The utilization of telehealth technologies is gaining momentum due to medical staff shortages as well as the recent pandemic situation. Clearly, it is critical to identify the exact outcomes of the use of these services in diverse populations and settings. Discharged patients often violate medication regimens and exhibit inappropriate disease activity, which leads to readmissions, negative patient outcomes, and financial losses for the healthcare system (Song et al., 2020). The purpose of the present study by Song et al. (2020) was to examine the impact of a telehealth educational intervention aimed at ensuring proper disease activity and medication adherence in rheumatoid arthritis patients who had been discharged. The significance of this study can hardly be estimated as it contributes to the exploration of various effects of the use of telehealth services in patients with a particular health issue.
The study design was the unblinded randomized controlled trial aimed at evaluating the outcomes of a 12-week educational intervention provided to patients by telephone and concerned with disease activity and medication adherence after hospital discharge. The study took place in a tertiary care hospital in Chengdu (China) in 2015. As to the sampling method, all eligible discharged patients with rheumatoid arthritis were invited to participate. The inclusion criteria were age (older than 18 years old), confirmed diagnosis, Chinese language proficiency, being discharged from hospital and willing to take part in the study. Excluding criteria included hearing impairment, severe mental disorder, no access to the telephone, and participation in other interventions. Out of 117 patients, 25 were excluded (twenty people) or refused to participate (five people). The overall number of participants was 92, with a mean age of 55.54. The drop-out rate was 16.3% as 15 patients (5 from the intervention and group and ten from the control group) withdrew from the study.
The sampling method is justified as the researchers attempted to explore particular attitudes of patients with arthritis. In order to implement a randomized control study, it was important to ensure the involvement of as many people as possible. Researchers attempted to engage all patients who had been discharged to elicit as large a scope of data as possible. The inclusion and exclusion criteria were also relevant as the focus was on a specific group of people in terms of their health status, age, and social status.
In order to assess the variables, the researchers utilized valid and reliable instruments. The Chinese version of the Compliance Questionnaire Rheumatology (CQR) was employed to analyze patients’ medication adherence. This tool is widely used in the clinical setting and clinical research and has been validated in several studies mentioned by Song et al. (2020). The Chinese form of CQR exhibited 0.847-point validity. The disease activity score was measured with the help of Disease Activity Score 28 and such physical evaluation as C-reactive protein test and erythrocyte sedimentation rate (Song et al., 2020). The authors mentioned that the combination of these tools had been employed in other studies and their validity was found sufficiently high.
In order to compare the differences in variables between the two groups, the following statistical analysis tools were employed by Song et al. (2020): Chi-square test, t-test, Mann-Whitney U test. The continuous variables were measured with the help of median and means, while categorical variables were presented by percentages and frequencies. These instruments validated in numerous studies are appropriate for the present research as they enabled the researchers to analyze the variables and address the research question.
Demographics data are not characterized by a high degree of heterogeneity. The majority of patients (71.4%) were females and had no medical insurance (74%). Due to the small sample size, the generalizability of the data is not high. In further studies, it is important to make sure that people admitted to different facilities across the community and country take part in the research. It is important to pay more attention to gender and makes sure that approximately 50% (compared to over 70%) are females.
The results of the study suggest that the educational intervention is effective as patients’ medication adherence was significantly improved. However, the program left patients’ disease activity almost unchanged, so the corresponding changes should be made. Song et al. (2020) shed light on the reliability and validity of the used tools, stating that the methods utilized had been checked in various studies that had been conducted earlier.
The authors noted their study’s limitations and implications for research and practice. As to the limitations. Song et al. (2020) stated that the primary weaknesses include the small sample size and the focus on a single tertiary care facility. The authors also claimed that the long-term effects of the educational program should be evaluated as well. Finally, the researchers mentioned that in addition to quantitative data, it is important to analyze medical workers’ and patients’ attitudes towards the intervention.
This study has a considerable value for nursing practice and research as it provides insights into the effects of an educational intervention delivered by telephone on some of the most relevant aspects, patients’ medication adherence. The use of telehealth is inevitably expanding and being accommodated to the needs of patients in various areas. Therefore, it is critical to make sure that this technology can be utilized effectively in different clinical settings. This study also unveils some gaps to be addressed in further studies.
Reference
Song, Y., Reifsnider, E., Zhao, S., Xie, X., & Chen, H. (2020). A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients.Journal of Advanced Nursing, 76(5),1172-1181.