Research Evidence of the Effectiveness of Telehealth
The practices of telehealth refer to the provision of healthcare services on a distance (Schlachta-Fairchild, Elfrink, & Deickman, 2008). This term can be used along with or replaced by such terms as telenursing and telemedicine. In that way, searching for the relevant research and evidence concerning the practice of telehealth must include all of these variations of the name. The body of research exploring the effectiveness of telehealth practices is substantial and concerns many different fields such as mental health, pediatrics, maternal care, chronic diseases, and long-term care, among others (CADTH, 2016).
The American Telemedicine Association (ATA) specializes in the collection of data and research as to the effectiveness of practices in this sphere. Currently, the ATA has a sufficient body of information that confirms the cost-effectiveness of telehealth for both the care providers and the patients (American Telemedicine Association, 2015). Namely, the researchers find that the telehealth models can adequately support the primary care practices and reduce the pharmacy and medical costs of the treatments, reduce the number of admissions to the hospital; in addition, telemedicine was reported to improve the patient experiences and overall treatment outcomes (American Telemedicine Association, 2015).
In particular, the study by Salisbury et al. (2016) demonstrated the effectiveness of telemedicine in depression and anxiety treatments and showed a higher response rate to this type of treatment. However, the research by Dixon (2016) that also involved the depression patients showed that the cost-effectiveness of the telemedicine approach was low due to the consumption of the practitioners’ time and the comparatively low gain in QALY. The evidence collected by NHS (n. d.) presented the results of home telemonitoring of the patients with diabetes, COPD, and heart failure and showed that in all three conditions, telemedicine helped reduce mortality and hospitalization rates significantly.
As a result, a conclusion may be made that telemedicine is a somewhat practical approach when applied to mental health conditions, chronic diseases, and long-term health problems. The primary positive effects for public health were the reduction of the mortality rates and hospitalization cases, thus reducing the hospitals’ costs. However, the time and effort spent on the provision of distance care are some significant factors that reduce the cost-effectiveness of the telehealth models.
Challenges Faced
Even though telemedicine is widely recognized as an effective, innovative approach that can strengthen primary and preventive care, it has a number of disadvantages. Practicing telemedicine, medical professionals are likely to face versatile challenges. For example, my experience of the telemedicine model was complicated by the fact that it targeted mainly the elderly population and required the use of the Internet (emails) and telephone connection. The problem was that almost none of the patients had regular access to the Internet or knew how to use the computers. Telephone communication was complicated by the fact that many patients had hearing and memory issues, and the likelihood was high that the patients would either misunderstand, misinterpret, or forget the information provided over the phone.
My personal impression was that telemedicine approaches that target the patients of age are far more effective when they include the caregivers (family members of close people), and the instructions are provided to the latter as well as the patients in order to ensure appropriate supervision. The report by O’Connell (2015) supported this point of view and provided evidence that the supervision was critical in the telehealth models based on self-assessment, daily questionnaires, and home testing.
In addition, there are many ethical questions that apply to the use of telemedicine when the monitoring and supervision are provided by the people who are not licensed medical professionals; some of these issues involve the acquisition of confined agreement to undergo procedures, and the appropriateness of the inclusion of untrained people in such activities as collecting and handling the medical test results (O’Connell, 2015). In other words, telemedicine may save costs to healthcare institutions, but it is also likely to cause a decrease in morality.
Another personal observation to add to this report concerns the importance of the stable connection between the medical personnel and the patients. Its meaning has been established and confirmed as a factor that improves patient experience, treatment response, and trust between the patient and the medical professionals. Telemedicine attempts to limit the in-person contact of the two parties and is likely to lead to the loss of trust and alienation of the patients (Hjelm, 2005).
Telehealth as an Alternative to Face-to-Face Practice
By nature, medicine, first and foremost, relies on the results of testing and assessments. As specified by Singh (2016), in some areas of health care, the results collected by telehealth methods can be equal in terms of their precision to the ones collected during a face-to-face assessment. However, many of the assessments cannot be conducted by the patients autonomously or by their caregivers.
In particular, such tests involve the use of complex equipment that requires that a professional or a specifically treated person operates it. In this aspect, face-to-face care is more beneficial. Besides, even though such methods of data collection as questionnaires that can be equally misleading when a patient does not disclose full information, during an in-person assessment, the medical professional can rely on their individual perception of the patient’s behavior and body language and detect whether or not the truth is being told. In this aspect, the advantage is also on the side of face-to-face medicine.
However, the studies show that telemedicine can be effective in the form of primary care, prevention strategies, and follow-up treatments (Gulla, 2013). This form of care allows the medical professionals to monitor a larger number of patients and provide a deeper and more thorough level of care the stretches out beyond the clinical settings.
To conclude, the results of efficiency and cost-effectiveness of telehealth differ depending on the area where it is applied and the type of care that is provided on distance. Basically, the results are controversial because, in different fields, the practices show different results. More research is required in order to find out which areas are more and less compatible with this form of care.
References
American Telemedicine Association. (2015). Research Outcomes Telemedicine’s Impact on Healthcare Cost and Quality. Web.
CADTH. (2016). Telehealth: Summary of Evidence. Web.
Dixon, P., Hollinghurst, S., Edwards, L., Thomas, C., Foster, A., Davies, B.,… Montgomery, A. A. (2016). Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial. British Journal of Psychiatry Open, 2(4), 262-269.
Gulla, V. (2013). Telehealth Networks for Hospital Services: New Methodologies. Hershey, PA: IGI Global.
Hjelm, N. M. (2005). Benefits and drawbacks of telemedicine. Journal of Telemedicine and Telecare, 11(2), 60-70.
NHS. (n. d.). Telehealth for patients with long term conditions. Web.
O’Connell, P. (2015). Advantages and Challenges to using Telehealth Medicine. Global Journal of Medical Research, 15(4), 19-22.
Salisbury, C., O’Cathain, A., Edwards, L., Thomas, C., Gaunt, D., Hollinghurst, S.,… Montgomery, A. A. (2016). Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomised controlled trial of a complex intervention. The Lancet Psychiatry, 3(6), 515-525.
Schlachta-Fairchild L., Elfrink V., & Deickman A. (2008). Patient Safety, Telenursing, and Telehealth. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (pp. 135-145). Rockville, MD: Agency for Healthcare Research and Quality.
Singh, N. N. (2016). Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities. New York, NY: Springer.