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TELE-HOME CARE: THE WAVE OF THE FUTURE

By Mary Beth Hardiman, R.N., C.D.E., Community Health Nurse, Visiting Nurse Association of Greater Philadelphia, Philadelphia, Pennsylvania
Reprinted with permission from Home Health FOCUS, August 1999, p. 20.

"Hello, Mr. Smith, you look well today. I would like to check your blood pressure, pulse, and listen to your heart and lung sounds." No incredible feat in the daily routine of a home care nurse, or is it? You may agree this is exceptional, since Mr. Smith is more than one hundred miles away. Psychic nursing? No, it is tele-home care.

The Visiting Nurse Association of Greater Philadelphia, American TeleCare, Inc., and Pennsylvania State University are conducting a tele-home care clinical trial with persons with diabetes. Eligible patients are randomly assigned to have tele-video equipment installed in their homes until discharge from home care or up to sixty days. The comparison group receives routine home care. The purpose of the project is to evaluate the effects of tele-home care on quality and financial costs associated with home health services.

Tele-home care technology has the capability to allow the nurse and patient to see and hear each other. Nurses use the equipment to assess the patient's physical and emotional status, teach new information, reinforce previous health education or observe a return demonstration of a newly taught procedure. Patients receive, on average, two to three video visits per week in addition to regular home visits.
This user-friendly technology can be used to reach nearly every patient. They need only to have a telephone line, electricity and the dexterity to activate the system with the press of a button. The patient station comes equipped with a blood-pressure cuff and stethoscope that assists the nurse in assessing cardiopulmonary status from the central station. A camera lets the nurse observe the patient's accuracy of insulin dosing and administration, blood glucose testing and the progress of wounds. This greatly benefits patients with low vision by allowing the healthcare professional to act as their eyes from hundreds of miles away.

The nurse's central station includes a screen, camera, speakerphone and headset to hear the heart and lung sounds. Still photography can be used to document wound healing. Weight, vital signs and blood sugars can be graphed.

Tele-home care provides better emotional support, patient motivation, assessment and triage than simple phone contact. In anticipation of being seen on video, most patients prepare for the video visit with more elaborate grooming. Patients style their hair and women apply cosmetics to enhance their video appearance. In addition to improved self-care, patients have increased their participation in management of their health. They bring the log they use to record blood sugars to share during the video visit. Others bring the diabetic education packet given to them on admission. Most patients have expressed a desire to have the equipment remain in their home at the time of discharge; some have wanted to pay for the service. Patients have ranged from those who could only comprehend simple instruction to those seeking detailed information about the equipment's technical function.

As nurses, we have learned that, to be a part of a successful tele-home care team, you must be flexible and willing to rise to the challenges presented when working with a new technology. Tele-home care has given us an opportunity to closely monitor our patients when a home visit is not necessary, feasible or economical. The video visit allows face-to-face contact that promotes focus on the content of the communication and enhances the nurse-patient relationship. The patients enjoy the uninterrupted attention, and the nurses believe it helps to convey important information in both directions.

Future plans include installing Internet access to allow educational information to be downloaded to patients, integrating glucometers (pending Federal Drug Administration approval) and using the equipment with other patient groups. In addition, the research results will be used to approach insurers about reimbursement for video visits.

The possibilities seem endless with ever-improving technology. With tele-home care, nurses may have another tool to help meet patients' needs. Perhaps this "wave of the future" will help to weather the tides of change as home care attempts to ride out the storm caused by the Balanced Budget Act of 1997.

Note: This project was supported by the Telecommunications Information Infrastructure Assistance.

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