Running head: CLINICAL IMPLICATIONS OF TELEHEALTH

ClinicalImplicationsofTelehealth
Chronicconditionsaretheprimarysourceofhospitalizationsandaccountforahigh
percentageofpreventabledeathsintheUnitedStates(CDC,2015).AccordingtotheCDC,
sevenofthetoptencausesofdeathin2010werechronicdiseases,includingdiabetes,chronic
obstructivepulmonarydisease(COPD),andheartdisease.Peoplelivinginunderservedruraland
urbancommunitieshavelimitedaccesstomedicalcare;however,researchhasbeguntoshow
thattelehealthcanprovideeducationenablingthesepatientstomanagetheirdiabetes,congestive
heartfailure(CHF),andchroniclowerrespiratorydisease.Thiseducationreduces
hospitalizationsandmortalitywhilealsoenhancingqualityoflife.Telehealthcanhelpimprove
patientsabilitiestomanagethesechronicdiseasesbyprovidingeffectiveeducational
interventions.However,insurancecompaniesintheUnitedStatesreimbursealimitednumberof
telehealthservices(CenterforTelehealthandEHealthLaw,2011).Theuseoftelehealth
interventionsraisessignificantimplicationsformodernclinicalpractice.Thepurposeofthis
paperistoapplythefindingsfromthefivestudiestoclinicalpractice.
Summaries
Carter,NunleeBland,andCallender(2011)examinedtheresultsofadiabetesself
managementinterventionamonginnercityresidentsandfoundareductioninbodymassindex
(BMI)(33%vs.27%),A1c(24%vs.10%),weight(33%vs.27%)comparedtothecontrol
group.Davisetal.(2010)analyzedtheeffectivenessofusingvideoconferencingtoolsduringthe
provisionofcaretoanunderservedruralcommunityinSouthCarolina.Theinterventiongroup
showedimprovementsintheirglycatedhemoglobin(13%vs.2%)andLDLcholesterollevels
(13%vs.0.6%)comparedtothecontrolgroup.

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Miguel,Smith,andLewin(2013)assessedtheeffectivenessofinhometelehealth
monitoringondecreasinghospitalizationratesamongCOPDpatientsinWesternAustralia.The
interventiongroupwashospitalizedlessthanhalfasoftenasthecontrolgroupand,when
hospitalized,hadshorterlengthsofstay.Venter,Burns,Hefford,andEhrenberg(2012)
evaluatedtheeffectivenessofinhometelehealthmachinesamongruralNewZealandresidents
withCHForCOPDand,foundthathospitalizationforthetelehealthgroupwasreducedby25%
comparedto19%inthecontrolgroup.Welch,Balder,andZagarins(2015)examinedtheclinical
impactofadiabetestelehealthinterventiononanurban,medicallyunderservedcommunity.The
telehealthprogramdecreasedHbA1cby0.6%andproducedan80%meanadherencerateto
medicationintheexperimentalgroup.
ClinicalImplications
Allofthestudiesresearchdesignsdiffered,buttheirauthorscametothesame
conclusion:Telehealthmethodsareeffectiveinaddressinghealthdisparityandinimproving
chronicconditions.Theirsuccessmaybeattributedtothenursingsupportandtothetimelycare
thatpatientsreceivedthroughouttheprogram.Allofthestudiesprovidedstrongevidencethat
thenurseledinterventionsimprovedhealthcaredeliveryandthatthenursesactionscontributed
tothoseimprovements;theymonitoredchronicconditions,managedhealthcareneeds,and
providedpatienteducation.Ifpatientshadabnormalvitalsigns,thenthenurseseducatedthem
onhowtoproperlymanagetheirhealthconditionsandrecommendednutritionalandexercise
strategiestoimprovepatienthealthoutcomes(Carteretal.,2011;Davisetal.,2010;Welchet
al.,2015).Byprovidinghealtheducation,nurseswereabletopreventhealthcomplicationsand

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thusdecreasehospitalization.Becausenursesareusuallythefrontlinehealthcareprofessionals,
theyplayakeyroleinthesuccessoftelehealthmedicine(Carteretal.,2011).
Thesuccessofallthestudiesmayalsobeattributedtotheconstantmonitoringallowing
earlydetectionandfasterinterventioninaddressinghealthproblems.BothMigueletal.(2013)
andVenteretal.(2012)foundthattelemonitoringcanreducepreventableemergencyroom(ER)
visitsandhospitalizations.Telemonitoringisbeneficialinassessingandproactivelymanaging
patienthealth,anditprovidespatientsasenseofsecurityandtrustthattheirhealthstatusisbeing
activelymonitored(Carteretal.,2011;Davisetal.,2010;Migueletal.,2013;Venteretal.,
2012;Welchetal.,2015).Further,telehealthcouldassistpatientsinmanagingtheirhealth
conditionsbetter,reducingtheirneedtogototheER.ThereducedERadmissionratesshouldbe
agoodmotivatortoinvestintelehealth(Steventonetal.,2012).
Carteretal.(2011),Davisetal.(2010),andWelchetal.(2015)establishedenough
evidencetoindicatethattelehealthinterventionscanbeeffectiveinunderservedcommunities.
Telehealthincreasedtheaccessibilityofhealthservicesinthesecommunities.Manypeople
livinginunderservedcommunitiesdonotreceiveregularmonitoringoftheirchronicconditions;
however,telehealthcanhelpbridgethatgap(Carteretal.,2011).Telemedicineiseffectivein
improvingaccesstocare,thuscliniciansservingunderservedpopulationsshouldembrace
telehealthandeducatepatientsonsuchoptions(Carteretal.,2011).
BarrierstoImplicationsandGaps
Whilethestudiesestablishedspecificfindings,eachfacedsomebarriers.Migueletal.
(2013)andVenteretal.(2012)wrotethattheirlengthofstudywasshortduetofunding
restrictions.Inaddition,Carteretal.(2011)explainedthatprovidingthetreatmentgroupwith

CLINICAL IMPLICATIONS OF TELEHEALTH

laptopsandtestingequipmentintheirhomeswasexpensive.However,Steventonetal.(2012)
foundthattelehealthsystemsareeconomicallybeneficialinthelongrun.AccordingtoCenter
forTelehealthandEHealthLaw(2011)geographicalvariationsinreimbursementfortelehealth
interventionslimitstheirpotentialadoption.Alimitednumberoftelehealthservicesare
reimbursedbyinsurancecompanies,andgeographicalandreimbursementconstraintslimitthe
potentialadoptionoftelehealth.UnderMedicaidandMedicare,stateschoosethetypeofservices
andthegeographicareasthatarecovered(CenterforTelehealthandEHealthLaw,2011).The
limitscreatedbythesechoicesareabarrierintheexpansionoftelehealthtomedically
underservedareas(CenterforTelehealthandEHealthLaw,2011).
Althoughtelehealthhassomegreatadvantages,privacyandsecurityrisksaccompanythe
useoftelehealthsystems.HaleandKvedar(2014)explainedthatstandardsshouldbedeveloped
toensureprivacyandsecurityprotectionfortelehealthinformation.Inaddition,theyexplained
thattheFederaltradeCommisionneedstocreatetelehealthprivacyandsecurityregulationsin
ordertoensuretheprivacyofpatients.Wheneverhealthinformationisbeingtransferredonline,
thereisapotentialforhackerstobreachsecuritymeasures(Hale&Kvedar,2014).
Oneofthemaingapsintheseresearchstudieswasthattheresearchersfocusedon
chronicconditionssuchasdiabetes,COPD,andCHF.Futureresearchstudiesshouldexamineif
telehealthcanbeutilizedinoccupationaltherapyorspeechtherapy.Allofthestudiesincluded
patientsbetweentheagesof49and88;futurestudiesshouldexamineiftelehealthcanalsobe
effectivelyutilizedinyoungerpatients.
Recommendations

CLINICAL IMPLICATIONS OF TELEHEALTH

Alloftheresearchersmadeconstructiverecommendationsforextendingthe
effectivenessoftelehealthinterventionsandnotedthatcontinuousmonitoringimprovedpatients
confidence,gavethemasenseofsecurity,andallowedthemtobettermanagetheirhealth
(Carteretal.,2011;Davisetal.,2010;Migueletal.,2013;Venteretal.,2012;Welchetal.,
2015).Thesemethodscanbeappliedtoexistingtelehealthprogramstoprovidepatientsasense
ofcontrolovertheirhealth.Davisetal.recommendedthattelehealthprogramsshouldinclude
motivationinterventionstoimprovebehavioraloutcomesinBMI,weight,andwaist
circumference.Futurestudiesshouldalsoexaminecostbenefitanalysistoseeiftheuseofsuch
systemsmightdecreasenationalhealthexpenditures(Carteretal.,2011;Venteretal.,2012).
Conclusion
Manypeoplelivinginruralenvironmentsandininnercitieshavelimitedaccesstocare
fortheirchronicdisease.Becausetelehealthtoolswerefoundusefulinbothinnercitiesandrural
areas,itislikelythattheywillalsobebeneficialtomanypopulations.Allofthestudies
demonstratedthattelehealthnursescouldworkwithunderservedcommunitiestoimproveaccess
tocareandenhanceoverallhealth.Implementationoftelehealthselfmanagementtoolscould
improveaccesstocareandleadtoimprovedhealthoutcomes.Further,telehealthself
managementeducationandtelehealthmonitoringcanprovidepatientsmorecontrolovertheir
conditionsandthusreducethosepatientscomplications.Becausetelehealthallowspatientsto
havedirectaccesstotheirhealthconditionsandtreatments,itcanalsoincreasetheircontroland
autonomy.

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References
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CenterforDiseaseControlandPrevention.(2015).ChronicDiseases:Theleadingcausesof
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/overview/
CenterforTelehealthandEHealthLaw.(2011).ReimbursementOverview.Retrievedfrom
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