Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Healthcare delivery has progressively evolved since the arrival of technology and the internet. Over time, healthcare providers have integrated numerous clinical systems into patient care to achieve higher effectiveness and efficiency. The continuous use of technology has benefitted healthcare delivery by reducing adverse events, better patient-provider communication, and improving patient privacy (Bates & Singh, 2018). Patients and populations can be better accessed, particularly rural and underserved populations. Among many clinical systems, telemedicine and telehealth systems have been central to delivering remote patient care. Telemedicine typifies remote medical services, while telehealth is broader since it includes all health-related services, including education, reminders, and continuous monitoring (Giacalone et al., 2022; HealthIT.gov, 2019). For timely delivery of care and improved access, remote patient care continues to dominate current practice. The purpose of this paper is to review the current literature on the effectiveness of remote care systems (telemedicine and telehealth) in diabetes care. Döğer, E., Bozbulut, R., Acar, A. Ş. S., Ercan, Ş., Uğurlu, A. K., Akbaş, E. D., … & Cinaz, P. (2019). Effect of telehealth system on glycemic control in children and adolescents with type 1 diabetes. Journal of Clinical Research in Pediatric Endocrinology, 11(1), 70-75. DOI: 10.4274/jcrpe.galenos.2018.2018.0017 Telehealth and related technologies continue to make remote patient care a reality. Döğer et al. (2019) evaluated the impacts of the telehealth system on diabetes control among children and adolescents with type 1 diabetes at Gazi University Faculty of Medicine. The patients confirmed the importance of telehealth in illness management and other outcomes crucial for comprehensive recovery and healthy living. Overall, telehealth was found to be an efficient system that improves access to care and reduces cost. Regarding outcomes, patients suggested that they mostly used Whatsapp for instant messaging, education from nurses, and consulting the diabetes team about glucose regulation and insulin doses. HbA1 values reduced significantly in patients contacting their providers frequently. The main lesson from the study is that age determines telehealth use and preferred technologies. Young people showed Whatsapp preference, as confirmed in the study. The other important note for nurses and other healthcare professionals is the importance and frequency of counseling. Regular counseling led to improved blood glucose control. Ju, H. H. (2020). Using telehealth for diabetes self-management in underserved populations. The Nurse Practitioner, 45(11), 26-33. DOI: 10.1097/01.NPR.0000718492.44183.87 Diabetes self-management is critical to improve outcomes among patients. Accordingly, patients should understand the strategies for effective disease management and be supported to achieve higher patient outcomes. Ju (2020) evaluated the importance of telehealth systems in meeting the needs of diabetic patients in underserved populations. Telehealth was found effective in medication management since it improved overall medication adherence. In diabetes care, medication adherence is a valuable self-care behavior for achieving glycemic control. The other theme central to improved outcomes in diabetes care was self-monitoring of blood glucose to achieve the recommended blood glucose goal. Above all, telehealth allowed patients to receive dietary education and exercise advice remotely. This support was crucial for improved outcomes, such as medication adherence, dietary regulation, and participation in various types of exercises. As healthcare practitioners continue supporting patients to use telehealth, awareness of the barriers to implementation is crucial. The awareness allows healthcare providers to customize care according to patient needs and ensure that healthcare services are accessed conveniently. Ju (2020) found that patients’ beliefs could be a key barrier to telehealth since some patients modified medications as their beliefs guided them. Accordingly, healthcare providers should continually monitor patients in all dimensions to ensure they adhere to all recommendations. Health education is crucial to counter cultural and religious barriers that might hamper telehealth effectiveness. Lee, P. A., Greenfield, G., & Pappas, Y. (2018). Patients’ perception of using telehealth for type 2 diabetes management: a phenomenological study. BMC Health Services Research, 18(1), 1-9. https://doi.org/10.1186/s12913-018-3353-x Type 2 diabetes has severe implications on one’s health if not effectively managed. Typically, the effectiveness of telehealth and related technologies depends on how patients benefit from them and their perceptions. In this study, Lee et al. (2018) explored patients’ perceptions regarding telehealth for type 2 diabetes management. One of the central findings underlining the importance of telehealth among these patients is the technology application in self-management. Patients embraced telehealth since it is an inevitable technology in today’s world and can help them to manage their health better. The other notable impact of telehealth related to effectiveness and efficiency was reliability and comfort. Patients noted that telehealth helped them to monitor their health and provide advice 24/7, even when healthcare services are limited, such as during weekends. One of the greatest lessons from this study is that telehealth usability depends on patients’ perceptions. In this case, patients use it more for diabetes management if they consider it beneficial to their health. As Lee et al. (2018) observed, patients perceived telehealth as “Big Brother” watching them at a distance. Patients also noted the importance of telehealth in providing a sense of security and comfort. Importantly, telehealth was a means to convenient access to healthcare services. It helps patients to have easy and convenient access to doctors. Therefore, implementing such systems could be beneficial for improved access to care and patients’ continued use of technologies for cost-effective, timely, and efficient care. Lee, J. Y., Chan, C. K. Y., Chua, S. S., Paraidathathu, T., Lee, K. K. C., San San Tan, C., … & Lee, S. W. H. (2019). Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients’ perspectives. BMJ Open, 9(10), e026575. http://dx.doi.org/10.1136/bmjopen-2018-026575 The importance of technology in independent and convenient care cannot be underestimated. In chronic disease management, independent care is crucial to reduce patient visits to providers and ensure patients are as comfortable as possible. In this study, Lee et al. (2019) conducted a randomized controlled study examining the use of telemedicine for diabetes management. Forty-eight patients within the Klang Valley participated in providing their experiences with the technology. Participants noted that telemedicine was convenient for diabetes management since it allowed them to overcome time constraints and logistical barriers that prevented them from attending clinics for physical appointments. Tele-monitoring devices further encouraged patients to monitor their glucose levels regularly to determine whether they needed detailed check-ups. The other observation instrumental in diabetes management is communication with providers. The system allowed patients to share health data privately, which helped them to be more accountable for their diabetes management. Despite the various benefits experienced through telemedicine in remote patient care, concerns, and challenges are widespread. Indeed, this is among the lessons from this study as healthcare practitioners continue promoting remote patient care in disease management. Participants stressed the need for user-friendly technology due to difficulties related to internet connectivity and availability in rural areas. Technology and internet access are low in low-income communities, hampering remote care in such areas (Graves et al., 2021). Other issues noted in the study include internet connection stability and cost, limiting patients’ ability to use tele-monitoring devices effectively. To help patients overcome the technical challenges, healthcare professionals should provide ready technical support to ensure successful telemedicine implementation.

Conclusion

The use of clinical systems has intensified in healthcare delivery as technology use intensifies. Nursing research continues to evaluate the practicality of these systems in achieving higher efficiency and other outcomes. In the four reviewed studies, remote care systems improve access to care and reduce costs. Patients with diabetes can use these systems for messaging providers, seeking advice, and seeking medication assistance. The studies have further underlined the importance of telehealth and telemedicine in improving self-care behaviors, medication adherence, and assisting patients in self-monitoring. Lessons include technology choice according to patients’ age, issues with security, and the importance of user-friendly systems. Continuous counseling of patients is also crucial for improved outcomes.

References

Bates, D. W., & Singh, H. (2018). Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11), 1736-1743. https://doi.org/10.1377/hlthaff.2018.0738

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