The U.S. healthcare system is the most expensive in the world and has comparatively poor outcomes. Containing costs and improving quality have become critical goals of health care reform, but achieving these goals seem exceedingly difficult and complex.
As we all know, lack of patient engagement and adherence to treatment are two of the fundamental reasons for poor health outcomes. Telemedicine is an opportunity to take a step in the right direction and a way to meaningfully reach patients outside of the medical office.
The good news is that such a system already exists. The bad news is that telemedicine use is limited because it is primarily funded only for people in rural areas and those who meet specific diagnostic criteria.
Currently, implementing more widespread use of telemedicine in urban and suburban areas is typically viewed as a mere substitute for face-to-face treatment. It is not considered an equal alternative to traditional medicine. But if we change this perception, telemedicine could help overcome poor patient adherence problems and vastly improve health outcomes, while simultaneously reducing patients’ out-of-pocket costs for transportation, co-payments, work absences and childcare.
Let us start by defining telemedicine. It is real time, interactive, audio and visual communication between patients and providers. It consists of self monitoring, self reporting and medication compliance tracking, and has potential to prevent complications that may occur when patients do not adhere to treatment directives.
Telemedicine could be particularly useful for patients with chronic conditions such as diabetes, congestive heart failure, kidney failure, stroke, cancer, chronic obstructive pulmonary disease and those prescribed blood thinners.
Diabetes affects 25.8 million Americans — about 8.3% of the population, according to the CDC. The agency’s statistics also show that heart failure is the primary cause of more than 55,000 deaths per year, — approximately 50% of these patients die within five years of diagnosis.
Reducing the prevalence of lethal chronic diseases such as these is possible, but involves lifestyle changes that most people find quite difficult and for which they need ongoing support. For many people, frequent visits to doctors’ offices are not viable.
There is strong evidence to support the use of telemedicine to overcome these barriers to care. Health outcomes tend to improve when patients are involved in their own care, and the expenses of both the patient and the provider are reduced. A 2012 Lancet study supports patient self-monitoring and self-management with suitable healthcare support as a safe option for patients of all ages.
Partners Health Care, an integrated health system affiliated with Brigham and Women’s Hospital and Massachusetts General Hospital, has had positive results with its Connected Cardiac Care Program (CCCP), which uses telemonitoring and education to follow heart failure patients. Among the 1,200 participating patients, healthcare providers have observed an approximate 50% reduction in heart-failure related hospital readmissions.
Current U.S. law supports only limited use of telemedicine in remote areas, where healthcare providers are scarce, but this may soon change. Under ongoing deliberation, Senate Bill SB662 would make telemedicine a service that would be covered by Medicare and Medicaid, regardless of geographic location. At present, members of the Senate Committee of Banking and Insurance are working on issues related to malpractice liability and confidentiality.
If we fail to recognize telemedicine as an effective way to encourage treatment adherence among patients with chronic conditions we will miss a great opportunity to improve health outcomes, promote better quality of life and reduce costs.
Rincy Joseph, RN, FNP-BC, NP-C, is a board certified Family Nurse Practitioner and a doctoral student at Pace University in New York.