Discussing Telehealth in Clinical Practice

Specifying a Clinical Problem

A clinical problem of obesity is a global epidemic that prevails mostly in the Western world. In particular, the evidence reports about “641 million adults being obese in 2014 (266 million men and 375 million women) compared to 105 million adults in 1975 (34 million men and 71 million women), as cited in Marcos et al. (2017, p. 3). While it is associated with the excessive weight gain, there are several co-morbidities caused by overweight and obesity, including hypertension, heart disease, diabetes, and many others. In nursing practice, obesity prevention and management refer to the assistance with weight loss, healthy nutrition, and adequate physical exercising. The mentioned interventions may be provided based on patient education and constant monitoring of patients’ health indicators.

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In order to control patients’ body mass index (BMI), physical state, and nutrition, one may suggest that telehealth is an innovative, relevant, and feasible way to apply for nurses. Since obesity requires significant time and efforts to prevent and manage, telehealth services seem to be pertinent to collect, store, and review data about patients. Marcos et al. (2017) consider that obesity needs a specific environment to confirm the effectiveness of interventions and address the identified health problem. It is possible to confidently claim that telehealth is capable of creating such an environment. More to the point, the identified service seems to be beneficial in assisting patients to address their problems with following a certain diet or exercising, as it was prescribed to them. One more weakness of the modern healthcare that can be eliminated by means of telehealth is a lack of knowledge that patients may encounter when they are diagnosed with obesity.

Relating Telehealth and the Clinical Problem

Regarding obesity management, a range of telehealth services may be implemented to assist patients with their health needs. One of the key interventions is keeping track of dieting through a telematic platform and providing timely screening instruments. For example, in the study of Marcos et al. (2017), participants were offered the mentioned platform and the Mediterranean Diet Adherence Screener (MEDAS). The study results demonstrate that BMI evolution, weight loss, and waist circumference (WC) were more noticeable in the intervention group compared to the control group that received traditional care. Accordingly, dieting monitoring may be applied to the community center located in Miami-Dade County as a valuable option for patients who need to reduce and control their weight.

In order to implement the abovementioned intervention in the target health organization, it is essential, first, to prepare the telematic platform and relevant materials, so that patients may easily access and understand information. One may anticipate that patient education will be required before the intervention since many people may be unaware of how to use the identified platform (Marcos et al., 2017). Furthermore, two groups should be selected based on weight indicators showing obesity. While the control group will receive traditional care, the intervention group will be offered telehealth services. At the end of a 6-month intervention, the results of both groups should be compared and contrasted to reveal the effectiveness of the proposed telematic platform to control patients’ nutrition.

Another way that should also be discussed is providing telemedicine videoconferencing within a certain period of time. The modern technology allows practicing a two-way videoconferencing that is useful for patients as they may ask any related questions and receive prompt replies. The recent study conducted in South Carolina revealed that behavioral weight management for overweight and obese patients is an effective tool to enhance their health (Brown et al., 2018). In particular, clinically meaningful weight loss as well as improved self-monitoring were noted (Brown et al., 2018). The importance of videoconferencing also lies in the fact that it is helpful for those living in remote or rural areas with difficult access to health care services. In addition, videoconferencing may be offered to people with physical disabilities that prevent them from visiting care centers.

Considering that the community center located in Miami-Dade County assists Hispanic patients and those with physical disabilities, the implementation of constant videoconferencing sessions for small groups of patients will be rather helpful. Among its positive effects in both short- and long-term periods, one may enumerate more qualitative patient education, reduced weight and BMI, and other decreased obesity indicators. It is also essential to pinpoint that videoconferencing in the given health care organization is likely to create a positive attitude of patients towards their health problem, which will further lead to better health outcomes. In their turn, nurses will receive a feasible tool to manage obesity through monitoring, education, and timely adjustment of related interventions if it is required by a patient’s condition.

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Speaking of videoconferencing implementation as a means of telehealth, one should note that the participation of a multidisciplinary team of professionals may be required. For instance, IT specialists, nutritionists, psychologists, and nurses are to collaborate in order to ensure that patients have the opportunity to receive an evidence-based intervention and learn obesity-related information as appropriate. Based on the existing evidence, one may suggest that the period of 20 weeks with 1-2 sessions per week seems to be pertinent to the needs of patients, who may encounter several barriers with their weight reduction. The team of specialists will be able to address their concerns and guide on the way to the better quality of life.

Discussing Barriers and Solutions

The first potential barrier to implementing telehealth in the mentioned health care organization is technology-specific. Scott Kruse et al. (2018) state that both staff and patients may encounter challenges associated with the proper use of technology, which makes the lack of computer literacy the key barrier. Patients are often reluctant to use telehealth servicers – either due to ignorance of its benefits or because of the inability to work with the computer and other technologies. Many care providers are dependent on the relationships with their patients and do not see any alternatives to personal communication (Scott Kruse et al., 2018). Today, information technologies are able to provide communication with patients at any time, even in the most remote areas. While telehealth services may connect care providers and patients from different areas, both of them need proper training to ensure the best quality possible.

One more significant barrier may be related to resistance to change, and it is also complicated by the high costs of technology (Scott Kruse et al., 2018). The cost of acquiring new telemedicine technologies is one of the main barriers to their implementation along with vaguely defined cost recovery mechanisms in many countries, especially in the United States. The procedures for reimbursement of costs for telemedicine at the federal level in the US are not clearly defined since they vary depending on the state and the type of disease. In some cases, the legal responsibility for the application of new methods scares health care providers, preventing them from moving decisively in a new direction. It is important to stress the fact that the identified barriers adversely affect both care effectiveness and efficiency. Even though these barriers are critical, there are ways to address them.

Staff training and patient education compose the main solution to both of the mentioned barriers. By providing comprehensive and systematic training sessions, it is possible to achieve greater computer literacy and eliminate pitfalls associated with technology use (Scott Kruse et al., 2018). It is possible to assume that 3-4 group meetings will be sufficient to provide the basis for further telehealth services’ use. Telemedicine should be used more often by patients and specialists as a more effective way of doing what was done before, but as a fundamentally new approach to providing medical services.

At the same time, new programs and policies may be developed to compensate for the costs of telehealth based on the ways to reimburse the investments (McGonigle & Mastrian, 2014). For example, providers of health insurance are likely to understand the economic benefits of telemedicine. In the US, telemedicine allows insurance companies to significantly reduce their costs for consultations since online services tend to be cheaper compared to traditional visits. The acceptance and the ease of use are two core elements that should be considered while providing telehealth to patients. With better awareness of technology in care services as well as understanding of its importance, nurses will acquire the opportunity to provide the best care possible. Thus, it is evident that further research is required to determine specific strategies and approaches to implementing the offered solutions into practice.

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References

Brown, J. D., Hales, S., Evans, T. E., Turner, T., Sword, D. O., O’Neil, P. M.,… DuBose-Morris, R. A. (2018). Description, utilisation and results from a telehealth primary care weight management intervention for adults with obesity in South Carolina. Journal of Telemedicine and Telecare, 1(1), 1-8.

Marcos, M. T., Royo, J. P., Carbayo-Herencia, J. A., Domenech, N. R., Presas, J. A., Panisello, E. C., & López, P. T. (2017). Application of telemedicine in obesity management. European Research in Telemedicine, 6(1), 3-12.

McGonigle, D., & Mastrian, K. (2014). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Publishers.

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.

Discussing Telehealth in Clinical Practice
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