Literature Review
Researchers have invested in studying the effectiveness of telephone-based and online care in monitoring patients’ conditions in post-acute care. For example, McMahon, Fonda, Gomes, Alexis, and Conlin (2012) explored how telephone-based care and online care can improve patients’ adherence to treatment in the context of poorly controlled type 2 diabetes. The research concluded that both telephone-based and online case management of patients with diabetes improved their condition and overall well-being over a one-year period. Importantly, patient education is essential in the case of online- and telephone-based care due to the possible difficulties in using technologies.
Mavandadi, Benson, DiFilippo, Streim, and Oslin (2015) underlined the importance of telephone-based support for caring for patients. The researchers placed special importance on this method of communication for patients that stay at home and are not physically active, which is the case with older patients. Also, telephone-based case management showed to be extremely cost-effective due to the elimination of the necessity for patients to visit a healthcare facility to monitor their condition. Since researchers evaluated both primary and secondary outcomes of patients who used the telephone- and online-based care, it was also shown that their levels of satisfaction with the quality of care increased. Patient satisfaction levels are important for ensuring adherence to treatment and improving communication between them and healthcare providers. For older patients who experience difficulties with treatment adherence, using the telephone- and online-based care is an appropriate solution that will strengthen their awareness about the importance of treatment.
Maslakpak, Razmara, and Niazkhani (2017) compared the effectiveness of telephone-based care with face-to-face interaction in the context of improving self-care behaviors and overall patient outcomes. It was found that the “overall self-care scores in the intervention groups were significantly higher than that in the control group” (Maslakpak et al., 2017, p. 1). It is important to note that face-to-face interactions were more effective in encouraging patients to stay more active and adhere to dietary interventions; however, telephone-based care showed effectiveness in blood glucose monitoring and controlling other vital outcomes.
Husebo and Storm (2014) researched the effectiveness of virtual home visits for older adults. The study emerged from two issues, such as the worldwide challenge of expanding the population of older people and the shortage of healthcare personnel to address the growing demand for their services. As older patients lose their ability to care for themselves, innovative methods of follow-ups and evaluations such as virtual home visits become temporary solutions that require later development. The researchers concluded that the use of online care in improving patient outcomes could become key in “providing support and guidance in the patients’ self-management of medication” (Husebo & Storm, 2014, p. 8). On the other hand, virtual visits cannot replace face-to-face interactions and evaluations, although have shown to supplement them.
In the context of evaluating the effectiveness of online care for improving patient outcomes, it is important to mention the existing research on the use of electronic health records and other online services. Mold and de Lusignan (2015) suggested that the use of electronic methods for monitoring patient outcomes could provide significant benefits, especially with regards to educating patients and reducing nurses’ workload. It was found that the access to online services offered patients increased convenience and improve their satisfaction with the quality of provided care. On the other hand, the researchers identified several challenges of using technologies for monitoring patient outcomes; for instance, patients lacked enthusiasm and education when it comes to using online tools, the unavailability of resources (especially among impoverished or elderly patients) to engage in communication, as well as complications associated with the uptake of communication between patients and their healthcare providers.
Methodology and Design
It is proposed to conduct a randomized controlled trial involving patients aged 65 and older that have been diagnosed with conditions that should be monitored and evaluated regularly. All patients involved in the study should complete a preliminary examination and given a treatment plan that they had to follow at home. The participants will be divided into control and intervention groups; the intervention group will be educated on the use of online technologies and the telephone to contact healthcare providers and report health outcomes. The control group will be asked to use any methods they like to contact healthcare providers, including face-to-face visits and standard protocols for post-acute transitional care. The estimated timeframe of the study is expected to encompass twelve months, with outcomes being measured at the end of the intervention. The participants in both control and intervention groups will be asked to sign consent forms to show that they agree with the use of their health information.
Mixed-methods (quantitative and qualitative) research was chosen for this study due to the necessity of not only finding the correlation between the telephone and technology-based care and better health outcomes but also evaluating patients’ attitudes toward the intervention. While the quantitative aspect of the study will focus on quantifying the correlation between the telephone and online care and patient outcomes in post-acute care, the qualitative aspect will determine whether patients were satisfied with the outcomes of the intervention. It is important to note that the quantitative assessment will include the entire sample of participants; however, the qualitative assessment (face-to-face interviews with patients) will involve a small portion of the sample. The current research will be sequential explanatory, which means that the analysis of quantitative data will be conducted first, while qualitative data will be used to explore the previously collected quantitative information. It is important to note that the weaknesses of mixed-methods research, such as time consumption, unequal evidence, and resolving discrepancies; therefore, additional tools will be necessary for addressing the mentioned problems.
Sampling Methodology
Simple random sampling will be used for selecting the research participants, which means that each of them has had equal chances of being selected. A computer can be used for making a random selection since the expected number of participants will reach around 200 people. This sampling methodology was chosen for the ease of its implementation, unbiasedness, and the representativeness of the sample. Study participants will be approached at healthcare facilities and asked to engage in the study. Nurses and physicians will be asked to provide health data of eligible participants in order to compose a list, from which they will be randomly selected. Inclusion criteria for participants are associated with patients being sixty-five and older and being diagnosed with the condition that requires post-acute care. Because it has been found that the elderly require extensive care to help them transition to an improved health condition, the inclusion criteria will not include too many factors.
Necessary Tools
Necessary tools for the current research will include tools for data collection, analysis, and general procedures to guide the study. For the collection of qualitative data, interviews will become key tools. Interviews will allow for the creation of a social situation between the interviewer and the interviewee in order to facilitate a discussion on topics at hand. For the collection of quantitative data, researchers will conduct preliminary evaluations of patients’ conditions prior to and after the implementation of the intervention. The software will be used to perform quantitative calculations; computers will become vital tools for conducting the study since they will be used for sample randomization, thematic analysis of interviews, sending out information to participants, and communicating with healthcare providers.
It is important to mention that the assistance of nurses will become an essential tool for conducting the study because patients will report health information directly to them. In addition, the healthcare personnel will be asked to provide education to patients on the use of technologies and telephone to evaluate their adherence to post-acute treatment. Overall, the use of technologies in the research will facilitate the effectiveness of the study, reduce the amount of time necessary for data collection and analysis, and become a tool for communicating with patients.
To conclude, the research on the effectiveness of telephone and online care for post-acute care of older patients presents a variety of opportunities. Due to the increasing demands of the older population to receive quality care, the use of technologies can become a suitable solution. It is important to invest in patient education and the engagement of healthcare professionals into the implementation of innovative methods of patient care to achieve the best intervention outcomes.
References
Husebo, A. M. L., & Storm, M. (2014). Virtual visits in home health care for older adults. The Scientific World Journal, 2014, 1-10.
Maslakpak, M., Razmara, S., & Niazkhani, Z. (2017). Effects of face-to-face and telephone-based family-oriented education on self-care behavior and patient outcomes in type 2 diabetes: A randomized controlled trial. Journal of Diabetes Research, 2017, 1-10.
Mavandadi, S., Benson, A., DiFilippo, S., Streim, J., & Oslin, D. (2015). A telephone-based program to provide symptom monitoring alone vs symptom monitoring plus care management for late-life depression and anxiety. A randomized clinical trial. JAMA Psychiatry, 72(12), 1211-1218
McMahon, G. T., Fonda, S. J., Gomes, H. E., Alexis, G., & Conlin, P. R. (2012). A Randomized Comparison of Online- and Telephone-Based Care Management with Internet Training Alone in Adult Patients with Poorly Controlled Type 2 Diabetes. Diabetes Technology & Therapeutics, 14(11), 1060-1067.
Mold, F., & de Lusignan, S. (2015). Patients’ Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice. Journal of Personalized Medicine, 5(4), 452-469.