According to recent figures from the Centers for Disease Control and Prevention, chronic diseases are the leading causes of death and disability and account for seven out of 10 deaths in the United States each year. More than half of these deaths are due to heart disease, cancer, and stroke. Treatment for patients with comorbid chronic conditions costs up to seven times as much as treatment for patients with only one chronic condition.Emerging evidence supports the feasibility and cost-effectiveness of using home telemedicine monitoring to promote health and chronic disease management.
Clinical telemedicine uses video conferencing, specialty cameras and diagnostic tools such as electronic stethoscopes to connect medical specialists from a medical center to patients in rural healthcare sites. The physician provides assessment and evaluation of new and follow-up patients in a variety of specialties and then sends recommendations to the primary care provider. A specially trained nurse or physician assistant or technician attends the “video visit” with the patient and acts as the physician’s “hands” while using special cameras that allow the physician to visualize and examine the patient as he or she would in their regular clinics office.
Results from a randomized controlled trial by Berman et al. (2012) demonstrated improved health outcomes and cost-effectiveness in high-risk patients with end-stage renal disease using remote technology (RT) for home health monitoring with remote care nurse (RCN) support. Self-assessment procedures used as therapeutic interventions to facilitate behavioral changes and yield positive treatment outcomes have been reported. It has also been suggested by the World Health Organization that the quality of the relationship between patient and healthcare provider (e.g., nurse, physician) is an important determinant of treatment adherence and may promote self-management and better outcomes. Numerous studies report patients face several obstacles (some self-described) in self-management programs (e.g., pain, diabetes, chronic conditions), such as inadequate family support, transportation, pain and fatigue, low self-efficacy, depression, and lack of discipline. Michel Tousignant’s clinical research team also found that high levels of satisfaction with healthcare increase patients’ motivation and treatment adherence.
A national model for telemedicine care and service is realized through Kentucky Telecare housed at the University of Kentucky, Chandler Medical Center. Providing access to patients in rural and underserved communities in Kentucky, the Kentucky Telecare program is directed By Rob Sprang, MBA and has served the Commonwealth since the early 1990s. Kentucky Telecare provides telemedicine clinics that offer services through telemedicine technology for Developmental Pediatrics, Pre-Operative Screening, Post-Op Follow Up, ENT, Dermatology, Endocrinology, Memory Disorder Clinic, Surgical Consultations, Gastroenterology, and Child Psychiatry. Learn more about Kentucky Telecare at this website: http://www.mc.uky.edu/kytelecare/clinical.asp
Sources & Resources
Berman SJ, Wada C, Minatodani D, et al. (2011) Home-based preventative care in high-risk dialysis patients: A pilot study. Telemed J E Health 17:283–287.
Centers for Disease Control and Prevention (2013). Chronic disease prevention and health promotion. Available at www.cdc.gov/chronicdisease/overview/index.htm
Katon WJ, Lin EH, Von Korff M, et al.(2010) Collaborative care for patients with depression and chronic illnesses. N Engl J Med363:2611–2620.
Kung H, Hoyert DL, Xu J, Murphy SL. (2012) Deaths: Final data for 2005. National Vital Statistics Reports. Available at www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10
McCant F, McKoy G, Grubber J, et al. (2009) Feasibility of blood pressure telemonitoring in patients with poor blood pressure control. J Telemed Telecare 15:281–285.
Otani K, Waterman B, Dunagan WC. (2012) Patient satisfaction: How patient health conditions influence their satisfaction. J Healthc Manag 57:276–292.
Tousignant M, Boissy P, Moffet H, et al.(2011) Patients’ satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists’ satisfaction toward technology for post-knee arthroplasty: An embedded study in a randomized trial. Telemed J E Health 17:376–382.
World Health Organization(2013). Adherence to long-term therapies. Evidence for action. Available at www.who.int/chp/knowledge/publications/adherence_report/
Thomas W. Miller, Ph.D.ABPP, Staff Writer
Thomas W. Miller, Ph.D.ABPP, is a Professor Emeritus and Senior Research Scientist, Center for Health, Intervention and Prevention, University of Connecticut and a retired tenured Professor in the Department of Psychiatry, College of Medicine, University of Kentucky