We’ll Meet You Where You Are: Benefits of Virtual Healthcare
During this time of healthcare uncertainty, it's more important than ever to meet patients where they are. An increased focus on achieving and maintaining connections between patients and providers is critical. While the worldwide COVID-19 health crisis has changed federal guidelines regarding virtual healthcare and significantly increased the overall use of telehealth, this important service will continue to benefit individuals for years to come. Primary care clinics now have a unique opportunity to improve healthcare outcomes for homebound patients through the increased use of virtual office visits going forward. In-home care provides an extra layer of safety and specialized care for the elderly and otherwise health-compromised individuals.
Virtual healthcare is necessary for patients of all ages but is of particular importance for the elderly, rural-dwelling families, and immunocompromised individuals. Travel can be a hindrance to seeking medical care. By removing this burden, patients may seek care sooner, which can help reduce morbidity associated with a variety of disorders. Specific short-term health conditions may also limit a patient's ability to receive timely medical care and may reduce overall compliance with prescribed medical treatments. As outlined in an article published by AARP, telehealth allows providers to improve access to quality care for individuals requiring:
- Transitional care after inpatient treatment
- Palliative care
- Ongoing health monitoring for acute and chronic conditions
- Acute symptom evaluation
- Mental and behavioral health follow-up
Many health conditions require frequent follow-up appointments for optimized care and outcomes. Particularly beneficial in the primary care setting, virtual office visits provide established patients with a quick, convenient evaluation and follow-ups for chronic health conditions such as:
- Dermatologic conditions
- Upper respiratory issues
- Pain management
Many companies have moved toward hiring telehealth nurses to meet their staffing needs - meaning the nurse can essentially work from anywhere. Given the virtual nature of telehealth, the nurse must have access to high-speed internet, specialized software programs accessing the employer’s network, and possibly telephone service. Time zone differences between the nurse’s current living country and the telehealth employer is a significant consideration as well.
Appropriate internet speeds can be a challenge living overseas. Many countries are still working with broadband or dial-up connections that can be too unreliable for telehealth work. Consistent access to internet can also be a challenge if power supplies are variable. According to statics published by Internet World Stats, only 54% of the world has access to online web systems.
Companies hiring nurses for at-home telehealth positions require the nurse to have an active and unrestricted license in the state where the company resides or affiliates. Many states participate in the Nurse Licensure Compact, which allows the nurse to provide care in all participating states without obtaining additional licensing.
While Telehealth nursing for American nurses living abroad is technologically possible, individual employers would consider such a hire on a case-by-case basis. Telehealth and at-home nursing services are a relatively new working environment for most companies with varying degrees of employee oversight and interaction requirements.
Telephone triage nurses have a challenging job. Nurses are trained to assess from the second they lay eyes on a patient. A significant part of a head to toe assessment is the initial presentation - what the patient looks like at first glance. Are they alert? What is their skin tone? Do they appear in distress?
Nurses, especially experienced ones, often operate off “gut feelings “ - the nagging feeling that something isn’t right. This presents a challenge when assessing over the phone. When a patient calls and speaks to a triage nurse, the nurse first asks what the main complaint is. From there, he or she asks questions about the complaint while listening to cues from the patient that may point to other health issues. For example, if a patient calls in with a complaint of fatigue, the nurse might pick up on shortness of breath or a cough which could be indicative of a breathing or cardiac issue. This assessment leads the nurse towards a more specific line of questioning.
Many organizations have triage protocols in place to ensure no significant assessment piece is missed. The protocols are developed and refined by clinical staff and are reviewed regularly to ensure they are appropriate and follow current evidence-based practices.
Telephone triage nurses, or telehealth nurses, are nurses who assist and advise patients over the phone. They are extremely helpful in reducing patient care loads for physicians while helping patients avoid potentially high co-pays for doctor or emergency room visits. More importantly, they can decide which service is appropriate for their needs.
While telephone triage nurses have access to electronic medical records, the difficulty lies in not being able to visualize the patient. Nurses are trained to assess patients from the moment they lay eyes on them. Much of a nurse's assessment comes from non-verbal cues. For example, a patient may say he is feeling tired lately, and light headed. A nurse can check for mottling or cyanosis, and deduce there may be a respiratory or cardiac issue going on. This can be challenging over the phone. A nurse may ask questions, but the patient may not know what to look for.
Many organizations develop protocols for telephone triage nurses to follow which will help collect pertinent data and determine the best service for them- such as home care advice, a doctor visit, or a trip to the emergency room.
While protocols are helpful, nothing beats a nurse's sharp assessment skills and clinical experience. Telephone triage nurses learn to hone listening skills and pick up on other cues and incorporate that into their assessment. For example, let's say a patient calls for the previously mentioned complaint of fatigue and lightheadedness. While asking pertinent questions, the nurse listens for shortness of breath, difficulty completing sentences, slurred speech and mental status changes. The patient may answer all the questions in which home care advice might be indicated, but a nurse's clinical judgment can override a protocol to recommend an ER visit.
Telephone triage can be challenging, but a strong nurse’s critical thinking and decision-making can overcome the challenges of not being able to lay eyes on a patient.
As community-wide safety continues to remain essential, telehealth offers patients the ability to communicate effectively with their primary care provider from the comfort of their home. Telehealth also allows the healthcare team to effectively integrate and individualize patient care. When appropriate, collaboration with on-site home health nursing staff will greatly improve the ability of clinic providers to assess and properly treat individuals through remote video conferencing. In this setting, a variety of clinical tools employed by the in-home nurse or caregiver will aid in offering a quality patient assessment. Concerns that typically require a scheduled office visit can be effectively addressed through a brief virtual consultation.
Home-health staff will also find value in improved communication with primary care providers. Patient condition changes, new clinical findings, and results around treatment effectiveness can all be readily and rapidly shared through the use of telehealth portals. This will save clinical and documentation time, as well as reduce the burden of travel for patients seeking follow-up care. Continuity of care rises as accessibility increases, which has led to reduced emergency room visits and decreased length of stay in some cases.
Gaining more frequent access to medical providers allows patients to embrace self-management practices under the direction of their primary care provider. Medication management, blood pressure monitoring, blood glucose monitoring, symptom checks, and follow-ups are among the many ways that individuals are empowered to maintain and improve their health.
Nurses can offer individualized patient education via telehealth, leveraging the ability to accurately assess the patients' understanding by return demonstration. Many elderly individuals already feel a general sense of isolation, and recent events have heightened physical and emotional isolation across various demographic groups. By removing the obstacles to receiving care, reducing the sense of isolation, and offering increased options for connecting to medical providers, virtual healthcare will lead the way in improving healthcare outcomes.
"Telehealth innovations have been instrumental in conducting a patient assessment, health and psychological interventions, patient and provider education, and remote patient monitoring on a real-time basis with critical information feedback between patient and provider."
The surge in telehealth during this public health crisis highlights the importance of readily accessible medical care. Individuals expect a continuation of the primary care relationship. Primary care providers have the opportunity to maximize patient care effectiveness by increasing patient contact through telehealth modalities.
Virtual healthcare is a progressive approach for both patients and providers and serves as an essential component of quality healthcare. It's critical to embrace the availability of virtual healthcare tools to meet our patients where they are.
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