The implementation of telehealth in disease management at patient-centered medical home

Purpose: Telehealth (TH) and video conferencing in the patient-centered medical home (PCMH) can bridge geographical gaps between patients and providers, by eliminating the inconveniences of leaving the house and traveling to appointments. The evidence indicates that TH also: provides clinical benefits in high-risk patients1, improves glucose control2, improves quality of life and reduces ED visits and hospitalizations for patients with COPD3, enables self-care of patients with heart failure4, reduces risk of admission for patients with asthma5, improves medication adherence6, results in potential cost savings7, and provides an opportunity to observe patients in a home environment. The specific aims of this project were the implementation of TH protocol and pilot testing at a nurse practitioner-run PCMH. Methods: Telecommunication equipment was acquired, approved TH software was set up, a clinic-specific protocol was developed including supporting documentation and teaching material. Evaluation was done by testing optimal equipment functioning, acceptance of proposed protocol by the clinic director, and analysis of TH related provider knowledge. Further evaluation included patient satisfaction with TH and the equipment functioning. Results: Optimal functioning of the equipment/software was achieved. Only minor audio technical difficulties occurred when connecting with patients residing in buildings with multiple WIFI users. Protocol and supporting documentation accepted by the clinic. The evaluation survey from the provider educational video demonstrated TH protocol related knowledge. Patients reported satisfaction with the overall TH experience and willingness to recommend it to family and friends. Conclusions: Telehealth services were successfully implemented at a nurse-practitioner run PCMH. Next steps include focusing on specific aspects of chronic illnesses (targeted DM interventions monitoring HbA1C over 6 months). Future study is needed to determine if TH would lead to decreased number of encounters and improved health outcomes for patients of this clinic. Keywords: telehealth, telemedicine, video conferencing, patient-centered medical home. References 1. McLean S, Sheikh A, Cresswell K, et al. The impact of telehealthcare on the quality and safety of care: a systematic overview. PLoS One. 2013;8(8):e71238. 2. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. The Cochrane database of systematic reviews. 2015(9):Cd002098. 3. McLean S, Nurmatov U, Liu JL, Pagliari C, Car J, Sheikh A. Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis. Br J Gen Pract. 2012;62(604):e739-749. 4. Radhakrishnan K, Jacelon C. Impact of telehealth on patient self-management of heart failure: a review of literature. J Cardiovasc Nurs. 2012;27(1):33-43. 5. McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma: a Cochrane review. Cmaj. 2011;183(11):E733-742. 6. Linn AJ, Vervloet M, van Dijk L, Smit EG, Van Weert JC. Effects of eHealth interventions on medication adherence: a systematic review of the literature. J Med Internet Res. 2011;13(4):e103. 7. Polisena J, Coyle D, Coyle K, McGill S. Home telehealth for chronic disease management: a systematic review and an analysis of economic evaluations. Int J Technol Assess Health Care. 2009;25(3):339-349.