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Telemedicine Outcomes for the Elderly – A Review of Three Studies

Posted by Michael Greiwe, MD | October 17, 2018 |
Michael Greiwe, MD

Telehealth is pushing the boundaries of medicine across specialty areas. Today, the majority of hospitals are using the technology for everything from diabetes education to orthopedic sports medicine; stroke consults in the ER, and home monitoring.

Each of these types of services has studies circulating that document positive outcomes when using telehealth technology. These positive results include reduced overhead costs for doctors and improved patient satisfaction scores. In fact, the majority of patients would consider a telehealth visit.

But what about the elderly patient? While it’s easier to assume that the younger digital native would easily embrace telehealth, how can this technology be used to treat an elderly population? Given that the majority of healthcare costs center around chronic care, can telehealth improve outcomes and costs even in an older population?

This article will review three clinical case studies that report outcomes from using telehealth technology in the chronically ill and older adult population in the United States.

Case Study #1 Remote Monitoring for Cardiac Patients

In 2015, an article was published in Gerontology and Geriatric Medicine called “Examining Older Adults’ Perceptions of Usability and Acceptability of Remote Monitoring systems to Manage Chronic Heart Failure.” As studies go, it was a small one, with just 21-patients over 12-weeks. The patients were all over 55-years old.

The goal was to determine the feasibility of teaching older patients how to self-monitor while using unfamiliar remote monitoring technology. The stakes were high – the challenges of monitoring long-term chronic conditions are well documented. Researchers noted that the aging population often experiences cognitive difficulties and reduced motor skills that can make the introduction of remote monitoring technologies challenging. The study sought to teach seniors and their families better mechanisms for care that would help eliminate some of the inconveniences associated with traveling to the doctor.

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As part of the research, the authors developed a multi-faceted feedback loop for assisting study participants in using technology to monitor their own health. It included individualized technology and healthcare education via telehealth and a written booklet as part of the remote monitoring program. The data collected from participants helped providers offer “tailored guidance to promote self-management behaviors.”

While the use of remote monitoring technology has been generally problematic in older populations, the design of this enhanced support model worked well in this study, prompting researches to note, “the design and testing of RMS (remote monitoring system) platforms to support self-management strategies may potentially enhance chronic HF (heart failure) disease management efforts in this high-risk population.”

Case Study #2 Providing Nursing Coverage for Home-Based Care

A second article published in The Scientific World Journal reviewed the feasibility of providing a virtual house call from a nursing service to elderly adults in their homes. The publication sought to review research from around the globe that tested the quality of care delivery to elderly populations aged 80 or over. Increased life expectancy has necessitated a rise in more costly chronic diseases, and disabilities in these at-risk populations. The paper pointed out that these elderly adults have a reduced ability to care for themselves, increasing the need for care from family members, community nursing, or other healthcare services. The paper sought to explore the use of technology solutions to extend nursing care for home-dwelling elderly patients.

The study compared data from the telehealth virtual visit in these scenarios to the traditional at-home nursing care experience. They found there was extensive data showing that replacing the in-person with a virtual visit with the goal of assessing a patient’s status, monitoring medications, or demonstrating procedures, could provide the following benefits:

  • The virtual visit could provide much-needed social contact in these settings and build trust between caregivers and their elderly patients.
  • These visits also provided needed patient education as part of medication monitoring.
  • The telehealth visit can improve patient satisfaction scores.
  • Some studies showed that telehealth could reduce hospital admissions even in patients over 80.
  • Telehealth greatly reduces overhead costs for nursing care.
  • The biggest challenge was the user-friendliness of the technology for the elderly patient.

The studies authors concluded, “The technology made it possible to deliver continuous and coordinated care, preventing relapses into poor health.”

Case Study #3 Canadians Extend Telehealth to Coordinate Care

A case study released in early 2018 illustrated the innovative ways telehealth can help coordinate care across a multi-faceted spectrum of specialties in the Canadian national health system. The study looked at Ontario’s Health Links Initiative, which seeks to improve care coordination for the provinces’ population of complex and high-needs patients.

Just like in the United States, this targeted population represents an increasing volume of patients that stretch across the country. Like the U.S. the Canadian system suffers from:

Fragmentation within the health care system. Care providers lack the tools needed to easily collaborate with one another and, as a result, silos in patient records and care management are created, putting patient safety and outcomes at risk.

The case study sought to break down these silos and improve care coordination by establishing a network of telemedicine services within the Health Links Initiative. The model allows the patient to meet virtually with a group of inter-professional caregivers, including family physicians and specialists, as well as community service providers. This is all down over a secure telehealth network with the goal of improving communication and breaking down care silos.

The results of this pilot initiative are highly positive:

  • Patient and provider satisfaction was at 97%. Participants stated that they had “increased confidence that the patient’s chronic care will be better managed as a result.”
  • 97% of participating family practice doctors said they “felt hopeful that the patient’s care will improve in the next six months as a result.”
  • 98% would use telemedicine technology again for a case conference.

Telehealth for All Ages and All Specialties

Today, telehealth is being leveraged as a technology to provide care in a variety of settings. The triad of benefits includes increased access to treatment, lowered costs, and improved patient outcomes. Telehealth can be used effectively for populations as diverse as millennials or the elderly, and for everything from workers compensation to chronic long-term disease management.

OrthoLive offers a telehealth application that’s a simple yet effective tool for all types of orthopedic patients. We’d like to speak with you about how telehealth could transform your practice. Contact us.

Topics: "telehealth", "telemedicine", technology, physician, elderly

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