telemonitoring of older people

Telemonitoring of older people

Roger Watsonwww.slideshare.net/RogerWatsonPhDRNFAAN

Telemonitoring: the idea is not new

Terminology

• Telehealth• Telemedicine• Telemonitoring• Teleconsultation• Telenursing• Telepharmacy• Telephysiotherapy

Telehealth

Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.

Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

Telehealth

Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.

Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

- telephone

- videoconference

- internet

Telemedicine

Telemedicine is the direct provision of clinical care, including diagnosing, treating, or consultation, via telecommunications for a patient at a distance.

Telemonitoring

Telemonitoring is the ongoing assessment of a condition—in particular cardiac arrhythmias and/or other objectively measurable indicators of disease (e.g., heart failure)—by sensors attached to the patient, signals from which are ported wirelessly to a central station or “node” where abnormalities will trigger a response by healthcare workers

Telemonitoring

Telemonitoring is the ongoing assessment of a condition—in particular cardiac arrhythmias and/or other objectively measurable indicators of disease (e.g., heart failure)—by sensors attached to the patient, signals from which are ported wirelessly to a central station or “node” where abnormalities will trigger a response by healthcare workers

- this implies a one-way process

Telemonitoring

Telemonitoring is the ongoing assessment of a condition—in particular cardiac arrhythmias and/or other objectively measurable indicators of disease (e.g., heart failure)—by sensors attached to the patient, signals from which are ported wirelessly to a central station or “node” where abnormalities will trigger a response by healthcare workers

- this implies a one-way process

- but it cannot work without a response!

Telehealth

Relationship between telehealth, telemedicine & telemonitoring

TelemedicineTelemonitoring

Teleconsultation

Teleconsultation

Teleconsultation is a general term for any consultation between doctors or between doctors and patients on a network or video link.

- The response to telemonitoring can be a teleconsultation

Why use telemonitoring?

• The technology exists

• Economies of scale

• Convenience (staff/patients)

When would you use telemonitoring?

• Remote geographical areas

• For people who may have problems attending clinics– Older people– Prisoners– Military

What are the potential problems?

• Lack of technology

• Technophobia

• Suspicion about surveillance

• Fragility of links (eg Skype/Facetime)

What can be telemonitored?

• Vital signs

• Mobility

• Location

• Falls

Pressure sensor

Movement sensor

Nursing Presence

Research at Hull (Dr David Barrett)

Approaches to teleconsultation (1)

Nurse-Patient teleconsultation: The nurse is remote from the patient and interacts via video. The patient is often accompanied by a third party – in this case, a family member.

Approaches to teleconsultation (2)

Nurse/Patient-Practitioner teleconsultation: The nurse is proximal to the patient. The nurse and patient interact with a remote practitioner – in this case, a doctor– via video.

Types of nursing presence• Operational presence: The nurse’s role in ensuring

the provision of healthcare services or meeting statutory organisational targets.

• Clinical presence: The delivery of specific healthcare functions or tasks.

• Therapeutic presence: Nursing activities that support the patient and/or carer, but are peripheral to the specific object and function of the task

• Social presence: Supporting the sense that the patient has someone ‘there’ with them. In addition, this relates to social elements of the interaction with no direct clinical or therapeutic purpose.

Nursing PresenceOperational

PresenceSocial

Presence

Therapeutic presence

Clinical Presence

Adaptations made to enhance the degree of presence

Factors that are most likely to impact on the degree of presence

Enablers that support adoption• Mainly focused on ‘value-add’ compared with the

telephone;– Increased richness of communication – “you

feel properly involved”– Ability to use two-way non-verbal

communication – “you do pick up on the non-verbal cues”

– Ability to carry out visual assessment of patient and environment -“...we can see whether they are caring for themselves”

• Recognition of user, carer and organisational benefit – “we are able to offer a lot more clinic appointments”

Constraints associated with teleconsultation• Technophobia -“I’m not very IT literate, so it has been a

steep learning curve for me”

• Technical difficulties – “the smallest problems are enough to act as really powerful barriers”

• Lack of physical proximity – “there is nothing to replace a cuddle. You know, a reassuring hand around the back.”

• Additional workload – “...it does take longer to do...”

• Clinical pathways, processes and environment not designed to incorporate TC – “...one of the problems has been actually finding a place to do it”

• Role anxiety - “…some really don’t like to do it. They would much rather be out there ‘hands on’ with the patient…”

Compensatory mechanisms• The third party: “but you can get someone over there to

press on it [a burn]…you can get the camera to focus in and say ‘right, press on that bit there, press on that bit here’.”

• Workforce development: “Before we even started, we had to make sure that all the staff had been given training on the actual use of equipment.”

• Temporal compensation: “I can keep going back and looking at a patient every half hour, which, out in the community, there’d be no chance I could do that at all.”

• Exclusion from teleconsultation: – “You would never see a new patient, a completely new

patient [via teleconsultation].” – “I would be shocked if anyone was given bad news via

something like that [teleconsultation].”

Evidence for telemonitoring

05/01/2023

© The University of Sheffield / Department of Marketing and Communications

48

Structured telephone support or non‐invasive telemonitoring for patients with heart failure

Cochrane Database of Systematic Reviews31 OCT 2015 DOI: 10.1002/14651858.CD007228.pub3http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007228.pub3/full#CD007228-fig-00102

All cause mortality

Structured telephone support or non‐invasive telemonitoring for patients with heart failure

Cochrane Database of Systematic Reviews31 OCT 2015 DOI: 10.1002/14651858.CD007228.pub3http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007228.pub3/full#CD007228-fig-00310

Re-hospitalisation

Conclusion

• Telemonitoring is widely used

• Telemonitoring has several applications including with older people

• There are advantages to telemonitoring

• There are disadvantages to telemonitoring

• A research base around nursing practice in relation to telemonitoring is beginning to grow

• There is evidence for efficacy of telemonitoring

r.watson@hull.ac.uk

0000-0001-8040-7625

@rwatson1955