The Relationship between Telehealth and Geriatric Patient Outcomes

Proposal Development for Applied Research Project

A course assignment presented to the College in partial fulfillment of the requirements for the Doctor of Health Science Degree at

01/09/2022

The Relationship between Telehealth and Geriatric Patient Outcomes
The American health system (or non-system to some cynics) has struggled to invent models of care delivery that provide quality care at a sustainable cost. Some of the challenges to achieving this goal include shortages of healthcare workers and inequitable distribution of the available professionals. Rural areas are worst affected as primary care physicians prefer affluent urban counties to work less and earn more. The coronavirus pandemic and the increasing realization of pockets of disease in marginalized ethnic and racial minorities have brought these inequalities into sharp focus; states and federal agencies have sought to bridge these gaps; one attempt is through using telehealth to increase access to primary care services in underserved rural areas.
The National Aeronautics and Space Exploration (NASA) is one of the early adopters of telehealth in the United States for monitoring astronauts during missions by physicians on planet Earth (Hyder & Razzak, 2020). Due to regulatory concerns, technological challenges, and suboptimal acceptance, widespread adoption in care delivery has been sluggish. However, the Covid-19 pandemic pushed its rapid adoption, enabling physicians to “see” patients in the comfort of their homes for management of acute and chronic conditions and monitor coronavirus patients on home isolation (Mishori & Antono, 2020). State and federal authorities have supported this shift by suspending state licensing requirements to offer services across state lines, authorizing Medicare and Medicaid reimbursements for remote services, and legitimizing prescriptions for controlled substances done under remote consultations (Mishori & Antono, 2020). The following sections in this proposal examine medication adherence in geriatrics, the logical basis for the proposed study, and its significance.
Background
Healthcare workers have resisted integrating technology in health due to fears about quality and autonomy. Traditional algorithms for diagnosis rely heavily on examination, touch, palpations, and auscultation, which would be adversely affected by remote consultations in the view of health care practitioners. Geriatric patients are a particular risk group—Americans above 65 years have the highest healthcare utilization. Many senior citizens have multiple prescriptions and consume considerable over-the-counter preparations for pain, dietary supplementation, and tonics. Consequently, adherence to prescribed medicine is a challenge and a significant contributor to high care costs and poor outcomes in elderly patients (Smaje et al., 2018).
Pharmacist-led medication use reviews and medication use counseling have produced good outcomes, especially when implemented immediately after discharge (Marcum et al., 2017). In a cross-sectional survey, Mayo-Gamble and Mouton (2018) recognized the relationship between health literacy and medication adherence among geriatric patients. According to the researchers, patients with minimal health literacy were more likely to forget to take their medications. Targeted and regular communication of health information, including medication use counseling, yields better outcomes in groups with limited health literacy, such as African Americans (Mayo-Gamble & Mouton, 2018). Kvarnström et al. (2018) confirmed that reinforcing information on medication use, side effects, and monitoring for response supports adherence. However, senior citizen cohorts also present with increasing levels of cognitive impairment, necessitating regular reinforcement of health messages which would be costly if the traditional home or office visits are to be employed to achieve the required level of health literacy.
Telehealth services can help ensure convenient and regular connections between providers and patients to improve adherence (Marupuru et al., 2021). Remote access to primary care physicians, pharmacists, and nurses increases the opportunities available to older patients to consult with providers at the comfort of their homes, saving costs for transport and accommodation and facilitating interprofessional collaboration (Badowski et al., 2018). Telehealth also offers seamless integration with mobile devices where mobile applications deliver targeted messages, generate reminders, and collect health data such as side effects and treatment responses. Consequently, the adoption of telehealth in rural geriatric patients enables healthcare providers to improve medication adherence in this cohort which improves health outcomes.
Rationale
The sudden shift to remote operations at the onset of the coronavirus pandemic forced healthcare providers to embrace telehealth to plug gaps in access and comply with state directions on in-person interactions. The adoption of telehealth services in geriatrics suffered from fears that this population has challenges with using technology, and remote consultations would be resisted due to sentimental attachments to doctor’s offices. Greenwald et al. (2018) investigated these assumptions by implementing a telehealth program at an emergency department that served 1052 seniors during the study. The researchers found that the patients were overwhelmingly satisfied with the program. Marupuru et al. (2021) reported a significant improvement in adherence after patients switched refills from 30 days to 90 days and received a pharmacist-delivered telehealth intervention. Bandwoski et al. (2018) posit that health outcomes are affected by provider factors, collaborations, technology, and applicable regulations. Therefore, the effects of the rapid adoption of telehealth services in the wake of the pandemic should be analyzed to find out if this mode of delivery has had a positive impact since the changes may become permanent.

Significance
Experts posit that some of the adjustments occasioned by the pandemic, such as working from home, are the new normal. Before the pandemic, the health system was under immense pressure to adopt technology to cut costs while maintaining quality. Therefore, telehealth is on course to become a permanent mode of healthcare delivery after the successful implementation during the pandemic. A hybrid of in-person and remote care is expected for some conditions, depending on patient preferences and the services required (Zulman & Verghese, 2021). This study seeks to investigate whether telehealth has improved medication adherence and health outcomes in geriatric patients. The study will also build the body of knowledge in this emerging field that will help health care providers decide whether to expand remote health service offerings or hold implementation until identified shortcomings are resolved.

References
Badowski, M. E., Walker, S., Bacchus, S., Bartlett, S., Chan, J., Cochran, K. A., Coon, S., Liedtke, M., Phillips, B. G., & White, T. (2018). Providing comprehensive medication management in telehealth. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 38(2), e7–e16. https://doi.org/10.1002/phar.2071
Greenwald, P., Stern, M. E., Clark, S., & Sharma, R. (2018). Older adults and technology: In telehealth, they may not be who you think they are. International Journal of Emergency Medicine, 11(1), 2. https://doi.org/10.1186/s12245-017-0162-7
Hyder, M. A., & Razzak, J. (2020). Telemedicine in the united states: An introduction for students and residents. Journal of Medical Internet Research, 22(11), e20839. https://doi.org/10.2196/20839
Kvarnström, K., Airaksinen, M., & Liira, H. (2018). Barriers and facilitators to medication adherence: A qualitative study with general practitioners. BMJ Open, 8(1), e015332. https://doi.org/10.1136/bmjopen-2016-015332
Marcum, Z. A., Hanlon, J. T., & Murray, M. D. (2017). Improving medication adherence and health outcomes in older adults: An evidence-based review of randomized controlled trials. Drugs & Aging, 34(3), 191–201. https://doi.org/10.1007/s40266-016-0433-7
Marupuru, S., Dhatt, H., Bingham, J. M., & Warholak, T. (2021). Evaluation of a novel pharmacist-delivered adherence improvement service via telehealth. Pharmacy, 9(3), 140. https://doi.org/10.3390/pharmacy9030140
Mayo-Gamble, T. L., & Mouton, C. (2018). Examining the association between health literacy and medication adherence among older adults. Health Communication, 33(9), 1124–1130. https://doi.org/10.1080/10410236.2017.1331311
Mishori, R., & Antono, B. (2020). Telehealth, rural america, and the digital divide. Journal of Ambulatory Care Management, 43(4), 319–322. https://doi.org/10.1097/JAC.0000000000000348
Smaje, A., Weston-Clark, M., Raj, R., Orlu, M., Davis, D., & Rawle, M. (2018). Factors associated with medication adherence in older patients: A systematic review. Aging Medicine, 1(3), 254–266. https://doi.org/10.1002/agm2.12045
Zulman, D. M., & Verghese, A. (2021). Virtual care, telemedicine visits, and real connection in the era of covid-19: Unforeseen opportunity in the face of adversity. JAMA, 325(5), 437. https://doi.org/10.1001/jama.2020.27304