Managing Chronic Illness with Telemedicine



What are chronic illnesses?


Modern medicine has brought us amazing advancements in our daily lives. Safe and effective medicines, vaccines, medical procedures and various diagnostic advancements have greatly expanded the lifespan of most people, even in impoverished communities.



Changes in global health policies have democratised access to such innovations. In a space of only a few decades, humanity has greatly controlled many severe and often fatal outcomes of thousands of diseases.



There is epidemiological evidence of this progress. Measurement of average lifespan is one of these measurements. Even in countries, which are least developed, have shown astounding gains in lifespan, decreases in child mortality and decreasing incidences of many infectious diseases.



Expanding both male and female education, is the cause for overall decreases in global poverty. Additionally, unparalleled access to various consumer products have also altered our lifestyles.



In urban settings, most of us are accustomed to various options of transportation, consumer habits, availability of cheap fast food and luxurious habits. However such luxuries come at a heavy price, throughout all social classes people are under more stress and are exposed to harmful environmental toxins.



Survival against fatal infectious diseases of the past (communicable diseases) also comes at a cost; increased life spans have also increased our chances of lifestyle diseases, also known as non-communicable diseases (NCD) such as heart disease, diabetes, cancer, mental health illnesses and other long-term debilitating illnesses.



Such chronic diseases used to affect the older generations due to degenerative processes of a stressful life, however due to the accumulation of negative health behaviours (bad diet, smoking, stress etc) such diseases are occuring in greater severity at younger ages.



Chronic disease management is very difficult, expensive and a serious burden to the population, resources, and healthcare skills development and various issues that may negatively impact a country's health system.



The ongoing pandemic crisis has exposed faults in healthcare management, even in developed nations. Due to re-allocation of resources and personnel, it seems that interest in effective disease management (not related to coronavirus infections) Has severely affected the much-needed management of patients with chronic illnesses.



Social lockdown has greatly affected the way patients can reach specialised healthcare services, and the way providers can help far off communities as well.



Therefore much interest has been shown on the potential of Telemedicine, and Telehealth as a whole, to provide support of services in these times.



A process that allows safe, quick and affordable communication is an obvious advantage even before the global COVID-19 outbreak. It is an interesting phenomenon that patient empowerment by digital health (or mhealth) as a sustainable option for home treatments, is now getting a great deal of interest.



In this publication we will discuss the capability of telemedicine services to help patients with chronic illnesses, to better manage their treatments with patient-centered ownership and self monitoring.



Chronic illnesses, such as asthma, COPD, diabetes, heart failure and hypertension represent a significant burden of disease. Burden of disease is measured in Disability-Adjusted Life Years (DALYs), which reflect years of life lost from premature death and years of life lived in less than full health.



In high-income countries, asthma, COPD and diabetes represent 11.1 million DALYs or 7% of the total DALYs. As well as their significance from the perspective of those affected, chronic diseases also impose huge costs on the health care systems responsible for managing them. In the US, the direct health care costs for patients with asthma, diabetes, heart disease and hypertension were $52.1 billion in 1996. Lack of appropriate caregiver support is another issue that is often ignored.




Does telemedicine have a role in the management of chronic diseases?


Before considering this question, it is worth thinking about where telemedicine would fit into the disease management process. Most of us would imagine that closer involvement of health care staff with a patient who has one or more chronic diseases would reduce morbidity and perhaps mortality. There is some evidence, for example, that use of nurse case managers (combined with a patient education programme) is efficacious.



Use of case managers is one aspect of providing integrated care. Integrated care is commonly thought of as a process that seeks to achieve seamless and continuous health monitoring, tailored to the individual patient's needs, and based on a holistic view of the patient. There are several synonyms, such as disease management, care management, managed care and coordinated care. Integrated care programmes seem to have positive effects on the quality of care.





Impact of Chronic Illness Management to Health Systems…..before COVID19



Health systems worldwide continue to struggle with three seemingly intransigent problems preventing this achievement;


(1) inequity of access to health care resources due to residential location, ability to pay, as well as social and cultural factors


(2) uneven distribution of quality health care due to location decisions by providers and practice patterns


(3) cost inflation resulting from scientific and technological advances, medical specialization, and increased demand for medical services.



The aging of the population and their increase in the prevalence of chronic illness among them have exacerbated all three problem areas. Differences in equity and quality of health care continue because of the inability to resolve the discrepancy between the locations of medical resources vis-à-vis those requiring care.



Generally, medical specialists tend to locate in large population centers where they can draw sufficient patient volumes to support their practices and also be in proximity to specialized medical centers.



Due to the complexity of most chronic illnesses, it is necessary for a combined multi department cooperation to help the patient manage their symptoms and, acute flare ups, access to the right medications, regular checkups and of course a helping hand to caregivers to overcome additional challenges.



Such multilevel medical collaboration is not cheap.


A great deal of specialised attention is needed since most chronic illnesses affect various systems of the body. Heart disease, hormonal disorders, diabetes, neurological disorders and can affect other organ diseases. Additionally many may have a psychological component as well.



Mental health illnesses can often be due to a systematic disorder, or may even be a cause of worsening of a chronic illness.



Specialists from other medical disciplines have to share patient data, manage convenient appointments and coordinate the overall clinical management. This is not easy nor is it always affordable for patients.



Certain countries have shown great impact in creating a managed care system eg. national health coverage in Europe, Japan, South Korea, NHS in UK and other developed health systems.



Chronic health management in other countries is extremely poor. There are severe deficiencies in all aspects of population health education, clinical skills, good quality medications and the collaborative policies that standard practices depend on.



These deficiencies have been magnified since the pandemic. Cracks in healthcare management have become open for the public to see. Systemic corruption and other man-made faults have been exposed by failure to prepare for the crisis.



Fragmented health systems have become even more fractured.


It is with great misfortune that even though there is great media sensation on the coronavirus outbreak, there is no mention in public forums on the truly deeper public health emergency.



Failure to adapt and maintain quality care for the chronically ill patient will create an even worse pandemic.



The global crisis of heart attacks, strokes, depression, suicides and many other adverse outcomes of unmanaged chronic illness is just waiting to happen (or maybe occurring now, silently)




Why is this medical chaos happening?


It is not easy to identify the sole reason for most cases of clinical mismanagement. Most healthcare services take decades for it to be properly running and to receive the right amount of funds.



A sudden global pandemic is not always easy to manage with just a simple phone call or directive. Large amounts of resources and manpower needs to be mobilised in a short space of time, at the expense of other highly needed resources as well.



Complex problems require complex solutions as well



Most healthcare institutions cannot quickly manage so many difficult cases related to Covid19, even those with some experience dealing with other infective viruses eg. SARS



Another issue that may have worsened chronic care management is the mass quarantine lockdown. People are unable or unwilling to leave their homes, nor are they able to find transportation. Many medical personnel have had this issue as well.



Due to the global shortage in effective sanitation and personal protective equipment (PPE), even healthcare staff are hesitant to see so many patients like before, especially when many colleagues have fallen sick or have died.



Sick patients are scared to leave the home in fear of infection (chronic diseases make them more susceptible to worse coronavirus infections) and healthcare specialists are unable or unwilling to attend their practices.



This has been a perfect storm of inadequate management and reallocation of resources away from chronic disease care, on a global scale.



Telehealth to the rescue


In moments of crisis the true value of innovation can be seen. Healthcare innovation has been in the limelight in the past few months, more than it ever has in the past decades.



Remote digital healthcare has been created in various forms and in varying use over the past 20 years, even in developed countries like the USA and Australia.



The upcoming chapters will clearly define the benefits and opportunities created by telemedicine services to help chronic illness sufferers.




Introduction to Telemedicine & Telehealth


Telemedicine is a connectivity solution to help people connect with a healthcare professional using digital tools, such as video conferencing mobile apps.



This method allows people to choose their health care provider, make appointments, have a conversation/consultation, check diagnostic reports, receive electronic prescriptions and many other health related counselling. All this is possible even if both parties are not even in the same city or country.



Telemedicine allows safe, secure and convenient communication without the hassle of arranging a doctor's appointment, spending a lot of time and resources to and from the hospital, and of course the ability to save money in the long run.





To learn some quick tips that patients can use for their first virtual care visit, download the guide here:

viosapp.com/patientguide




How has telemedicine been used to support integrated care in chronic disease management?



The purpose of telemedicine has been in providing education (to improve self-management), in enabling information transfer (e.g. telemonitoring), in facilitating contact with health professionals (e.g. telephone support and follow-up) and in improving electronic records. That is, telemedicine has been used in both the process of care and the outcome as a part of the continuity of care.



Note that the term “telemedicine” has a wide definition – medicine practised at a distance – and a correspondingly wide range of telemedicine applications has been trialled in the management of chronic diseases.



The telemedicine interactions have been of two types, either taking place in synchronous real time (video-based conferencing) or asynchronously (transmission of data from a home glucose meter).



Monitoring applications (mhealth) have been entirely automatic (e.g. passive monitoring of activity using room sensors or IoT devices) or have required the patient to do something (e.g. transmit bodyweight values manually).





Managing chronic illness patients with virtual care


Chronic disease management continues to be a major concern for healthcare providers and their patients. A chronic disease is one that lasts three months or longer, such as cancer, type 2 diabetes, and chronic heart disease. Nearly half of all adults have a chronic disease and, almost a third of the population is living with more than one chronic condition. Just seven chronic diseases – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness – have a total impact on the economy of $1.3 trillion annually.



The greatest advantage of digital health is that it increases access to health care services, which would otherwise be a significant obstacle in many cases. Patients often have issues with healthcare access in terms of not being able to afford standard quality care, inadequate insurance coverage, knowledge deficiency in figuring out what type of doctor is required, geographic distance that needs to be covered to reach the nearest health centre and of course there are issues with follow-up care.



Telemedicine is unique in that it democratises healthcare communication to the masses – at least those with access to internet telecommunications and smartphone devices:



Increase Access to Specialized Care


Many patients currently living in a rural area, lack access to care facilities. They may have to drive long distances to see their primary care provider or a specialist, which tend to be in short supply in rural areas.



Patients with a chronic condition tend to have more trouble traveling long distances to see a care provider. They may suffer from a lack of mobility or have trouble sitting still for long periods of time. Patients with chronic diseases also tend to rely on specialized care when treating their symptoms, which can be hard to find in certain parts of the country, making it that much harder for them to see their care provider on a regular basis.



With telemedicine, patients can correspond with care providers, including specialists, from the comfort and safety of their own home. This increases the patient’s access to specialized care, while reducing the cost of care by lowering or even eliminating travel expenses. Some patients will see their condition get worse if they fail to see their care provider on a regular basis, but telemedicine can make it easier for patients to get the care they need.



Monitor Patient Lifestyle Changes


In addition to medication and other forms of treatment, patients living with chronic conditions may have to change their lifestyle with effective behaviour modification if they want their condition to improve. This may include changes in diet, quitting smoking, and getting more exercise. But when left to their own devices, some patients may have trouble following through on these kinds of treatment regimens, which means their condition will only worsen.



But when care providers can remotely monitor a patient’s condition, they will know whether the patient is following the treatment guidelines. If a patient has been overeating and not getting enough exercise, the doctor might have the patient step on a Bluetooth scale to see how their weight has changed. Doctors can use mobile devices and live video and audio to quickly remind patients to take their medication, eat healthy, or find ways to stay active, improving the patient’s chances of recovery.



Triage New Symptoms in Real-Time


Patients with chronic diseases may see a new symptom appear from time to time. This may be a minor concern, a sign their condition is deteriorating, or the start of a new chronic condition, this is often an acute presentation of a chronic illness. Some patients may decline to consult with their care provider about this new symptom until their health takes a turn for the worse, especially if they have to travel long distances or pay high fees for an in-person consultation.



But with telemedicine, patients can quickly consult with their care provider about the new symptom as it appears in real-time. The doctor will then either recommend a change in treatment or urge them to visit a local emergency room if the condition is serious. This ensures the patient will receive the care they need on a timely basis as opposed to ignoring the symptom all together.



Reduce Hospital Readmissions


Patients with chronic diseases account for 81% of all hospital admissions, which tend to be one of the most expensive aspects of care. But when doctors and specialists can remotely monitor a patient’s condition, they can help the patient manage their treatment regime, reducing their chances of being readmitted to the hospital.


This reduces the cost of care for both patients and care providers. Doctors can use telemedicine to make sure patients are keeping up with certain lifestyle changes, answer questions about medication, and triage new symptoms quickly to reduce hospital readmission rates.



Telemedicine can improve chronic disease management by keeping patients in touch with their care providers, reducing the chances of a lapse in treatment and hospital readmission rates. Without these digital tools, many patients will have trouble consulting with a care provider




What do Doctors think?



“It’s really interesting to me because in a lot of ways patients are even happier,

So many patients who come in to see me, like for a blood pressure recheck or to see how they're doing with their depression medications, see that it doesn't need to be in the office.

Most people have been totally blown away at how much can be done by telemedicine.”


Maria Barrell, DO

Family Medicine Physician in a California-based Primary Medical Group



Telemedicine has seen unprecedented adoption by healthcare specialists, who are traditionally resistant to technological innovation in the past, have now realised that this will help them ensure and even enhance their clinical practice.



Health care providers have noticed the following benefits to including telemedicine in their usual practice, either exclusively or alongside their clinic hours:


1 | Telemedicine allows social distanced communication so as to decrease unnecessary

exposure to infected persons


2 | Many doctors are able to build up their patient rapport to improve on their history

taking abilities


3 | Many insurance companies are increasing their coverage and reimbursements to

doctors who not only practice telemedicine but are able to provide preventative care

management for patients with chronic diseases


4 | Specialist and consultants are able to oversee difficult cases in many locations while

supervising junior staff without the need to physically travel between locations


5 | Theoretically, providers who may not be willing or able to carry out procedures by

hand can at least take on a teaching role to upgrade the skills of junior doctors


6 | Telemedicine provided by private organisations or startups may provide sustainable

revenue to some specialist who are otherwise not in great demand due to the

decrease in patient turnover



Healthcare providers are looking for ways to lower the cost of chronic disease management without negatively impacting the quality of care. Telemedicine, including what’s known as remote patient monitoring, can reduce the cost of chronic disease management.


Doctors and specialists can use live video and audio, mobile devices and other smart digital tools to manage a patient’s condition from a distance, reducing the need for in-person consultations.




Additional benefits to doctors can be discussed in a previous literature by clicking on the following link for a direct download.


Link to e-book – https://www.viosapp.com/ebook8




Is Telehealth affordable?


As innovative a solution may be, true customer success is defined by its affordability to the masses. Even a premium service can create customer loyalty with the right value, regardless of price



Nonetheless healthcare financing or more precisely health care provider payments is a very complex issue in modern medicine. Sustainable models and reimbursing healthcare professionals for their services is a very controversial topic amongst public health officials, hospital administrators, medical insurers and of course patients themselves.



Developed countries provide comprehensive universal health coverage funded by taxes. In some cases, robust medical insurance companies include chronic disease care as part of their managed care packages as well.



Unfortunately throughout the world, out of pocket payments are still the most common method by which patients can access specialist treatments and procedures. This is why complications of unmanaged chronic disease can lead to medical bankruptcy, as caregivers struggle to manage the necessary funds for expensive treatments.



Telemedicine providers have been trying to lobby for easing of regulations to allow flexible payment structures by patients and carers, so that the right specialist can provide much needed healthcare and lifestyle counselling to chronic disease patients, as affordably as possible.



Majority of telemedicine providers are eager to partner with medical insurance companies, to provide coverage to the communities in need. Even so, out of pocket purchasing of telemedicine services (by digital payments) is still relatively cheap compared to the cost of transportation, time off work, arranging babysitting, and of course the travel back home.



During the global lockdown, people have realised the deficiencies of the local health care systems. Many communities lack health centres, adequate healthcare staff, timely management and in many cases the total absence of any patient referral system. Due to mass desperation, people have become willing to accept telemedicine to at least have easy access to a provider – no matter how far away the consulting centre is.

The convenience of this specialist care is evidence of a novel method and minimising costs to patients



However it should be noted that a single telemedicine session is insufficient to create long-lasting health outputs. Effective care management requires long-lasting, continuous, responsive and adaptive relationship building between doctors and patience.



Therefore telemedicine is the ideal platform to provide the opportunity for patience to have any number of digital health sessions with a trusted provider, any time and anywhere as (most slogans go)



Naturally, successful chronic illness management requires almost weekly or monthly reviews to assess the compliance. The provider needs up-to-date health monitoring feedback; either through the patient records or through connected medical devices (medical IoT).



Again the issue of affordability arises as the patient needs to be motivated to purchase on demand sessions as recommended by the provider, or to purchase a care package according to various telemedicine providers. Both options may not be feasible for lower income groups (who are more susceptible to adverse outcomes of unmanaged chronic diseases).



The COVID-19 pandemic has sped up the process of innovation, not just in products but also in processes. Less stringent regulations and proactive partnerships by medical insurance companies have show great potential in making telemedicine even more affordable



A strong push by grassroots organisations, with strong consumer demand by patients can push for greater financial inclusion for affordable disease care, using digital health.





How can chronic disease patients get the most out of Telehealth?


Telehealth can be delivered in several different ways. Live (synchronous) videoconferencing which allows a two-way audiovisual link between health care providers or between a patient and a provider. Or, store-and-forward (asynchronous) videoconferencing where there is an exchange of recorded patient health information between providers or between a patient and a provider.


Overall, a virtual visit is similar to visiting a doctor’s office, but in these unusual times, more meticulous preparation is helpful.



The helpful patient guide can be used to prepare for telemedicine consults:

www.viosapp.com/patientguide




How will Telemedicine specialists help chronic disease patients?


Telemedicine is best thought of as a system of care that relies on information and communication technology to acquire, store, process, retrieve and exchange information in various modalities of care delivery. Its goal is undifferentiated from that of health care in general, namely to promote health and prevent disease, treat the sick, rehabilitate the infirm and disabled, alleviate pain and suffering, as well as provide support at the end of life.



As such, telemedicine constitutes an increasingly accepted option to meet the health care needs of a growing segment of the population while simultaneously addressing and reining in associated health care costs. This can be accomplished through connectivity, continuity, patient engagement, informed decision making, patient-centered care and positive health behavior.



Connectivity

The tools of telemedicine enable interaction and information exchange between patients and providers regardless of time and distance barriers in either real time or ‘store-and-forward’ modes. These interactions include continuous monitoring of older adults while living at home, including the collection of vital data, symptoms, and compliance with medication regimens as well as responding to questions and inquiries.



The underlying information and communication technology (ICT) has become a necessary and prominent feature in all sectors of modern society, including education, commerce, transportation, banking, entertainment, and of course health care. It is ubiquitous, versatile, user-friendly, and affordable.



Continuity of Care

Telemedicine systems are typically established as networks, some as hub-and-spoke and others as virtual networks involving participants in various locations connected electronically. The use of the EMR assures ready availability of patient medical history, allergies, medications, test results, etc. for all providers within a participating network. This constitutes a critical foundation for continuity of care.



Patient Engagement

The continuous availability and access to information exchange between a regular source of care, typically staffed by advanced practice providers (nurse practitioners or physician assistants with physician supervision) are managed through established protocols that provide patients with explicit guides concerning medication compliance, a variety of health behaviors tailored to each patient, as well provider assistance on an “as necessary” basis.


This assures patient engagement in a variety of activities, including regular reporting of relevant information, all aimed at minimizing symptom exacerbations and avoiding complications.



Patient-Centered Care Medical Home

Patient connectivity, continuity and engagement can be enhanced simultaneously in the “medical home,” also known as the patient-centered medical home, a team-based health care delivery system led by and under the direction of a healthcare provider. It is intended to provide comprehensive and continuous medical care to patients with a goal of realizing maximized health outcomes.



This concept involves the coordination of treatment (and chronic care management) so that the patients receive the necessary, appropriate and comprehensive care where and when they need it in a manner they understand.



Positive Health Behavior

This is a critical component of an integrated system. Patients are provided information and incentives to maintain a healthy lifestyle, as practical as possible to their context. This would include smoking cessation, moderate alcohol intake, balanced diet, exercise, and compliance with prescribed regimen. Periodic or as necessary relevant behavior assessments and educational modules are personally or electronically provided.



Informed Decision-Making

Informed decision-making refers to an educated and informed consent process. Traditionally in an outpatient setting, patients are provided relevant information regarding the nature of the decision to be made in their treatment, available alternatives, risks and benefits, related uncertainties and assessment of their understanding and eliciting patient preference. This is especially pertinent when symptoms of chronic illness call for more invasive procedures.




Questions to ask your telemedicine provider


Before initiating a telemedicine session it is important to verify the credibility of the provider. Most telemedicine services have strong employment/membership policies when vetting appropriately skilled and certified healthcare professionals.



After confirming a suitable appointment is made, prepare your surroundings for a comfortable telemedicine experience.


  • You may take some steps to make sure that the room you are in as well lit and quiet


  • Your mobile device is charged


  • If the session is arranged for a senior patient it may be advised to have a caregiver present alongside them for support and clarification.




During the session:

During the digital appointment it is important to provide as much information to your doctor in order for them to assess your condition, provides a practical strategy for you or even guide you to the next best step in clinical management



And you should be ready to communicate any prior diagnostic and laboratory information as requested. Most reports have a simple conclusion written by the technician, you may simply state this conclusion to your provider or show them the results or images.



A complete medication history is a vital part of any chronic disease management. Therefore you should clearly communicate what medications or procedures have been given. If the specialist it's not familiar with the drug name, you may simply show the medication package (which includes the generic name of the drug).



Clearly and calmly you may initiate a conversation with your provider. Fully describing the current health status, any acute conditions and any appropriate issues that you wish to discuss. Remember it is not necessary to go into much detail on the first day, chronic disease management is like a long lasting relationship, perhaps you may discuss additional issues on future telemedicine sessions as convenient.



For more tips and advice on ensuring a good telemedicine experience, you may read the patient guide that may help you prepare:

www.viosapp.com/patientguide



Essential patient history tips

Every disease has its own features that should be discussed, for the sake of simplicity the following important key questions may be asked to start the conversation:



  • Discuss your current medications


  • Ask about lifestyle tips for example types of exercises you can do


  • How to stop smoking cigarettes


  • How to decrease alcohol intake


  • Dietary advice


  • Causes of leg swelling or face swelling for patients with heart or kidney issues


  • Best way to lose weight


  • How to assess vision problems


  • How to motivate elderly parents to be more active


  • When to consider we know dialysis or kidney transplant


  • Effective ways to treat joint pains and miscellaneous aches


  • Questions regarding healthy ranges of blood pressure, blood glucose, and any other biometric measurements


  • Ask for mental health assistance


  • Quick remedies for any non-emergency acute conditions (related or unrelated to underlying diseases) such as rashes, tiredness, joint pains, medication side-effects such as dry mouth and others


  • Sexual disorders can be openly discussed in telemedicine due to data privacy and anonymity


  • Basic guidance on practical physiotherapy may be very useful


  • You may discuss with the provider on the need for additional diagnostic procedures perhaps requested by local physicians (bearing in mind that some differences in standard practice may exist between countries)



If a strong rapport has been created the patient may discuss the need for a physical visit with the current provider in person. This method is a better way of preparing both parties in terms of actual need for physical visit, arranging PPE, prior sanitation and other supportive measures which can be taken.



These are just a sample of common questions patients usually have with the doctor, before the covid19 lockdown. A telemedicine session does not seem so strange when considered as part of an honest conversation with an empathic caregiver.



Whether sitting face-to-face or through a glass screen, the core essentials of chronic disease management is based on a two-way communication, compromise, mutual understanding and a flexible approach to long-term benefits for both parties.




How will I know that I am getting better?


Patients of all ages, especially older adults, must be encouraged and supported to assume greater responsibility for managing their own health, including (a) the adoption of healthy life styles to mitigate, if not prevent, chronic diseases, reduce premature death, and diminish reliance on the health system; (b) compliance with prescribed medication regimens and treatment to avoid adverse events and ineffective dosage, and (c) symptom recognition and severity assessment to assure appropriate use of service.



Indeed, the failure to achieve optimal levels of population health, including older adults, cannot be accounted for solely by the quality or effectiveness of the prevailing health system.



One of the reasons why it is so difficult to treat chronic diseases effectively its because of their silent and long term onset. Disorders that affect heart function, blood glucose regulation, hormone balance and other necessary processes of the human body take a long time to manifest; such as tiredness, changing appetite, gradual weight loss or weight gain and other ambiguous complaints that are often ignored until the damage becomes worse enough to seriously impact our daily lives.



Often patients with chronic illnesses arrive at a doctors office in the later stages, although most illnesses can be managed by behaviour modification and proactive lifestyle changes, the sad reality is that most patients may not be motivated enough to change and therefore require constant medications (even surgical interventions).



Even in situations where patients receive good quality management in the form of specialist guidance, regular medication and other interventions, improvement can take just as long to notice as well.



Whether or not telemedicine will actually improve the quality of life of chronic disease patience is highly controversial. How we measure improvements in patient health depends on the following features:


  • Compliance with provider messages


  • Appropriate treatment plans according to clinical evidence


  • Available data gathered by high-quality research


  • Cooperation by telemedicine providers to analyse feedback



The important thing to consider, is that telemedicine will not actually cure anything. Incorrect or incomplete marketing messages may confuse patients as to what digital health will do.



Telemedicine by itself will not alter disease progress and any way


Telemedicine is meant to improve the communication between patients and qualified providers, so that a rapport can be created, even though both parties may be very far from each other.



What both parties do with this interaction, and what happens after the screen goes off is the most important aspect in comprehensive continuity of care in digital health.



A patient will only feel better when any of the following outcomes are established:


  • An empathic conversation with a qualified provider who has properly explained the disease condition, realistic projections, practical guidelines and is available for follow-up at the patient's convenience. (Modern medicine is actually centered around the providers’ convenience in terms of appointments, costs, coverage and other limitations that patients often complain about)



  • Availability and access to pharmacy delivery options at the patients’ site


  • At home or nearby laboratories support, if telemedicine provider request for any bloodwork


  • Legal support for providers and patients alike


  • Progress with regulatory changes to increase access and affordability from patients


  • Quality control from telemedicine providers



To truly measure customer success that is possible patient experience from telemedicine, there should be feedback options, for an open discussion to see if the right outcomes were provided in a timely manner.



There are two ways to measure the long-term impact of telemedicine on the health care system:


Quantitative analysis

Population measurements on changes in blood pressure, random blood sugar, weight loss, decreasing emergency visits, decrease in hospital stays, increased consumption of necessary medications and other markers.


Qualitative methods

Focus group discussions with random samples of patients who have used telemedicine, will allow for a subjective view on whether such a communication improves the quality of life of a patient.


A return to a functional way of life, even with some discomfort, is sometimes the most realistic outcome of chronic disease (even chronic pain) clinical management.




Telemedicine is not replacing medicine. It is merely another level of care.





Future of Chronic Healthcare Management with Digital Health


It seems that under the cover of this global health crisis, there is a renewed interest in digital health. Policymakers and medical insurers are greatly motivated to invest in preventive health initiatives – to preserve the quality of life of their constituents and of course to decrease the abnormally large costs associated with chronic health management.



Perhaps even the wider public may be motivated to participate in digital health innovation, since there was already a trend in health-related IOT devices (Fitbit) and the consumer demand in secure private health data systems. It is natural that greater participation in telemedicine-based health management will be part of the new normal as well.



In consideration of how people actually change their behaviours, it can be thought of as the way people generally put a value on practices that we have the greatest outcome, with the least amount of effort. The global economy is built on the premise of providing modern convenience in every form, therefore in order for telemedicine to become mainstream - a clear identification of convenient access should be well communicated.



Efficient management of chronic illness can be measured according to the improvements in the quality of life, decreased costs to beneficiaries and a decrease in overall mortality. Quite simply, any process that not only enhances the lifespan of the population, but also the quality of life gained, can be considered a monumental success.



To be considered as a long-term viable solution for people, an economic incentive should be placed to support such positive health choices. Tax breaks, decrease in insurance premiums and other benefits of taking a proactive role in one's health management (additionally greater reliance on telemedicine); may be the key to incorporating telehealth into a more intensive corporation in our daily lives.



Affordability of an innovation is a key driver to consumer acceptance





Conclusion


There is still much research required to fully analyse the impact of telemedicine in the private sector and the public sector, to boost up the capacity of a health system. There is much to consider when investing in telemedicine infrastructure as a viable healthcare solutionIn population health, in the post covid future.


Already many groups of people have shown favourable responses to available telemedicine solutions in their country. In developing countries such digital health may be the catalyst required by the government to promote telemedicine into mainstream public health care services.



“The benefits to patients are clear: greater engagement, more adherence, better outcomes. The benefit to clinicians is improved communication with patients, communication with patients’ families, greater collaboration with other clinicians, increased productivity, fewer no show appointments, etc. The benefit to businesses is lower costs, more learning, less recidivism, and ultimately, fewer demands on resources.


Even after covid is under control, people will still keep on using virtual care to a large extent.....”



Jane Metcalfe

CEO Neo.Life & Cofounder Wired Magazine







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