While telehealth can increase access to care, its benefits should be balanced with remote care's potential to increase nurses' workloads, researchers said in new study.
Nurses performed about twice as many activities with telehealth patients compared to in-person patients, according to University of Missouri researchers' analysis of nearly 800 nursing activities performed for Type 2 diabetes and hypertension patients. While in-person visits led to follow-ups about once every three months, the patients using telehealth submitted their blood glucose and blood pressure levels multiple times a week.
While telehealth helped improve patient health through medication adjustments and lifestyle changes, it also resulted in more work. There were an average of 14.1 nursing activities related to monitoring blood glucose levels, reminding patients to submit their data, consulting with primary-care providers and making referrals for the home-based patients and 7.3 for the in-person cohort over a 12-week span in 2014, according to the study published in the Western Journal of Nursing Research.
"What we see in the literature is that telehealth is very effective at bringing resources to patients and effective at delivering high quality care. But we don't have a lot literature or research on what goes on behind the scenes," said Chelsea Howland, lead author of the study and a doctoral student at Missouri's nursing school. "For participants who had an in-home monitoring system, there were more nursing activities related to diabetes and health education, more medication adjustments and more follow-ups with nurses."
Telehealth proponents are hopeful that telehealth, coupled with the right remote monitoring technology, can ease the burden of chronic diseases. Care for U.S. diabetes patients costs about $327 billion a year and about $53 billion for hypertension patients.
But while telehealth has demonstrated its convenience and flexibility, particularly over the COVID-19 pandemic, some are concerned that it could lead to redundant care, exacerbate health disparities and spur more fraud.
Telehealth often relies on a team-based treatment approach that leans heavily on nurses and advanced practice practitioners. University of Missouri researchers are worried that additional work could cause an already stretched and short-staffed nursing population to leave the field.
Howland experienced this firsthand with her dad, who has Type 2 diabetes. Telehealth has helped reduced access barriers for her dad, who would otherwise have to drive more than an hour to see the nearest endocrinologist, she said.
But to ease the care transition, clinic nurses should receive more training on how to best analyze and respond to blood glucose levels, blood pressure readings and other metrics, Howland said.
"There should be some additional training in how to integrate the technology into the workflow," she said. "We can't expect nurses to use these tools successfully without better understanding the impact it will have on their workload."