Telehealth in Heart Failure Management, Research Paper Example

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Research Paper

Introduction

Heart failure is a very serious condition in which the heart fails to pump enough blood to meet the needs of the body (Wick, 2007). This condition manifests itself in two ways, namely; the heart may not be filled with enough blood, or the heart may fails to pump blood to all parts of the body with enough force. Both problems may occur in some people while some people may manifest only one problem. The term heart failure at most cases confuses many people, the term does not mean that the heart of an individual stops or is about to stop working completely. However, it is a serious health [problem the need medical care. This paper will discuss heart failure as a serious health issue and provide a detailed explanation on telehealth in heart failure management. Most importantly, this paper will provide the benefits of telehealth in management of heart failure and cutting the costs there off.

Overview of heart failure and its current issues

As the pumping system of the heart grows weaker and weaker, heart failure develops gradually over time. This problem affects either the right side of the heart only or both sides of the heart. In most cases, the condition involves both sides of the heart. Heart failure of the right hand side occurs when the heart cannot pump blood to the lungs to pick up needed oxygen by the body. While left –side heart failure occurs when the heart cannot pump enough oxygenated blood to the rest of the body. Mostly, right-side heart failure may lead to fluid buildup in the feet, ankles, liver, abdomen, neck veins and legs (Wick, 2007).

In addition, right side heart failure may cause fatigue and breathe shortness which is both dangerous conditions which may cause one to faint or collapse abruptly. Heart failure is caused primarily by the diseases that damage the heart like, coronary heart disease, high blood pressure and diabetes. The problem has become common with around 5.8 million people in the US suffering from it. Heart failure attacks both children and adults but symptoms and treatments differ from each other. The condition manifests itself in children differently from the way it manifests itself in adults and it is treated differently depending on the age of the patient i.e. child or adult (Wick, 2007).

Presently, there is no known cure for heart failure although use of certain medicine and changes in lifestyle can make people with the condition to live longer and actively participate in life activities. Because this condition is on the rise currently, researchers are working tirelessly to study and invent new ways of treating it and the complications attached with it. Effective and innovative approaches are really required to improve individual self-care and improved health outcomes for the affected people (Hebert, Korabek, & Scott, 2006)

Statistics: number of individuals diagnosed with heart failure

Emory Healthcare,( 2011) provides that in every 34 seconds a person in the United States of America dies from a heart disease. 2500 Americans dies from heart diseases each day. Other reports reveal that, every 20 seconds a person in the United States contracts a heart disease/ suffer from a heart6 disease. In summary, at least 250,000 people die from the heart disease/ heart failure annually before they reach hospital for medication. Emory Healthcare,( 2011) Research reveals that almost, 6 million hospitalizations every year is due to cardio vascular disease. Each year, about 670, 000 people get diagnosed with the condition and die within one year from diagnosis. In 2006, heart failure was the contributing cause of 282, 754 deaths in the United States.  In 1020, heart failure cost the US $39.2 billion for medication, health care services, and lost productivity (Whitten, & Mikus, 2007).

Symptoms of heart failure include:

  1. Shortness of breath
  2. Trouble in breathing when lying down or asleep.
  3. Gain in weight and swelling of the legs, ankles and lower back.
  4. General fatigue and weaknesses.

Earlier diagnosis of this condition can improve the quality of life and mortality rate of people suffering from heart failure (Whitten, & Mikus, 2007).

Health care cost – current cost associated with heart failure

Emory Healthcare ( 2011) suggests that heart failure imposes great economic burdens and greatest expenditure occurs in treating and managing the problem. Studies on full financial impact of heart failure were unveiled in 1990. Those studies reveal that the cost of managing heart failure amounts to about 1-2% of the total health care expenditure. Hospitalization is the most costly with about 2/3% of the total health care cost consumption (Emory Healthcare, 2011).

The costs associated with heart failure are usually high because of the components of expenditure considered in establishing formal heart failure service. For instance, cots must be allocated for administration and office space equipment, specialist heart failure nurses, cardiologists and other key health care professional, staff training, clinic equipment, travelling costs, communication, investigational and monitoring costs, data management, auditing of key outcomes like morbidity and mortality and patient booklet. Across all the continents, there are substantial, up-front costs associated with their establishment of heart failure health care service.

The real cost depends on the type of intervention undertaken and the number of patients managed without forgetting the expertise of the staff and variations of health care costs locally. For instance in UK it was estimated that 70 million pounds could be used to mange heart failure in the year 2000 (Wick, 2007).

Definition of telehealth

Grigsby (2004) urges that Telehealth is the delivery of health services via telecommunication technology such as, internet, video conferencing and /or internet. Health care professional are working hard to develop telehealth treatments for many diseases including heart failure especially for people in rural areas who have inadequate access to healthcare (Grigsby 2004). Telehealth is an innovative and effective approach to improving individual health care, self care. It helps patients to follow a plan of care which culminates to improved health care and better quality of life.

Thesis statement or objective of the study

The purpose of this study is to explore telehealth in heart failure management in improving management and controlling the cost. As earlier highlighted, heart failure is a very serious and chronic illness that requires treatment which is complex for a long period of time. Over time, self-care has been a big problem for the large the population of victims of HF without a better innovative and effective approach. The development of telehealth has made it possible for individuals with HF to follow a plan of health care so that they improve their health and better their quality of life. Ideally, the use of telehealth in heart failure care and management has   enabled self-care (Grigsby 2004).

Heart failure disease management: Standard or traditional heart failure management

Heart failure is a chronic illness that needs appropriate care and management. The development of telehealth has played a big role in improving self-care and individual management. Patients of heart failure are increasing greatly which results in hospitalization. This ends up costing a lot to the patient due to rising costs of hospital treatment and affects the hospital by reducing the bed space hence poor health management services (Wick, 2007). The current care is inadequate and especially with traditional care management which is not well structured to prevent acute happenings in patients with chronic heart failure. Research provides that there are tremendous advances in the understanding of heart failure pathophysiology and development of efficacious therapies however, the quality of care for patients with HF is still suboptimal. Traditional model of care is associated with frequent hospitalization due to episodic encounters, and little attention to common modifiable factors that result in much hospitalization. McAlister, Lawson Teo et al (2001) provides that proper care management can reduce hospitalization of HF patients by 2/3 this will be made possible if patients adhere to their prescribed drugs, diet regimen and seeking earlier treatment for escalating symptoms. Traditional management of heart failure also result in poor discharge planning, haphazard follow ups after discharge, lack of patients social support systems, and it fails to address patients cognitive impairments, low income, depression and other co-morbidities that  exposes them to rehospitalization.

Because traditional care seems to be inadequate for most heart failure patients standard care based on technology forms the best innovative and effective alternative healthcare delivery model (Steinberg, Lipton, Eckhart, Goldstein, Sullivan, 2011).. The standard model of care delivery is categorized into two either, heart failure special clinics or home based interventions. The above heart failure management categories are multidisciplinary and involve the use of a variety of components that can include drug optimization therapy, constant follow ups after discharge, and earlier identification of patient problems that may lead to heart failure exacerbations.

Great number of heart failure disease management programs has demonstrated positive care outcomes. Research suggests that patient who is cared for by this programs experience remarkable fewer rehospitalization, incur, lowered healthcare costs, and enjoy better quality of life. Heart failure specialty care includes counseling and education (McAlister FA, Lawson FM, Teo KK, et al 2001).

Wang, Zhang, Ayala, Wall, & Fang, (2010) provides that Patients of heart failure encounters several problems or issues, which results in poor care management. The issues include poor patient compliance; In this case patients fail to comply with drug prescription rules / guidelines. This is likely to lead to patient decompensation and rehospitalization and the need to re-stabilize the patient or death of the patient.  Often when patients are discharged from hospital and fell a little bit well they do not need to take so many tablets leading to non-compliance to prescription (Wang, Zhang, Ayala, Wall, & Fang, 2010).

Another issue associated with heart failure care management is lack of support. Research suggests that Patient s with heart failure requires constant social and medical support. This will enable them to manage the condition and be able to cope with the side effects of the disease. Poor social Support systems increase the patients’ risk of earlier rehospitalization and death. Therefore in heart failure management, it is important that the patients are provided with social support to decrease the negative outcomes.  Social support ranges from providing the patients with financial support, adequate access to healthcare personnel, reception of constant follow ups, and assistance in psychological conditions. When the patient misses the above support, anxiety and depression raise tremendously leading to rehospitalization and worsening of the condition (Wang, Zhang, Ayala, Wall, & Fang, 2010).

Third issue associated with heart failure patient care management is lack of education.  Majority of the people are not informed about the effects and caused of heart failure.  This ignorance causes many people indulging in activities like smoking and over eating that accelerates the risk of contracting the disease. As well the patients are not fully informed on the need for self care and as a result they fail to follow the physician’s prescription and guidelines. Lack of knowledge of the disease has made the management and treatment of the disease very difficult.

Telehealth interventions on heart failure management

Heart failure management has been revolutionalizing in the past few decades and a number of interventions have been proposed and researched by many scholars. One of the most innovative and effective interventions which is hailed by many is telehealth intervention. Telehealth intervention on heart failure entails the use of telecommunication technology to provide exchange of information for diagnosis, treatment, and delivery of clinical care when at a distance .telehealth in heart failure management plays a very important role and through telehealth, patients have been able to receive improved care and quality services (Hjelm, 2004). the benefits associated with telehealth include; improved access to information, provision of care which was not previously deliverable, improved access to services and increasing delivery of care, improved professional education, reduced health-care costs and  improved quality of screening  programmes.

Hjelm (2007) suggests that, telemedicine can improve access to information for health professionals, patients and the general public. For the case of heart failure, patient’s information can be sent via mail or advanced telecommunication systems to health professionals, and care givers in case the patient conditions change abruptly.

Telehealth also provides valuable information to patients about heart failure prognosis, the reasons for checkups, and the effects of any medical treatment. Once the patients have been informed it becomes very easy for the health professional to have shared decision making with the patient hence easy management and care. As well, information provision to patients empowers the patients and encourages self care/ self help. Many heart failure patients are hospitalized due to the severity of the condition, this makes the hospital cost to be very high for the patient and the hospital as well. Telehealth intervention for heart failure patients helps in reducing the hospitalization a rehospitalization costs. This is because it has potential to restructure fundamental health care delivery ways. It enables redistribution of resources from the hospital environment into primary care and finally home patient care delivery.

Telehealth intervention in heart failure enables quality control and screening programmes. This helps all the test centers to give reproducible results over a long period of time. The use of telecommunication methods for distribution of the results make it faster in delivering the results of the disease than traditional quality control programmes.

Telemonitoring

Telemonitoring is ma medical practice that involves monitoring of f patients who are far from the medical care provider (Grigsby, 2004). With this practice, patients are provided with a number of monitoring devises at home, to monitor the patient’s medical results and the results are sent to the health care provider via telephone, internet or mails. this is one of the best convenient method patients use top avoid travelling costs and do basic work of healthcare themselves. Maric, Kaan, Ignaszewski, & Lear (2009) suggests that Heart failure patients need active social support and after discharge visits. Incorporation of telemonitoring devises for heart failure patients provides a better method of reducing unnecessary rehospitalization and promotes self care from home. In case on any emergency the information about the patients health is sent very fast to the healthcare provider who will responds as quickly as possible.

Given that telemonitoring devices keep track of blood pressure, heart rate, weight, blood glucose and hemoglobin, it is easy for the home care agencies to keep track of heart failure causes and provide a remedy or intervene accordingly. Telemonitoring will give information about vital signs when the patient is in a location with monitoring equipment at his/her location. Depending on the severity of the condition of the patient, the health provider is able to monitor the statistics daily or weekly to ascertain the best intervention or the most appropriate course of treatment (Maric, Kaan, Ignaszewski, & Lear, 2009)..

Integration of telehealth with the traditional heart failure management

Frank, Wandell, Headings, Conant, Woody, and Michel (1997) provides that treatment of heart failure patients accounts to about 79% of the US health care spending.  This cost poses a great challenge for Medicare and insurers in trying to manage the spending and care. There are multiple factors that have been identified as barriers to provision of healthcare management. The barriers to best management programs are associated with traditional methods of heart failure patient management. The integration of telehealth with traditional heart failure management forms a very good blending which promotes heart failure management and quality of life. Development of better system based approaches to improving heart failure care management, profession of education and technology incorporation forms the basic process of integrating conventional heart failure management and telehealth.

Benefits of telehealth in heart failure management

Hjelm, (2007) provides that Telehealth in heart failure management has the following benefits;

It enables the health professionals, patients and the home care agencies to get improved access to information. The information can be received either through telephone, telemonitoring machine or internet at a faster rate.

It enables the provision of care that was nor previously deliverable. Patients can be served from home instead of travelling to hospital for re hospitalization. Patients can also participate in self health care due to proper monitoring of their condition. This was not previously there with traditional heart failure management (Elford, 1997).

Telehealth provided improved access to services and the increasing care delivery due to advanced technology and good telecommunication devises. The patient blood pressure, heart rate can be monitored from home a necessary actions are taken by the health care provider without the patient needing to travel to hospital. Thus telehealth helps in reducing unnecessary hospitalization.

It provides improved professional education. The patient’s diagnosis, Prognosis and condition is analyzed and provide to the patient or other healthcare providers. This provides a very good ground for the patient and the health professional to share about the condition of the patient hence management becomes easier (Coulter, Entwistle , Gilbert)

It provides reduces health care costs. Hospitalization costs, transportation and rehospitilization costs are reduced significantly with this method of heart failure management inter venation. This intervention reduces the rate of patient re-admission hence saving the health care expenses to be incurred by the government and the patient as well (Hersh, Helfand, Wallace, et al.2001).

Recommendations

  1. health care professionals to embrace telehealth in improving heart failure management service delivery
  2. Education should be provided to the general population about the causes of heart failure and the possible ways of preventing it.
  3. Information about the patient heart failure condition must be provided or made available to patient. This will foster managed care sharing and it will help in decision making.
  4. More research to be done to determine the efficacy or cost effectiveness of telemedicine applications. This will help in evaluating any telehealth applications properly.
  5. Healthcare workers to be informed of their role and status to avoid fear of implementation of telehealth devises as a means of out facing them from work.
  6. Telehealth to be technologically updated to avoid its obsolescence due to rapid technological advances.

Conclusion

From the foregoing it if evident that  telehealth has the potential of augmenting conventional methods of heart failure health care provision so that high quality of care is  made available to everyone. Telehealth can achieve this important healthcare management goal by principally increasing access to information by improving its exchange all over the health care pyramid. telehealth  intervention in traditional heart failure movement  will provide high quality services and this will reduce the death rates as result of heart failure as well as reduce  enormous health care costs incurred in taking care of hospitalized heart failure patients. The benefits of telehealth as pertaining to heart failure management are many and substantial (Chen, Kalish, & Pagan, .2011). However, more research is needed so that the draw backs accompanying telehealth are eliminated or reduced.

Reference

Chen, H. F., Kalish, M. C., & Pagan, J. A. (2011). Telehealth and hospitalization for medicare home healthcare patients. The American Journal of Managed Care, 17(6), e224-e230.

Coulter A, Entwistle V, Gilbert D. Sharing decisions with patients: is The information good enough? Br Med J 1999;318:318–22

Elford DR. (1997) Telemedicine in northern Norway. J Telemed Telecare 1997;3:1–22

Emory Healthcare,( 2011) Heart Failure Statistics.. Available at: http://www.emoryhealthcare.org/heart-failure/learn-about-heart-failure/statistics.html.

Frank AP, Wandell MG, Headings MD, Conant MA, Woody GE, Michel C (1997). Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation. Arch Intern Med;157:309–14

Grigsby B. (2004) TRC Report on US Telemedicine Activity. Kingston, NJ: Civic Research Institute, Heart Failure Disease Management Improves Outcomes and Reduces Costs http://www.innovations.ahrq.gov/content.aspx?id=275

Hersh WR, Helfand M, Wallace J, et al.(2001) Clinical outcomes resulting from telemedicine interventions: a systematic review. BMC Med Inform Decision Making 2001;1:5

Hjelm NM. (2004) Will Telemedicine Run? Hospital Management International Yearbook. London:International Hospital Federation, SPG Media, 2004:32–3

Hjelm,N. M. (2007). Benefits and drawbacks of telemedicine. Journal of Telemedicine and Telecare. 2.

Maric, B., Kaan, A., Ignaszewski, A., & Lear, S. (2009). A systematic review of telemonitoring technologies in heart failure. European Journal Of Heart Failure, 11(5), 506-517.

Wang, G., Zhang, Z., Ayala, C., Wall, H. K., & Fang, J. (2010). Cost of heart Failure-Related Hospitalizations in Patients Aged 18 to 64 years. The American Journal of Managed Care.

McAlister FA, Lawson FM, Teo KK, et al (2001). A systematic review of randomized trials of disease management programs in heart failure. Am J Med. 2001;110(5):378-84.

Steinberg AG, Lipton DS, Eckhardt EA, Goldstein M, Sullivan VJ  (2011). The diagnostic interview schedule for deaf patients on interactive video: a preliminary investigation.

Whitten, P., & Mikus, M. (2007). Home telecare for COPD/CHF patients: outcomes and perceptions. Journal of Telemedicine and Telecare

Hebert, M., Korabek, B., & Scott, R. E. (2006). Moving research into practice: A decision framework for integrating home telehealth into chronic illness care. International Journal for Medical Informatics.

Wick L. (2007) St. Mary’s Duluth Clinic Heart Center Heart Failure Program. PowerPoint presentation. Accessed December 14, 2007.

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