., 2020).
Furthermore, with telemedicine-facilitated health education, the patients’ attitudes, health behaviors, and self-management skills increase, resulting in improved hypertension treatment. Telemedicine innovations increase the demand for professional communication, information exchange, and decision support, hence encouraging multidisciplinary collaboration. Moreover, telemedicine allows for the provision of treatment to a larger population beyond the hospital’s vicinity, and in the age of Covid19, decreases the chance of transmission of the dreadful infectious disease.
Telemedicine-facilitated health education, monitoring of patients’ vital parameters, and consultations have been linked to better blood pressure reduction and an increase in the proportion of patients meeting blood pressure management targets. In addition to hypertensive patients, telemedicine interventions are effective in certain special demographic groups, such as people with both hypertension and diabetes.
Omboni et al. (2020) include a summary of four randomized control studies in which hypertensive patients with diabetes comorbidity were placed in an intervention group receiving telemedicine coupled with nurse or clinician management, and according to the findings, the patients achieved greater reductions in blood pressure, hemoglobin A1C, and LDL cholesterol.
An additional benefit is that telemedicine interventions are relevant in all healthcare settings, including community and primary care settings, and may be employed across all socioeconomic groups, including low, medium, and high-income groups.
While telemedicine interventions offer various benefits, they also have drawbacks and limitations. In the age of telemedicine, the declining quality of the patient-provider physical relationship cannot be overlooked. Because of the absence of personal contact between the patient and the physician, it may be difficult to execute critical interventions on the patients, such as focused cardiovascular examinations, resulting in missed diagnoses (Hwei & Octavius, 2021).
Furthermore, patients with age-related sensory deficits, such as poor eyesight or hearing, may have difficulties utilizing the different telemedicine equipment. Technological faults in measuring or transmitting data may potentially jeopardize the utilization of telemedicine approaches.
Telemedicine poses a danger to healthcare practitioners’ employment and may lead to them being seen as simple technicians (Hwei & Octavius, 2021). Telemedicine raises payment concerns for hospitals since reimbursement may only cover some components of the intervention. A detailed examination of the pros and downsides is therefore required before implementation.
Although various studies have shown telemedicine to be a beneficial method in the treatment of chronic illnesses, there are multiple barriers to its implementation. First, although there are various technologies on the market, none serves as a benchmark model for standardizing the deployment of telemedicine in health care (Omboni et al., 2020).
Second, the initial purchase of equipment, maintenance of computer gear and software, and assuring security are all costly, limiting the use of telemedicine treatments in resource-limited situations (Scott Kruse et al., 2018). Third, poor informatics skills, resistance to change, hatred for technology, and insufficient awareness of the therapeutic efficacy of telemedicine are key cultural hurdles to telemedicine intervention implementation (Omboni et al., 2020).
The fact that the majority of the systems are not interoperable and that there may be difficulties with the privacy and confidentiality of patient’s health information may limit physicians’ trust in the use of telemedicine therapies.
Care Coordination and the Utilization of Community Resources in the Management of the Patient
Nurses have the responsibility to develop an effective care coordination plan while performing clinical tasks and holding positions of leadership. According to Anderson and Hewner (2021), patient care coordination refers to a concerted effort by healthcare practitioners to organize patient care, share information, and make choices that aim to satisfy patients’ needs and preferences. Mr. JM’s management would benefit from two primary methods to care coordination: technology and collaboration.
The telemedicine approach, which is a multifaceted intervention, demands effective teamwork in which members are aware of their responsibilities. Breckenridge et al. (2019) conducted a pre-post analysis in which data from two large waiver-funded care coordination projects from two urban hospitals were compared to data from patients served at two comparison hospitals to determine the impact of patient care coordination on hospital encounters and related costs.
According to the statistics, the hospital encounters of patients who got waiver-funded care coordination services reduced by 0.85 encounters over the year (Breckenridge et al., 2019). Furthermore, the fewer hospital contacts associated with the waiver-funded care coordination plan resulted in a $1550 per patient per year cost savings (Breckenridge et al., 2019). A multidisciplinary team (physicians, nurses, health informatics team, pharmacists, nutritionists, community health workers, and preventive healthcare experts) that is aware of their duties is critical for the intervention’s effectiveness.
Utilizing community services and partnerships with many community stakeholders is critical to achieving the expected outcomes of telemedicine. There is a plethora of programs, equipment, and initiatives available in the community that may be utilized to encourage positive health behaviors.
Community recreation facilities, such as football playgrounds, swimming pools, gyms, and cycling resources, encourage physical exercise, a non-pharmacological strategy for hypertension control. In a systematic analysis, Pescatello et al. (2019) discovered that low to vigorous-intensity activities reduce incident hypertension in adults with normal blood pressure by 2 to 5 mmHg systolic blood pressure and 1 to 4 diastolic blood pressure.
In the same systematic analysis, Pescatello et al. (2019), the blood pressure response to physical exercise is as follows: The decreases in systolic blood pressure varied from 5 to 17 mm Hg, whereas the reductions in diastolic blood pressure ranged from 2 to 10 mm Hg. Additional community resources, such as point-of-decision signage or reminders like “use the stairs instead of the elevator,” encourage physical exercise, supporting a healthy lifestyle devoid of chronic ailments.
What I observe in practice, where patients with chronic, so-called lifestyle diseases are urged to participate in non-pharmacological interventions, the majority of which involve lifestyle interventions, is consistent with the research supporting their roles in chronic illness management.
While care coordination and the use of community resources are advantageous in the treatment of hypertensive patients, they confront major challenges that may impede their successful use. Individuals may have a skewed sense of the relevance of physical exercise, causing them to overlook lifestyle change as a non-pharmacological therapy and prevention of hypertension (Bhandari et al., 2021).
Furthermore, the persistent belief and trust in traditional medicine impede the best possible utilization of community resources. Individually, financial restrictions may be a barrier since coordinating treatment is expensive, and people may find adhering to non-pharmacological therapies, such as rigidly adhering to a set diet every day for a lifetime, rather expensive.
At the community level, there may be insufficient community health workers to successfully execute a workable care coordination strategy, and stigma associated with chronic illness deters progress with hypertension control (Bhandari et al., 2021). The lack of coverage of health promotion in mainstream media, such as radio and television, may also contribute to the barriers to effective care coordination and community resource utilization.
State Board Nursing Practice Standards and/or Organizational or Governmental Policies Associated with Healthcare Technology, Care Coordination, and Community Resources
Various regulatory and policy issues must be addressed to guarantee the safe use of telemedicine in the treatment of hypertensive patients. Hardware and software capable of measuring patients’ vitals and interpreting and providing a diagnosis are among the components of telemedicine and are therefore categorized as medical devices.
Telemedicine devices must be created, evaluated, and approved by regulatory bodies. This is particularly true for health apps, which have been renamed fitness or wellness products to circumvent the regulations. In Europe, the EU Regulation 2017/745 specifies how medical software fulfills health regulatory and validation criteria (Omboni et al., 2020).
The Food and Drug Administration rules are used in the United States to guarantee that a device fits the regulatory definitions (Omboni et al., 2020). These laws guarantee that telemedicine equipment fulfills the criteria required for providing safe and quality treatment and that they are also effective platforms for avoiding patient extortion in healthcare.
Although telemedicine may traverse national borders, medical licenses cannot. As a result, the United States intends to impose unique legislation requiring physicians to give telemedicine services to patients residing in foreign nations. In the United States, 12 states foresee a special license that permits doctors to practice beyond state borders for telemedicine alone, whereas 6 states foresee physicians registering if they desire to operate across state lines (Omboni et al., 2020).
Because telemedicine includes data gathering and sharing, precautions are required to secure patients’ protected health information. As a deferral policy, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 comes in useful with its privacy regulations. Telemedicine developers are required to comply with privacy standards to maintain the integrity of the user’s health data.
Over the years, professional groups and regulatory bodies have examined the ethical issues related to telemedicine and telehealth. Consent and autonomy are two issues that often raise concern. The following questions must be considered to guarantee an effective informed consent process: how effectively is the patent informed, how effective are the consenting processes, and what options does the patient have? (Kaplan, 2020).
Participants in telemedicine must consent to the intervention, and the significance of the consent must be evaluated in light of family and community pressures, as well as difficult-to-understand privacy policies. Furthermore, telemedicine treatments must be capable of offering beneficence as an ethical concept by providing education and personalized care as needed (Keenan et al., 2021).
To guarantee justice in the use of telemedicine, physicians advocate for equitable access to telehealth technology and for balancing the demands of the individual with the requirements of the larger community (Keenan et al., 2021). However, due to huge gaps in access to technology, securing justice might be difficult at times.
Compliance with HIPAA security protections is critical to avoid breaches of privacy and confidentiality of patient’s health data to avert damage or to achieve nonmaleficence as an ethical standard (Keenan et al., 2021). These ethical standards may influence the quality and efficacy of healthcare services; hence healthcare providers must strive to satisfy them at all costs.
Conclusion
The application of technology greatly benefits the treatment of chronic illnesses. Adoption of technology had even stalled, notably during the Covid19 period, when there was a pressing need to continue with care procedures without physical touch between patient and physician.
Telemedicine, which employs information and communication technology to offer treatment, health education, and monitor patients’ vital data, is likely the most widely used technology in the Covid19 age. Numerous studies support telemedicine as an effective solution for improving treatment quality and patient safety and lowering healthcare costs for both the system and the person.
While it is effective, achieving the expected outcomes of telemedicine requires a multidisciplinary team as well as the utilization of community resources. In today’s world, when diseases emerge entirely as a consequence of poor lifestyle choices, using community resources to achieve health promotion and preventative measures is important.
References
Anderson, A., & Hewner, S. (2021). Care coordination: A concept analysis. The American Journal of Nursing, 121(12), 30–38. https://doi.org/10.1097/01.NAJ.0000803188.10432.e1
Bhandari, B., Narasimhan, P., Vaidya, A., Subedi, M., & Jayasuriya, R. (2021). Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change. BMC Public Health, 21(1), 1524. https://doi.org/10.1186/s12889-021-11548-4
Breckenridge, E. D., Kite, B., Wells, R., & Sunbury, T. M. (2019). Effect of patient care coordination on hospital encounters and related costs. Population Health Management, 22(5), 406–414. https://doi.org/10.1089/pop.2018.0176
Hwei, L. R. Y., & Octavius, G. S. (2021). Potential advantages and disadvantages of telemedicine: A literature review from the perspectives of patients, medical personnel, and hospitals. Journal of Community Empowerment for Health, 4(3), 228. https://doi.org/10.22146/jcoemph.64247
Kaplan, B. (2020). REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19. International Journal of Medical Informatics, 143(104239), 104239. https://doi.org/10.1016/j.ijmedinf.2020.104239
Keenan, A. J., Tsourtos, G., & Tieman, J. (2021). The value of applying ethical principles in telehealth practices: Systematic review. Journal of Medical Internet Research, 23(3), e25698. https://doi.org/10.2196/25698
Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., Logan, A. G., Magid, D. J., Mckinstry, B., Margolis, K. L., Parati, G., & Wakefield, B. J. (2020). Evidence and recommendations on the use of telemedicine for the management of arterial hypertension: An international expert position paper: An international expert position paper. Hypertension, 76(5), 1368–1383. https://doi.org/10.1161/HYPERTENSIONAHA.120.15873
Pescatello, L. S., Buchner, D. M., Jakicic, J. M., Powell, K. E., Kraus, W. E., Bloodgood, B., Campbell, W. W., Dietz, S., Dipietro, L., George, S. M., Macko, R. F., McTiernan, A., Pate, R. R., Piercy, K. L., & 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*. (2019). Physical activity to prevent and treat hypertension: A systematic review: A systematic review. Medicine and Science in Sports and Exercise, 51(6), 1314–1323. https://doi.org/10.1249/MSS.0000000000001943
Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare, 24(1), 4–12. https://doi.org/10.1177/1357633X16674087
Assessing the Problem: Technology Care Coordination and Community Resources Considerations Instructions
In a 5-7 page written assessment, determine how health care technology, coordination of care, and community resources can be applied to address the patient, family, or population problem you\'ve defined. In addition, plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you\'ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during the second 2 hours of your practicum.