Evidence-Based Patient-Centered Needs Assessment

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NURSFPX6011: Evidence-Based Practice for Patient-Centered Care and Population Health Instructor

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Addressing Patient Engagement

Diabetes, a major health concern in the US, significantly affects mortality rates. This article focuses on managing diabetes-related issues in older adults. It encompasses type 1 and type 2 diabetes, impacting individuals uniquely. Complications, like neuropathy, retinopathy, nephropathy, and cardiovascular problems, affect various organs. As of 2023, an estimated 34.2 million Americans (10.5% of the population) have diabetes (Sadana et al., 2022). Understanding the complexities, risks, and treatments upon diagnosis is crucial. Personalized care plans, crafted by collaborative healthcare teams, are vital. Patients and families play key roles in treatment success, impacting satisfaction, knowledge, and adherence. Engaged patients, per ElSayed et al. (2023), exhibit better understanding, adherence, reduced anxiety, and improved health outcomes. Challenges, like economic disparities and individual needs, may impede optimal care for diabetic patients, highlighting the need for comprehensive support.

Information and Communication

Providing care for diabetes patients within the community setting broadens the scope to encompass diverse ethnicities, cultural backgrounds, educational levels, and age brackets. However, catering to patients from varied backgrounds poses certain challenges. Language barriers and differing educational levels often necessitate assistance in effective communication. Addressing these limitations, professionals deploy resources to enhance consumer health literacy. Consumer health literacy denotes the capability individuals possess in locating, comprehending, and utilizing health-related information and services for themselves and others (Office of Disease Prevention and Health Promotion, n.d). To that end, the United States Department of Health and Human Services has devised a wide-ranging strategy to ensure that all citizens have ready access to reliable health data. This initiative aims to deliver person-centered health services while fostering continuous learning and skills essential for improving health (Department of Health & Human Services, n.d).

Health Care Technology Modalities Used to Improve Consumer Health Literacy

In order to improve diabetes patients' and their families' health literacy, healthcare providers may use technology to improve their communication with those affected by the disease. Facilities can deploy technological solutions by integrating certified medical interpreters, offering various modes like face-to-face, telephonic, or video remote interpretations. Yet, in locales with multiple nationalities but limited access to interpreters, healthcare providers can opt for remote services through specialized companies. Medical professionals may instantaneously speak with patients whose native language is spoken by an interpreter via a tablet or other camera-equipped device, ensuring their understanding of the condition and active participation in patient-centered care, irrespective of geographical constraints. The availability of interpreters is beneficial as it fosters trust between patients, their families, and the interdisciplinary healthcare team, leading to improved treatment adherence and a reduced risk of hospitalization (ElSayed et al., 2023).

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Mobile Applications, Telehealth Features, and other Technology

Patients often struggle to access healthcare providers, especially in remote areas, exacerbating the challenge of establishing regular contact. Some encounter barriers reaching specialized care. Telehealth emerges as a solution, enabling remote consultations through video chat platforms. Emory Healthcare exemplified this in 2020, training 2,374 providers and conducting 53,751 audio-video telehealth encounters and 10,539 phone consultations in eight weeks (Reed et al., 2021). Telehealth bridges gaps for patients unable to travel, granting access to distant providers. Active patient engagement significantly improves health outcomes, satisfaction, cost-effectiveness, and benefits clinicians (Ruben et al., 2020). Despite telehealth's advantages, the older population may need support in understanding and using this technology, highlighting the need for assistance and education in this demographic.

Value and Relevance

Advancements in healthcare technology play a pivotal role in amplifying patient engagement, particularly in diabetes care. Electronic medical record systems (EMRs) stand as a cornerstone in modern healthcare facilities, fostering seamless communication between providers and patients. Epic, a globally recognized EMR system, boasts a customizable interface that equips healthcare providers with a range of tools. These tools enable providers to establish personalized reminders, effortlessly share critical results and notes, and leverage specialized functionalities to address health disparities. The comprehensive capabilities of Epic significantly influence the management and overall care quality for individuals grappling with diabetes. Through its adaptable features, Epic facilitates a tailored approach to diabetes management, ensuring a more effective and personalized healthcare experience for patients while empowering providers to deliver optimized care.

Proposed Technology Modality Encouraged Patient Engagement

Epic and similar electronic medical record (EMR) systems allow patients to share essential personal details, aiding healthcare teams in providing culturally sensitive care. This inclusivity significantly boosts patient satisfaction and health behaviors, particularly among minority groups (McGregor et al., 2019). EMRs, like Epic, also enable patients to access test results and upcoming reminders, ensuring adherence to care plans. For instance, a diabetic patient with cardiac concerns might receive prompts for an upcoming electrocardiogram due to specific medications. EMRs help reinforce medical recommendations and organize vaccination schedules and screenings. These systems support telehealth and interpretation services, allowing interdisciplinary teams to communicate in patients' preferred languages and generate materials accordingly. Effective communication, especially across language barriers, emphasizes simplicity and clarity. EMRs thus play a vital role in fostering patient engagement and understanding within diverse healthcare settings.

Health Information Exchange and Interoperability of Technology Modalities

Technological advancements streamline medical information sharing among providers via Electronic Medical Records (EMRs). These records encompass comprehensive data like medical history, family records, medications, test results, and vital signs (Manias et al., 2020). This sharing capability reduces redundant tests, minimizes errors, and enhances patient safety (The HIPPA Journal, n.d). However, challenges arise with data fragmentation across multiple locations, potentially causing information gaps that hinder accurate diagnoses. Additionally, EMR-based information sharing heightens vulnerability to data breaches, with each breach estimated to cost $9.3 million and impact 40 million patient records in 2021 (Department of Health & Human Services, n.d). Cyberattacks pose threats of identity theft, data tampering, and extortion. Implementing access controls, encryption, and audit trails becomes imperative to mitigate cyber risks, safeguard patient confidentiality, and prevent unauthorized data access or breaches. These security measures aim to uphold patient privacy and prevent unlawful information sharing.

Innovative Strategies

Healthcare technology is advancing swiftly, offering substantial support for patients and facilitating high-quality and ethically sound care. For older individuals managing arrhythmias, home-based monitoring using technology can significantly enhance their health outcomes. According to recent research conducted by Gangl & Krychtiuk (2023), it has been shown that the use of remote monitoring techniques for tracking blood pressure, weight, symptoms, and home ECG recordings exhibits superior performance when compared to traditional in-clinic follow-up methods. The affordability of purchasing monitoring equipment however, remains a challenge, particularly for the elderly population often on fixed incomes. Compatibility issues with devices in various languages further limit the reach and benefits of such technology. Nevertheless, those who can access home ECG monitoring can gain from more frequent telehealth visits focused on discussing their arrhythmias. Those who keep their diabetes under control are substantially less likely to get arrhythmias like atrial fibrillation (Afib) (Ostropolets et al., 2021). While virtual telehealth visits can be scheduled more regularly, some individuals still prefer in-person care, influenced by cultural preferences for face-to-face treatment. Zupa et al. (2021) posit that confidentiality concerns and preferences for initial in-person appointments are significant factors affecting participation in telehealth hence, healthcare providers must collaborate with patients to develop culturally sensitive plans to achieve the best possible outcomes in diabetes management and care.

Mitigating Risk for Safety

The utilization of Electronic Medical Records (EMRs) and the sharing of health information undoubtedly offer numerous advantages. Patients with diabetes may be identified by current outpatient EMRs, as well as those who are overdue for suggested tests or screenings and those who have not met evidence-based clinical objectives for glycemic, lipid, or blood pressure management. However, ethical concerns also arise, particularly regarding patient autonomy (Sly et al., 2022). Autonomy signifies an individual's right to provide consent and make informed decisions regarding their medical care. In the context of managing arrhythmias among older individuals, a common scenario involves multiple interdisciplinary team members, such as primary care providers, cardiologists, electrophysiologists, neurologists, and other essential healthcare professionals. Each of these team members contributes to their respective EMRs, which share information across the involved providers. This collective sharing of information may occur without explicit patient consent, potentially undermining the patient's right to be informed about and consent to the comprehensive data sharing among providers.

Conclusion

As healthcare providers navigate evolving technologies in patient treatment, it's crucial to adopt innovative strategies that uphold high-quality, ethical, and pragmatic patient care standards. While technology offers considerable benefits in information sharing and treatment, providers grapple with ethical dilemmas. One such dilemma revolves around the potential limitation of not obtaining the complete patient picture when sharing information across platforms, raising concerns about compromising patient autonomy in their care decisions. Studies indicate that patients who actively engage in their healthcare decisions often achieve more favorable overall outcomes, underlining the significance of patient involvement in the care process. Thus, providers must strike a balance between leveraging technology for efficient care while ensuring patient autonomy and involvement in decision-making remain at the forefront.

References

Department of Health & Human Services. https://www.hhs.gov

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., ... & Gabbay, R. A. (2023). 5. Facilitating positive health behaviors and well-being to improve health outcomes: standards of Care in Diabetes—2023. Diabetes Care, 46(Supplement_1), S68-S96. https://doi.org/10.2337/dc23-S005 

Gangl, C., & Krychtiuk, K. (2023). Digital health—high tech or high touch?. Wiener Medizinische Wochenschrift, 173(5-6), 115-124. https://doi.org/10.1007/s10354-022-00991-6 

Manias, E., Bucknall, T., Wickramasinghe, N., Gray, K., Schaffer, J., & Rosenfeld, E. (2020). Patient and family engagement in communicating with electronic medical records in hospitals: a systematic review. International journal of medical informatics, 134, 104036. https://doi.org/10.1016/j.ijmedinf.2019.104036 

McGregor, B., Belton, A., Henry, T. L., Wrenn, G., & Holden, K. B. (2019). Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & disease, 29(Suppl 2), 359. https://doi:10.18865/ed.29.S2.359  

Office of Disease Prevention and Health Promotion (.gov). https://health.gov/healthypeople

Ostropolets, A., Elias, P. A., Reyes, M. V., Wan, E. Y., Pajvani, U. B., Hripcsak, G., & Morrow, J. P. (2021). Metformin is associated with a lower risk of atrial fibrillation and ventricular arrhythmias compared with sulfonylureas: an observational study. Circulation: Arrhythmia and Electrophysiology, 14(3), e009115. https://doi.org/10.1161/CIRCEP.120.009115 

Reed, M., Huang, J., Graetz, I., Muelly, E., Millman, A., & Lee, C. (2021). Treatment and follow-up care associated with patient-scheduled primary care telemedicine and in-person visits in a large integrated health system. JAMA network open, 4(11), e2132793-e2132793. https://doi:10.1001/jamanetworkopen.2021.32793

Ruben, M. A., Blanch‐Hartigan, D., & Hall, J. A. (2020). Communication skills to engage patients in treatment. The Wiley Handbook of Healthcare Treatment Engagement: Theory, Research, and Clinical Practice, 274-296. https://doi.org/10.1002/9781119129530.ch15 

Sadana, P., Edler, M., Aghayev, M., Arias-Alvarado, A., Cohn, E., Ilchenko, S., ... & Kasumov, T. (2022). Metabolic labeling unveils alterations in the turnover of HDL-associated proteins during diabetes progression in mice. American Journal of Physiology-Endocrinology and Metabolism, 323(6), E480-E491. https://doi.org/10.1152/ajpendo.00158.2022 

Sly, B., Russell, A. W., & Sullivan, C. (2022). Digital interventions to improve safety and quality of inpatient diabetes management: a systematic review. International Journal of Medical Informatics, 157, 104596. https://doi.org/10.1016/j.ijmedinf.2021.104596 

The HIPAA Journal. https://www.hipaajournal.com

Zupa, M. F., Piette, J. D., Stoll, S. C., Obrosky, D. S., Boudreaux-Kelly, M., Youk, A. O., ... & Rosland, A. M. (2021). Patient and supporter factors affecting engagement with diabetes telehealth. The American Journal of Managed Care, 27(10), 409-414. https://doi.org/10.37765/ajmc.2021.88758

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