Evidence-Based Practice Telemedicine Sample Paper
Introduction
Technology in medicine has made it possible for healthcare providers to remotely diagnose and treat patients. Other factors such as reduced mobility due to diseases and chronic conditions have advanced the case for telemedicine. Evidence-Based Practice help nursing practitioners to make effective decisions concerning the healthcare services provided to patients. EBP is a critical part of nursing practice because it ensures the use of up-to-date information and technology to diagnose and treat patients within and outside the healthcare settings. There are numerous technologies used for diagnosing and dispensing medicine remotely such as remote patient monitoring video and technologies, and store and forward technologies. In America, up to 95% of Americans own cell phones while 77% have access to smartphones (Cristancho-Lacroix et al., 2017; Ng, Alexander & Frith, 2018). These devices are being leveraged to increase access to medical care and boost health outcomes. This paper is an evaluation of community-based clinic utilizing virtual telemedicine in helping diabetic patients with uncontrolled diabetes
Methods/PICOT
The purpose of this study was to develop an assessment, control, and monitoring criterion for evaluating telemedicine outreach compared to a telephonic outreach. The study also aimed at developing the appropriate pharmacologic treatment plan for the remote monitoring of patients through telehealth technologies. Being the most common chronic disease in the US, diabetes remains a dangerous chronic disease that affects millions of people across America and Canada (Sipes, 2017). This study contains a comprehensive description of what diabetes is, its causes, and the best pharmacology treatment for the disease.
Research methodology refers to the process of collecting data and analyzing the data. This process shows how data was collected, the methods used for collecting data, and how data is interpreted to give it meaning. For this particular research, data was obtained from two sources, i.e. primary sources and secondary sources. The research aims to find out if a virtual telemedicine outreach in comparison to a telephonic outreach with a case manager does influence diabetes control over 6 months period. Thus, the PICOT question is: In primary care patients with uncontrolled diabetes (A1c>9%) how does virtual telemedicine outreach compare to a telephonic outreach with case manager influence diabetes control over the next 6 months?
Primary Sources
The research aimed to get a first-hand account of how telemedicine changed the lives of patients particularly those who have reduced mobility. The best way to get this information was by conducting an extensive interview with the selected participants to find out their experiences (Ledford, 2018). From the research materials provided, some studies were conducted through online surveys, interviews, and others were done through quasi-experiments. The surveys and the experiments captured all the pertinent areas that the study sought to cover concerning telemedicine. Interviews were done in the participants’ natural environment which gave the researchers a good opportunity to observe how telemedicine works and its impacts on patients. The interview questions consisted of open-ended questions as well as some sections with multiple answers. A total of twenty women working in the oil and gas industry were interviewed in this research. This interaction with the participants was particularly helpful to the research because researchers were in a position to identify any biases on the part of the respondents as well as any weaknesses in the research. Apart from getting a first-hand account of the respondents, the researchers also got valuable opportunities to observe the participants in their natural living environment which helped in shaping the direction of this research work.
Secondary Sources
Apart from using primary sources of data, many of the research articles being studied also relied heavily on secondary sources of data. Secondary sources of data such as scholarly books, articles, journals, and periodicals were integral sources of information for providing background information on telemedicine (Fletcher, 2017, p. 181). Many of the works being studied relied on previous scholarly studies and experiments done in this area. The importance of relying on previous literary work on telemedicine is that these materials gave background information on telemedicine. By analyzing secondary sources, the researchers were able to identify the areas that have not been covered regarding the issue of telehealth/telemedicine use in patient treatment and management. By dwelling on areas that have not been covered in the available literature, the researchers were able to give a new and different perspective to the study of telemedicine that has not been explored before by other studies.
Research Design
Research design is a detailed account of how the research is carried out. It entails how data was collected, the instruments used in the process of data collection, how these instruments will be deployed or put to use, and how the data collected was be analyzed. Since all the articles being studied are qualitative research, more than one research design method was used in the collection and analysis of data. The research design methods used in this study are ones that best captured the scope and goals of each study. From the articles, there are two fundamental questions that the studies seek to give solutions to through research design (Fletcher, 2017). The first question is about what is happening (descriptive research) and why is it happening (explanatory research) (Ledford, & Gast, 2018). The descriptive part of the research is concerned with what is going on, which in this case is the impact of telemedicine on health outcomes. This part gives an in-depth analysis of the situation by describing it in great detail. For example, this part seeks to find out if telemedicine has any impact on health/patient outcomes. To accurately and effectively capture the experiences of the participants, the phenomenology research method was employed. Phenomenology is the process of investigating and studying people’s personal experiences to get a detailed account of the issue being investigated (Department of Veterans Affairs, 2018). To give valid meaning and interpretation to the experiences of the participants, going out to the field to collect information was crucial to the process of data collection.
The other research design method employed in this research is the case study. The case study is a research method that uses an up-close and detailed study of the subject of discussion. Using a case study in research was important because it helped researchers narrow down the scope of the research. This research method was chosen for two major reasons. One of the advantages of this research design method is that it is comprehensive. This method offers a holistic review approach to the study, unlike stand-alone research methods which only give snapshots to a study. A case study allows researchers to use an array of tools in single studies, which means researchers have space and time to come up with a detailed background to a study (Marczyk, 2017). Secondly, a case study is critical because it reduces biases. Case studies allow researchers to approach a study from different perspectives rather than from a single view which limits the researcher’s options (Creswell, & Creswell, 2017). Approaching a research study from many perspectives gives researchers a deeper understanding of the subject matter. The research articles for this study were done through interviews, online surveys, and experiments. The answers received from the said respondents contained lived experiences as well as personal experiences which puts into perspective the phenomenon of telemedicine.
Findings
The overall finding from the sampled studies is that virtual visits and treatment were beneficial to people with mobility problems. Overall, virtual visits were less effective compared to in-person visits, however, virtual visits enabled more frequent patient engagement compared to in-person visits. Another advantage presented by the virtual visit is that there was a high level of patient satisfaction. Concerning providers, there was an overwhelming consensus that telemedicine is a critical tool in diagnosing and treating patients especially now that there is a need for social distancing and curfews on mobility due to the COVID-19 pandemic (Smart et al., 2021). Out of the 141 scheduled in-person visits, 120 were done through virtual AD visits. This is equivalent to a 74% retention rate for the diabetes patients being monitored.
Secondly, telemedicine leads to better patient outcomes. Patient monitoring, diagnoses, and treatment have a direct impact on a patient, the intervention method chosen, the treatment plan, the provision of quality care, and the overall outcome. Through CPRS, the chances of medical errors are very minimal because of the accuracy it confers in capturing patient data. Further, CPRS promotes interprofessional cooperation of different health professionals which improves the quality of care given to patients. This project (CPRS) can improve patient safety, precision in diagnosis, communication, and overall effectiveness of patient care. For example, in the past, the facility that I am proposing this project to has witnessed a few cases of patient misdiagnosis due to incorrect capture of information, or other factors. In one case, the hospital misdiagnosed a patient with Parkinson’s disease when the patient was suffering from a case of a traumatic head injury.
Diabetes patients require frequent observation because of the nature of the disease. There is a high level of efficacy and feasibility in using telehealth to monitor and treat diabetes patients. For example, through telemedicine, the majority of participants greatly improved in terms of taking medicine. The monitoring tools alerted them when to take medicine and when the situation changed so that immediate care is taken before things got out of hand. Out of the 17 particular diagnoses, no differences were observed in the labs ordered (Wang et al., 2020). However, two of the diagnoses indicated some differences in images ordered. Additionally, there were four recorded differences in the prescriptions (Jabour et al., 2017). The overall observation was that more labs were recorded (0.16 virtual, 0.33 in-person p<0.0001) as well as in the images ordered (0.07 virtual, 0.16 in-person, p<0.0001) for in-person visits (Lyer et al., 2021). These differences were major because of the general medical exam visits that the patients had to do physically. There was also the issue of repeat visits that became necessary after the initial in-person visits (19% virtual, 38% in-person, p<0.0001) (Horrell et al., 2020). From the experiment, 10 out of 17 diagnoses indicated differences in the frequency of visits modalities. Visits for both diabetes (5.3x, p<0.0001) and anxiety (5.1x, p<0.0001) were much more frequent in the virtual conditions.
Strengths and Limitations
From the reviewed studies, the major strength is that the researchers succeeded in proving the efficacy of telemedicine. Based on the findings, adequate evidence was adduced to prove that telemedicine plays a critical role in improving health outcomes especially for patients with mobility problems. However, the major weakness of telemedicine is that it is still less effective compared to in-person visits. This is because in-person examination and diagnoses of patients are still the best way of accurately assessing patients and prescribing treatment. However, the research shows that telemedicine is mostly effective for follow-up where an initial in-person visit had been done.
Another limitation of the review is that it does indicate the differences between labs ordered in virtual visits and in-person visits. For instance, the study by McGonigle (2017) showed that there are increased orders for in-person visits for tests and diagnoses among diabetes patients (McGonigle, 2017). Further, the research indicates that there were no differences between prescriptions, lab, and images produced in in-person visits and virtual visits. This is contradictory because, in the conclusion section, the researchers conclude that many patients still preferred in-person visits because it is more efficient compared to virtual visits. While it may be difficult to subjectively deduce the reason for the observe disparity, it is likely that preference for in-patient visits is a factor of access to telemedicine technology, doubts on the reliability of such technology or simply the need for physical interaction with the care provider.
Discussion of Conclusions Drawn from the Review
Caring for people with diabetes disease is costly as one hundred percent of cases of advanced diabetes end up in death since there is no cure for the disease. Over five million Americans and thirty-five million people worldwide have diabetes disease which means that all of these people require some form of caring whether formally or informally. Caring for people with Diabetes is one of the difficult tasks and yet most people do not even have basic information on how to take care of people suffering from the disease.
While this study appears inadequate in the area of statistical power which could pose problems of efficacy to the research, I believe that this research has been successful in providing an alternative method for providing information and education to caregivers of people suffering from Diabetes, especially the informal caregivers. Drawing from previous findings, I believe this study has successfully demonstrated that online facilitation of caregivers can help them to acquire functionalities such as personalization, flexibility, socialization, and dynamism which are all important qualities in a caregiver given the stress levels associated with diabetic patient care. Furthermore, the researchers conclude that there was very limited acceptance of the online Diapason program by caregivers which is a pointer to the fact that the program needs to be rolled out in a structural manner that allows the caregivers to be able to interact with other professionals as well as the broader online community.
The articles analyze the efficacy and acceptability of web-based educational and telehealth programs intended for informal caregivers to people with diabetes using methods of research analysis. The studies asserts that there is a substantial growth in the aging population which has also seen cases of dementia and diabetes grow to the astronomical figure of 35.6 million people annually (Mosier, 2017). All of these people require round-the-clock care just to get by. By the year 2012, Diabetes Association indicated that over 12 million caregivers gave more than 17.5 billion hours of care (unpaid) which was equivalent to USD 216 billion (Mosier, 2017). Presently, majority of people with diabetes are cared for at home by their relatives which has also seen the emergence of chronic stress in such caregivers.
Summary
The best method for determining the impact of evidence-based practice clinical guidelines is through scientific measurement of patient outcomes. The implementation of EBPCG works best when it is practiced by both nurses and patients. The impact factor, in this case, is measured based on the number of citations present in the research or paper. In this work, such metrics provide a reliable and effective method of measuring the impact that clinical guidelines have on scientific research on evidence-based practice. However, the AHA and ACC point out that the growth of analytical tools used in harvesting information from online databases has helped the research on evidence-based practice clinical guidelines to take a multi-disciplinary approach such as sociological approach, scientific approach, structural approach, and technological approach.
References
- Cristancho-Lacroix, V., Wrobel, J., Cantegreil-Kallen, I., Dub, T., Rouquette, A., & Rigaud, A. S. (2017). A web-based psychoeducational program for informal caregivers of patients with Diabetes disease: a pilot randomized controlled trial. Journal of Medical Internet Research, 17(5).
- Creswell, J. W., & Creswell, J. D. (2017). Research design: A qualitative, quantitative, and mixed method approaches. Sage Publications.
- Horrell, L. N., Hayes, S., Herbert, L. B., MacTurk, K., Lawhon, L., Valle, C. G., & Bhowmick, A. (2021). Telemedicine Use and Health-Related Concerns of Patients With Chronic Conditions During COVID-19: Survey of Members of Online Health Communities. Journal of Medical Internet Research, 23(2), e23795.
- Department of Veterans Affairs. (2018). Lean processes cut wait time. Accessed 24th March2021 From https://www.research.va.gov/pubs/varqu/fall2016/16.cfm
- Jabour, S. M., Chander, G., Riekert, K. A., Keruly, J. C., Herne, K., Hutton, H., Beach, M. C., Lau, B., Moore, R. D. & Monroe, A. K. (2021). The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS and Behavior. https://doi.org/10.1007/s10461-021-03175-2
- McGonigle, D. (2017). Nursing Informatics and the Foundation of Knowledge. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781284142990/ https://doi.org/10.1016/j.outlook.2008.09.010