NURS-FPX4040 Assessment 3 Annotated Bibliography

NURS-FPX4040 Assessment 3 Annotated Bibliography Nursing Informatics in Healthcare Sample Paper

A slew of technological advancements has accelerated in various industries, including healthcare. Whenever the topic of patient care improvement comes up, various solutions aim to integrate technology into care practices. As a result, and in accordance with this discussion, Telehealth-use of information communication technology (ICT) devices in care coordination and continuum (Gajarawala & Pelkowski, 2021) is extensively discussed.

The rationale for this topic is that telehealth, or technology in general, improves patient care and safety by enabling remote access to care services, thereby bridging the gap between care providers and patients. Owing to the Covid19 predicament, and after being challenged to consider new ways of non-physical healthcare delivery, I take a keen interest in the topic.

During the literature search, reputable medical databases such as PubMed, ProQuest, Google Scholar, and the Cochrane library. The literature search strategy included using related search terms like Telehealth, Telehealth in the Covid19 era, Telehealth and care outcomes. As can be seen, Boolean operator search, particularly the ‘and’ operator, was used. An annotated bibliography on the impact of Telehealth on the management of various diseases is provided in the discussion that follows, along with a brief elaboration on the organizational factors that influence the technology’s selection.

Annotated Bibliography

De Marchi, F., Sarnelli, M. F., Serioli, M., De Marchi, I., Zani, E., Bottone, N., Ambrosini, S., Garone, R., Cantello, R., Mazzini, L., & CANPALS Study Group. (2021). Telehealth approach for amyotrophic lateral sclerosis patients: the experience during COVID-19 pandemic. Acta Neurologica Scandinavica, 143(5), 489–496. https://doi.org/10.1111/ane.13373

De Marchi and colleagues conducted a prospective study on patients with a confirmed diagnosis of Amyotrophic Lateral Sclerosis (ALS) to see how Telehealth affects their care outcomes. Despite the fact that ALS is an incurable fatal disease with a median survival of three years (Masrori & Van Damme, 2020), survival and quality of care can be improved by implementing a telemedicine-driven interdisciplinary care team.

ALS patients are typically seen every three months; however, this practice is being challenged by the European Federation of Neurological Societies, which recommends visits based on the patients’ progression. With the Covid19 arriving in the last two years, close monitoring of these patients was difficult due to physical movement restrictions, necessitating an alternative model of care, Telehealth.

19 ALS patients were followed for at least two months and were treated by a multidisciplinary team of specialists, including a neurologist, dietician, psychologist, and physiotherapist. During a video Tele visit with a physician (neurologist), 11/19 patients’ medications were changed, 3/19 were started on antidepressants, 3 /19 on antispasticity medications, 2/19 on antisialorrhea medications, and 4/19 on analgesics.

The ALSFRS-R score decreased from 32.05 at T1 (first month of follow-up) to 28.20 at T2 (second month of follow-up); however, this was not statistically significant, indicating a negligible correlation. On the other hand, the dietician reported an improvement in BMI from 23.76 at T1 to 23.44 at T2 (positive outcome). The psychiatrist reported a significant reduction in anxiety and depression scores, while the physiotherapist reported that the dependency rate changed from severe at T1 to moderate at T2, a positive outcome. De Marchi et al. (2021) concluded that Telehealth driven multidisciplinary care of ALS patients is significantly associated with improvement in quality of life and survival rates.

The technology is relevant to nursing practice in two ways: it provides a frequent-consultation medium for terminally ill ALS patients. It also provides a less-physically interactive media that is appropriate in preventing the spread of emerging infectious diseases such as Covid19. As evidenced by the technology, it enables a multidisciplinary approach to healthcare, as four healthcare professionals (neurologist, dietician, psychiatrists, and physiotherapist) collaborated to provide care to ALS patients.

The Tertiary ALS Center considered availability when selecting technology—they used an online platform, the IoMT Connected Care Platform, that the health informatics team could easily secure and operate. Furthermore, the facility chose a well-trained and committed multidisciplinary team to be in charge of patient follow-up, so employee commitment and experience were also considered.

Golledge, J., Fernando, M., Lazzarini, P., Najafi, B., & G Armstrong, D. (2020). The potential role of sensors, wearables and telehealth in the remote management of diabetes-related foot disease. Sensors (Basel, Switzerland), 20(16), 4527. https://doi.org/10.3390/s20164527

This article provides an overview of the use of technology, specifically Telehealth, in the remote management of diabetes-related foot diseases. Diabetes foot diseases (DFD) are a catch-all term for diabetic foot infections, ulcers, and gangrene. DFD is a significant cause of disability, so prevention strategies are essential.

Because of the high risk of DFD recurrence (approximately 40%), preventive strategies must be implemented as soon as possible. Long-term medical care is usually required to reduce recurrence, necessitating the integration of technological approaches such as sensors, wearable devices, and Telehealth, which reduces the risk of DFD and the risk of Covid19 transmission.

According to the review, the remotely monitored devices target the following DFD prevention and management goals: blood glucose, blood pressures, foot temperatures, plantar pressures, and lipid profile. Wearable devices have proven effective in continuous blood glucose monitoring every 5 minutes for 24 hours, ensuring effective glycemic control and lowering the risk of amputation.

In type 1 diabetes patients, the devices are linked to an automatic insulin pump, which provides automated insulin delivery and thus improves glycemic control. Blood pressure control has also shifted away from traditional inflatable cuffs wrapped around the upper arms and toward novel cuff-less wearable devices that provide repeated blood pressure measurements, allowing for better management. In terms of lipid level control, a low-density lipoprotein sensor has yielded promising results; however, further development and testing are required.

Because medication adherence is potentially associated with lower DFD risks, but most diabetic patients have poor compliance due to costs and regimen complexity, sensors that monitor medication ingestion have been invented. The Proteus Discover, for example, is made up of an ingestible sensor, a wearable patch, a patient’s mobile application, and a provider’s web portal, with information and communication flowing in the order the devices are mentioned.

The mobile app will remind the patient to take the medication as directed. If there is a problem with medication adherence, the care provider will intervene and determine the cause. Integrating various devices for monitoring patients has ensured effective blood glucose monitoring, blood pressure monitoring, lipid, and HbA1C control. As described, the devices’ relevance to nursing provides better ways to closely monitor diabetic patients and reduce DFD risks, which necessitates a multidisciplinary approach involving physicians, dieticians, podiatrists, nephrologists, and others.

Cost is an organizational factor that influences the use of technologies; for example, a glucose sensor costs around $80 and must be replaced at least weekly (Rodriguez-León et al., 2021), so only a few patients can afford them. This publication was chosen because of its relevance and timeliness. Furthermore, it addresses a chronic disease that causes significant morbidity, where well-implemented preventive strategies provide massive risk reduction.

Bhatt, S. P., Patel, S. B., Anderson, E. M., Baugh, D., Givens, T., Schumann, C., Sanders, J. G., Windham, S. T., Cutter, G. R., & Dransfield, M. T. (2019). Video telehealth pulmonary rehabilitation intervention in chronic obstructive pulmonary disease reduces 30-day readmissions. American Journal of Respiratory and Critical Care Medicine, 200(4), 511–513. https://doi.org/10.1164/rccm.201902-0314LE

Chronic Obstructive Pulmonary Disease (COPD) is a long-term illness that causes significant respiratory morbidity. The statistics show that the readmission rate of COPD patients is around 20% (Bhatt et al., 2019). Numerous multidisciplinary interventions, including frequent phone calls, behavioral risk reduction such as smoking cessation, close follow-up, and inhaler training, have been tried to reduce readmission rates.

Pulmonary rehabilitation, which is a set of supervised activities for COPOD patients that includes breathing techniques, health education, and exercise training has been shown to reduce readmission rates by 56% over a median of 9 months after discharge (Bhatt et a., 2019). In this regard, Bhatt et al. (2019) conducted research to determine the impact of an early application of a video Telehealth pulmonary rehabilitation on the 30-day readmission rate following hospitalization for acute COPD exacerbation.

Eighty people were enrolled in Telehealth pulmonary rehabilitation, while 160 people served as a control group (unexposed to Telehealth). The intervention group was given data-enabled smartphones, allowing two-way videoconferencing between the patient and the care provider. The intervention consisted of 36 sessions (stretching, breathing exercises, aerobic exercises, resistance training, and health education) spread out over 12 weeks, with an exercise physiologist coordinating the program.

An automatic blood pressure machine and an oximeter were also provided to measure the heart rate and oxygen saturation before and after the exercises. The results showed that the 30-day all-cause readmission rate in the Telehealth group was lower than in the unexposed group (6.2% vs. 18.1%). Furthermore, 30-day readmissions for acute COPD exacerbations were lower (3.8%) in the Telehealth group versus 11.9% in the unexposed group.

The time to first readmission was also found to be longer in the Telehealth group (235-295 days) compared to 187-233 days in the unexposed group. The results were statistically significant, with a p-value less than 0.05 indicating that Telehealth pulmonary rehabilitation is significantly associated with better outcomes in COPD patients.

This intervention is relevant in nursing practice because it reduces nurses’ burden when caring for patients with chronic diseases, such as COPD. It is also worth noting that without the participation of a multidisciplinary team, the efforts would be futile. The availability, or rather, the cost of acquiring data-enabled smartphones (estimated to be $30 each), as well as policies, as the devices acquired must be HIPAA (Health Insurance Portability and Accountability Act) compliant, are organizational factors that influence the use of this technology. The commitment of the care providers and their expertise determine the success of the intervention. This publication was chosen because it addresses the improvement of care for chronic disease (COPD) with significant respiratory morbidity.

Summary and Recommendation

The three articles analyzed are concerned with the use of Telehealth in the management of chronic diseases such as ALS, diabetes, and COPD. The nature of the interventions and how they are designed are nearly similar in the articles. It should be noted that a multidisciplinary team is involved in providing both pharmacological and non-pharmacological care, forming a full spectrum of chronic disease management. All of the interventions have been shown to improve patient outcomes, implying a greater need for technology integration in healthcare.

It is clear from the discussion that multiple organizational factors influence technology choice. When selecting the IoMT Connected Care Platform, the Tertiary ALS Center, for example, took availability into account. Its ease of use was also considered. During the discussions, the project team’s commitment and expertise were also considered and elaborated on. For example, in the management of ALS, the multidisciplinary team included a neurologist, dietician, psychiatrist, and physiotherapist, all of whom were highly skilled specialists who would ensure the patients’ physical and mental well-being.

Similarly, in the management of diabetes and COPD, a multidisciplinary team ensured the interventions’ success. Another organizational factor considered in the technology selection was policy, as evidenced by the Telehealth pulmonary rehabilitation, which chose a data-enabled smartphone that would enable HIPAA-compliant video conferencing.

The patient outcomes are sufficient proof of the technologies’ effective implementation. Telehealth management of ALS patients resulted in lower BMI, less dependence on caregivers, and lower anxiety and depression scores. Telehealth contributed to better control of blood glucose, blood pressures, serum lipids, and plantar pressures in the management of diabetes.

Furthermore, the integration of Telehealth in the management of COPD showed promising results, as patients’ readmission rates decreased significantly. With a growing body of evidence supporting the use of Telehealth in healthcare, I advocate for greater technological integration across all aspects of patient care.