Care Managers work with a variety of high-risk patients that have multiple comorbidities. Care management in the transitional care phase, which is post discharge, can be even more difficult when patients do not answer the phone or return calls to care manager. Traditional telephonic care management saw patients answer calls between one to five times over a 12-month period, (Bachtiger, P., Goodman, E., Panch, T., Reidy, P., 2019). In order for care management to be success both the care manager and patient have to be engaged.
This article addresses adding in the intervention of a digital tool. This study added an app that was on the patient’s smartphone or tablet. The app was customized, interactive, and included a daily health check-list for patients (Bachtiger, et. al, 2019). This digital app allowed patients to interact with care manager at a time that was convenient for them. This app also allowed for the education to be patient centered and viewable multiple times as patient desired. This intervention showed improvement in the interaction between care manager and patient. Care managers would send out a median of 10 messages per patient. Patients sent a median of six messages to care managers, (Bachtiger, et. al 2019). Other benefits that were identified through the research was reduction in health care cost, increased patient satisfaction, and clinical outcomes. This is an area that was in the works in my organization but had not yet been utilized. The outbreak of COVID 19 has expedited telehealth and video health in our organization. As a care manager, I have been able to utilize video visits and messaging through patient portals. This is an area that is going to continue to grow and be utilized more regularly. The evidence shows the many benefits of utilization of digital tools to better serve and connect with our patients.
Reference:
Bachtiger, P., Goodman, E., Panch, T., Reidy, P., (2019). Improving Care Management frot Patients with Chronic Disease in a Transitional Care Setting Using Digital Health and Artificial Intelligence. Journal of Managed Care Nursing, 6(2), 4-10. http://aamcn.org/jmcn/JMCN%20V6N2.pdf.
Digital health technologies are definitely in the forefront right now. Utilization of video visits and messaging will likely become more popular not just in case management but in overall patient care. For example, digital health solutions have helped to manage care in cancer patients. Digital health solutions should promote a patient-centeredness framework. The problem of ensuring universal access to care or after care can be challenging for those who live in remote or rural areas distant from cancer centers (Charalambous, A. 2019). The increasing prevalence of cancer contributes to the problem of providing care for those patients. The use of technology has the ability to supplement the limited time for patient report and communication within the confines of the ambulatory care and face-to-face visit (Charalambous, A. 2019). It also holds the potential of real-time communication with the patient and/or family caregiver that allows an immediate assessment and decision-making on appropriate interventions (Charalambous, A. 2019). Health digitization may prove challenging for those who are not digital literate, those who do not own or cannot afford to own the technology, and may contribute to dehumanization. However, digital health has transformed the traditional health care system and will only continue to grow. Digital health solutions provide better access to health information and health services, improve patient care and safety, greater coordination of care, and empower more patients (Charalambous, A. 2019).
Charalambous, A. (2019). Utilizing the advances in digital health solutions to manage care in cancer patients. Asia-Pacific Journal of Oncology Nursing, 6(3), 234-237.
Telemedicine could literally be a life saver for cancer patients during our current COVID 19 pandemic. Patients with cancer are especially susceptible to infections because of systemic immunosuppression, chemotherapy, or recovery from recent surgery. Telemedicine increases access to 24/7 care, increases screening, and reduces dangerous overcrowding of infected and noninfected patients (Greene, Keenan, Letson, Paculdo, Speiss, et Peabody. 2020). Telemedicine allows at risk patients to remain in the safety of their home and maintain care with their oncologist. Congress passing a law that made telemedicine visits reimbursable was a key factor in the increased use of telemedicine during this time. The hope is that telemedicine visits will continue to be a reimbursable charge after the pandemic. Thus, allowing access to healthcare to our most vulnerable populations. In my community we have seen a collaboration between providers and home health. Local home health agencies have provided the technology for patients to complete telemedicine visits. They have also provided the support that a patient who no experience with technology requires for telemedicine. I am encouraged at what telemedicine will provide for patients in the future.
Reference:
Greene, J., Keenan, R., Letson, G., Paculdo, D., Peabody, J., Spiess, P., (2020). Meeting the Challenge of the 2019 Novel Coronavirus Disease in Patients with Cancer. American Cancer Society Journals. DOI: 10.1002/cncr.32919. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32919.
Telehealth services can be a great way to expand healthcare to those who otherwise would not have access. I appreciate that it can be a potential issue for those who are not “digitally literate” as was noted in the first response from ecnavarro. As telehealth has been pushed forth worldwide there are other issues that we will continue to see come about as well. This includes protection of patient privacy. Gopichandran, Ganeshkumar, Dash, & Ramasamy (2020) report that individuals in lower income nations such as India are especially at risk of breaches in patient information that can be collected because of inadequacies in their federal regulations. They describe an incident where patients enrolled in an AIDS treatment program left the program out of fear of privacy infringements, compromising their health rather than promoting health for these individuals (Gopichandran, Ganeshkumar, Dash, & Ramasamy, 2020). I am curious to know if you came across any information on protection of patient data in your research on this?
Gopichandran, V., Ganeshkumar, P., Dash, S., & Ramasamy, A. (2020). Ethical challenges of digital health technologies: Aadhaar, India. Bulletin of the World Health Organization, 98(4), 277–281. https://doi-org.ezproxy.fhsu.edu/10.2471/BLT.19.237123
Telemedicine is a helpful tool for patients. The article that I looked at talked about telemedicine use in psychiatric patients and making sure they are compliant with their medications. If patients are compliant with their medications, it typically decreases the number of patients that are needing inpatient admission. At the hospital that I work at, we use telemedicine for psychiatric care at night time and also neurology 24 hours a day. It is helpful because we are able to get the specialists to see that patients face to face versus having to either transfer the patient or wait for them to come see the patient.
Basit, S. A., Mathews, N., & Kunik, M. E. (2020). Telemedicine interventions for medication adherence in mental illness: A systematic review. General Hospital Psychiatry, 62, 28–36. doi: 10.1016/j.genhosppsych.2019.11.004
I am a case manager for a home health agency for pediatrics and being in contact with the parents can be difficult at times. Using the patient portal is a good way to keep communication and have a place they are able to look at their current care. Telemedicine has also been a great help in continuing to provide services and visits when in person visits are not recommended due to the patient being susceptible to this pandemic at this time.