Volume 2, Issue 3 |
September 27, 2004 |
Telehealth or telemedicine is the use of remote technologies for patient monitoring. Telehealth can be used by hospitals that do not have a specialty on site but can consult specialists via remote technologies wherever they are.
Telehealth is slowly making its way to Home Care via tele-monitoring and Point of Care (POC) devices. With telehealth, patients are remotely monitored for continual diagnosis. A person with Congestive Heart Failure is a good candidate for telehealth since he/she needs regular checkups in order to prevent the worsening of a condition that would often send him/her to the hospital. With telehealth these checkups would be daily instead of weekly!
For Home Care agencies, the intensity of nursing activities is based on telehealth findings and visits are done on a as-needed basis. According to the first studies, telehealth could reduce re-hospitalizations and ER visits by 70%. Manufacturers have included processors that allow instant translation to other languages than English so there’s no barrier to communication in between patients and telehealth nurses.
Some designers are going as far as embedding sensors into furniture, carpets and televisions to monitor patients’ whereabouts within their home at all time. The nurse will know if a fall has occurred but also if the patient is staying too long on the couch!
Detractors argue that diminishing physical contact with a population that is already isolated, would make matters only worse. A visit from the nurse or therapist is often a “social event” that some patients look forward to. Could telehealth take care of the heart both physically AND spiritually? Agencies are reluctant to invest into a technology that does not promise a quick return on investment. Analysts for Home Care also anticipate resistance from veteran personnel because of the lack of physical contact and distrust of the technology.
Telehealth has already started by making some homes an almost paperless environment with the use of Personal Digital Assistants (PDAs), laptops and scanning devices.
These do not prevent the nurse from coming to the patient’s home on a regular basis but rather eliminates a lot of administrative tasks and the redundancy of reporting to agencies. Most major Home Health agencies are already equipped with such devices. Although HIPAA regulations have slowed down the process, most agencies are leaning toward the electronic reporting methods.
Another application of telehealth is tele-education where physicians, nurses, therapists and Aides can participate in training without the burden of having to travel far away.
It will take some time, but everybody knows it will come: Government and regulations are heading that way in the effort to cut costs. The existence of the Office of Advancement of Telehealth shows the government is ahead of the game. Rural areas are the first to take the heat!
References: NAHC Caring Magazine, July 2004 Vol. XXIII, No. 7—telehealth.hrsa.gov—Association of Telehealth Service Providers.
| Ingredients | 1 lb. of beef for stewing | 2 cups of cubed carrots |
| 2 cups of cubed red potatoes | 1 cut up leak | |
| 1 cubed medium onion | Bay leaf and dry thyme sprigs | |
| salt and pepper to taste, oil | 2-3 cups of water |
In the 4-quart pot, put 1 tablespoon of oil and brown the cubed 1/2 inch. beef. Set aside. Put another tablespoon of oil in the pot and cook the cubed onion. Add leak and carrots. Cook 2-3 minutes. Add the beef back in. Add 2 cups of water. Add the bay leaf and thyme. Bring to a gentle boil, cover and cook 30 minutes. Add the potatoes. Add water if necessary. Bring to a gentle boil again, cover and cook until potatoes are soft. Remove the bay leaf and thyme. Add salt and pepper to taste. Serve with toasted garlic bread. Enjoy!
It is a story of “What came first”: the egg or the chicken?
What came first of the diabetes or the depression is still not clear for researchers like Dr. William Eaton from the Johns Hopkins University. In a 13-year study of nearly 2,000 people, he and his team concluded that depressed people were more than twice as likely as others to develop type 2 Diabetes.
The American Diabetes Association leads more for the greater risk of having depression if you already have diabetes, even before you know that you have diabetes.
The extra workload to control your blood sugar level at all time, the tension with family, physician, and yourself add up.
Colder days are just around the corner now, and with them colds and flu. If for most of us it is a burden, for people with Diabetes it can be life threatening. People with type 2 diabetes, especially older people can develop hyperosmolar hyperglycemic nonketotic coma. In general, when you are sick, your blood sugar levels rise. It is very important for persons with diabetes to check their blood sugar level often: probably 4 times a day during sickness.
To plan ahead of time for the days of sickness, start with your doctor or nurse: ask him/her to help with your personal sick day plan.
You will have to keep hydrated, so plan to always have water supplies handy if you don’t drink water from the faucet. In case your stomach is queasy store regular gelatin and pudding, crackers, soup and broth, applesauce, fruit juice, yogurt and sherbet. If you are planning to take over the counter cold or flu medicines watch out for sugar content! Also remember that large doses of aspirin can lower blood sugar levels. Some antibiotics lower blood sugar levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood sugar levels.
References: American Diabetes Association.
You will find the Diabetes Patient Education Guide on the shelf where the admission packets are. This give is a good source of general information for patients that are new to the world of diabetes. They will find information about understanding diabetes and the disease process, medication management, nutrition, complications and standards of care. It is a good reference for them to have once the teaching id done and the nurse is gone. Make sure to pick one up to review.
Electrical stimulation (ES) and electromagnetic therapy (EM) for wound treatment are both now available in the home health setting. These are to be provided exclusively by a physical therapist or a physician.
Medicare will cover treatment for chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers if no measurable improvement is evidenced after at least 30 days of standard wound therapy.
Chronic ulcer: ulcers that have not healed within 30 days of occurrence.
Measurable signs of improvement healing: decrease in wound size, decrease in amount of exudates, and decrease in amount of necrotic tissue.
During therapy, wound must be evaluated at least monthly by the treating physician and any changes must be reported to the treating physician in a timely manner. If measurable signs of healing have not been demonstrated within any 30-day period of treatment, these therapies must be discontinued because they will not be covered.
References: NAHC
N.B.: This newsletter has been re-edited for the web posting.