Develop a PowerPoint Presentation in regards to the issue of Advanced Practice: Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.? This top
Develop a PowerPoint Presentation in regards to the issue of Advanced Practice: Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.
This topic is important because patient access to technology varies significantly. Addressing this issue is crucial for improving health outcomes and reducing healthcare disparities, especially in underserved populations such as rural areas.
1. Identify a current research problem related to advanced nursing practice that is of interest to you. Include WHY this is a problem. (Limit response to no more than 3 sentences). Develop a research question to provide information about the research problem.
2. Based on your research question, do you believe it will best be answered by a qualitative or quantitative study ? Support your decision as to why you believe the answers would best be provided by the type of study you have chosen.
3. Select a middle-range theory and identify the application of nursing theories to your research problem.
Conduct a literature review ( PLEASE SEE Uploaded file with my literature review with 4 articles, and based on these articles, please create a PPT).
4. Based on your literature review answer the following questions:
If qualitative,
Identify the purpose of the study.
Briefly, describe the design of the study and explain why you think it is either appropriate or inappropriate to meet the purpose.
Identify ethical issues related to the study and how they were/were not addressed.
Identify the sampling method and recruitment strategy that was used.
Discuss whether sampling and recruitment were appropriate to the aims of the research.
Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study.
Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study.
Identify four (4) criteria by which the rigor of a qualitative project can be judged.
Discuss the rigor of this study using the four criteria.
Briefly, describe the findings of the study and identify any limitations.
Use the information that you have gained from your critique of the study to discuss the
trustworthiness and applicability of the study. Include in your discussion any implications for the discipline of nursing.
If quantitative,
Identify the purpose and design of the study.
Explain what is meant by ‘blinding’ and ‘randomization’ and discuss how these were addressed in the design of the study.
Identify ethical issues related to the study and how they were/were not addressed.
Explain the sampling method and the recruitment strategy was used.
Discuss how the sample size was determined – include in your discussion an explanation of terms used.
Briefly, outline how the data was collected and identify any data collection instrument(s).
Define the terms of validity and reliability, and discuss how the validity & reliability of the instruments were/were not addressed in this study and why this is important.
Outline how the data were analyzed.
Identify the statistics used and the level of measurement of the data described by each statistical test – include in your discussion an explanation of terms used.
Briefly, outline the findings and identify any limitations of the study.
Use the information that you have gained from your critique of the study to briefly discuss the trustworthiness and applicability of the study. Include in your discussion an explanation of the term statistical significance and name the tests of statistical significance used in this study.
Submission Instructions:
The presentation is original work and logically organized.
Follow current APA format including citation of references.
The PowerPoint presentation should include 10-15 slides which are clear and easy to read.
Speaker notes expand upon and clarify content on the slides.
Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).
Literature Review
Telehealth in Managing Chronic Diseases: Diabetes and Hypertension
Gurzhii Tetyana
St. Thomas University
NUR-611
Dr. Corzo-Sanchez
July 13, 2024
Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.
Telehealth is the method of healthcare delivery using communication technologies, including computers, tablets, smartphones, remote monitoring devices, and wearable technology. While the adoption of telemedicine has increased in recent years, its role in improving care provision during the coronavirus pandemic has cemented its place as an important channel to deliver vital services. Telehealth encompasses prescription management and adherence to the treatment regimen, physical examination, nutritional evaluation, and patient education. This topic is important for research as telemedicine has great potential to manage chronic diseases and, specifically, address glycemic control and weight management in youth and adults. Addressing this issue is crucial as it helps to improve the ability of patients to self-manage their conditions and provide more personalized, professional, and safe management, resulting in improved life quality. The purpose of this paper is to provide a literature review on four RCT studies investigating trends and perspectives of using telehealth to improve symptoms and manage hypertension and diabetes.
SMS-Based Home BP Telemonitoring
Purpose
The goal of research conducted by Calderón-Anyosa et al. (2023) is to determine whether an SMS-based home BP telemonitoring system is strong enough to improve symptoms of uncontrolled high BP and decrease BP in patients receiving main treatment in a primary care center.
Subjects
Authors involve 38 patients in this RCT. 68% of research subjects are females, and their mean age is 68 years (Calderón-Anyosa et al., 2023). Current study includes patients with uncontrolled hypertension; 19 persons receive follow-up control, while 19 subjects receive intervention.
Methodology
Experts apply quantitative research methodology and use RCT design. The intervention group is engaged in the telemonitoring system, while the control group is offered the usual management.
Results
Calderón-Anyosa et al. (2023) discover a significant difference in diastolic BP change (-1.2 [6.4] mmHg versus -7.2 [9.8] mmHg) for control and intervention groups. A significant reduction in diastolic BP and values is also observed in those subjects who use telemonitoring if compared to the control group. Therefore, home BP telemonitoring based on SMS delivery is effective in decreasing diastolic BP, particularly when working in collaboration with primary care facilities.
Telehealth Intervention Versus Telemonitoring and Care Coordination
Purpose
Unlike previous research that compares telemonitoring systems and usual management of BP, the study conducted by Crowley et al. (2022) investigates the effectiveness of two interventions such as (1) comprehensive telehealth and (2) a simple telehealth approach based on telemonitoring and care coordination to improve symptoms in people with persistently poorly controlled T2DM. Here, the goal is to compare comprehensive and simple telehealth interventions and highlight their effectiveness in improving health outcomes, including HbA1c levels in patients who have poorly controlled diabetes.
Subjects
Unlike previous research that includes 38 patients with uncontrolled hypertension, current research randomizes 200 adults (45 females and 155 males) with persistently poorly controlled T2DM. 101 participants are involved in comprehensive telehealth, and 99 persons are engaged in telemonitoring/care coordination. Their mean age is 57.8.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Here, authors compare a comprehensive and simple telehealth intervention, consisting of care coordination and telemonitoring for T2DM.
Results
Current research supports findings of previous study despite the fact that authors discuss different medical conditions, they still highlight effectiveness of using telehealth intervention in chronically ill patients. Specifically, researchers reveal that changes in HbA1c constitute −1.59% (10.17% to 8.58%) in comprehensive group from baseline to 12 months. Moreover, at 12 months, those engaged in comprehensive telehealth, show greater improvements in self-effectiveness, self-care, and distress related to their diabetes diagnosis.
Telemedicine Management of T2DM in Obese Youth and Middle-Aged Patients
Purpose
The current research seeks to assess the effectiveness of telemedicine management of diabetes in obese youth and middle-aged patients with diabetes during the coronavirus crisis.
Subject
99 subjects are involved in research and complete the 6-month follow-up. 52 respondents are involved in the intervention group, and 47 individuals are involved in the control group. Their mean age is 47.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Authors randomly assigned 52 patients to the intervention telemedicine group and 47 patients to the control group (traditional outpatient clinic appointment) (Yin et al., 2022).
Results
Unlike previous research highlighting that comprehensive telehealth show greater improvements in self-effectiveness, self-care, and distress related to diabetes diagnosis, current one states that the intervention group demonstrates a decrease in postprandial blood glucose, triglyceride, and LDL cholesterol level and significant reduction in BMI.
Home Blood Pressure Monitoring and Videoconferencing
Purpose
The research seeks to explore the safety and effectiveness of telemedicine for managing hypertension in Japanese patients.
Subject
Unlike previous research that involves obese patients with diabetes, the current study includes 99 patients with hypertension, 54% of whom have untreated conditions (Yatabe et al., 2021). 49 persons are allocated to telemedicine, and 50 subjects are allocated to usual care.
Methodology
Previous studies and current research apply quantitative research methodology with RCT design. Here, the authors compare the effectiveness of telemedicine (monitoring and videoconferencing) and usual care in improving BP control.
Results
Current research supports findings of Calderón-Anyosa et al. (2023) highlighting effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP and state that antihypertensive therapy through home BP telemonitoring and video conferencing helps to achieve better BP control.
Conclusion and Direction for Further Research
Telemonitoring is an effective patient management approach involving various information technologies for monitoring clients at a distance. Besides improving adherence to treatment, the telemonitoring system increases awareness of disease. Due to the low level of control among people with hypertension, health experts propose telemonitoring blood pressure at home, thus increasing the proportion of patients with controlled conditions. Besides hypertensive patients, diabetic patients affected during COVID-19 can improve their self-effectiveness and management ability through telehealth technology. In the future, the use of SMS-based home telemonitoring of BP will have to be expanded in rural areas, and health providers should evaluate the utilization of this technology for longer follow-ups and involve a larger sample size. As most of the reviewed studies involve small size, it is necessary to determine the advantages of telemedicine use in treating hypertension and poorly controlled diabetes on a larger scale. In addition, current studies provide a solid basis for developing individualized telemedicine management models for chronic conditions.
References
Calderón-Anyosa, R., Tincopa, J. P., Raza, M., & Cárcamo, C. P. (2023). Randomized
controlled trial of home telemonitoring of blood pressure with an adapted
tensiometer with SMS Capability. European Journal of Investigation in Health,
Psychology and Education, 13(2), 440-449. https://doi.org/10.3390/ejihpe13020033
Crowley, M. J., Tarkington, P. E., Bosworth, H. B., Jeffreys, A. S., Coffman, C. J.,
Maciejewski, M. L., … & Edelman, D. (2022). Effect of a comprehensive telehealth intervention vs telemonitoring and care coordination in patients with persistently poor type 2 diabetes control: A randomized clinical trial. JAMA Internal Medicine, 182(9), 943-952. https://doi.org/10.1001/jamainternmed.2022.2947
Yatabe, J., Yatabe, M. S., Okada, R., & Ichihara, A. (2021). Efficacy of telemedicine in
hypertension care through home blood pressure monitoring and videoconferencing: Randomized controlled trial. JMIR Cardio, 5(2), e27347. https://doi.org/10.2196/27347
Yin, W., Liu, Y., Hu, H., Sun, J., Liu, Y., & Wang, Z. (2022). Telemedicine management of
type 2 diabetes mellitus in obese and overweight young and middle-aged patients
during COVID-19 outbreak: A single-center, prospective, randomized control study.
PLoS One, 17(9), e0275251. https://doi.org/10.1371/journal.pone.0275251
Evidence Matrix
Name: Gurzhii Tetyana Date: 07/13/2024
|
Author |
Journal Name/ Year of Publication |
Research Design |
Sample Size |
Outcome Variables Measured |
Quality (A, B, C) |
Results/Author’s Suggested Conclusion |
|
Calderón-Anyosa et al. |
European Journal of Investigation in Health, Psychology and Education/2023. |
Quantitative. RCT |
38 |
The aim of the study is to assess how SMS-based home BP telemonitoring influences hypertensive patients and their symptoms (Calderón-Anyosa et al., 2023). |
B |
Authors do not reveal a significant difference in systolic BP changes in control group (−7.2 [14.9] mmHg) and intervention group (−16.3 [16.7] mmHg). However, experts detect significant differences in diastolic BP changes (−1.2 [6.4] mmHg) for control group and −7.2 [9.8] mmHg for intervention group. In conclusion, experts highlight the effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP. This intervention serves as an important alternative option for controlling BP in hypertensive patients. |
|
Crowley et al. |
JAMA Internal Medicine/2022 |
Quantitative. RCT. |
200 |
The aim of the study is to address gaps in clinical evidence that hinder the smooth utilization of telemedicine in poorly controlled T2DM by comparing simple and comprehensive telehealth interventions. |
B |
From baseline to 12 months, changes in HbA1c constitute −1.59% (10.17% to 8.58%) in the comprehensive group and −0.98% (10.17% to 9.19%) in the telemonitoring group. At 12 months, clients involved in comprehensive telehealth show greater improvements in distress, self-effectiveness, and self-care related to diabetes diagnosis. If compared to the conventional treatment approach, comprehensive telehealth improves multiple medical outcomes in patients with poorly controlled diabetes (Crowley et al., 2022). Current research supports using comprehensive telehealth for assigned medical conditions in health systems with relevant |
|
Yatabe et al. |
JMIR Cardio/2021 |
Quantitative. RCT. |
99 |
The objective of research is to examine safety and effectiveness of telemedicine for managing high blood pressure in Japanese patients. |
B |
Baseline BP is similar in both control and intervention groups, but the level of systolic BP at the end of the first year of intervention is lower in telemedicine group (125, SD 9 mmHg versus 131, SD 12 mmHg). The rate of SBP (135 mmHg) is higher in telemedicine group (85.3% versus 70.0%) than in control group (Yatabe et al., 2021). Antihypertension intervention through web-based visits and home telemonitoring helps to better control BP control if compared to traditional care. This safe alternative treatment requires further examination to reveal how offered interventions benefit patients with other chronic conditions. |
|
Yin et al. |
PLoS One/2022. |
Quantitative. RCT. |
120 |
The objective of the research is to estimate the effects of telemedicine management on obese youth and middle-aged people with T2DM during the coronavirus pandemic. |
B |
On 22nd day, the level of fasting glucose in the intervention group decreased if compared to the control group (p < 0.05), and the self-rating depression scale of the control group significantly increased in comparison with the baseline value (p < 0.05). At the end of 3 months, the level of FBG and HbA1c in the intervention group decreases if compared to the control group (p < 0.01) (Yin et al., 2022). At the end of 3 and 6 months, patients in the intervention group show a lower BMI if compared to the control group (p < 0.01). Authors conclude that telemedicine is an effective strategy to regulate blood glucose, lose weight, and relieve depression in T2DM patients. |
,
Citation: Calderón-Anyosa, R.;
Tincopa, J.P.; Raza, M.; Cárcamo, C.P.
Randomized Controlled Trial of
Home Telemonitoring of Blood
Pressure with an Adapted
Tensiometer with SMS Capability.
Eur. J. Investig. Health Psychol. Educ.
2023, 13, 440–449. https://doi.org/
10.3390/ejihpe13020033
Academic Editor: María del Mar
Molero Jurado
Received: 6 January 2023
Revised: 9 February 2023
Accepted: 10 February 2023
Published: 12 February 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Article
Randomized Controlled Trial of Home Telemonitoring of Blood Pressure with an Adapted Tensiometer with SMS Capability Renzo Calderón-Anyosa 1, Jean Pierre Tincopa 1,2,* , Mabel Raza 3 and Cesar P. Cárcamo 1
1 Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima 15102, Peru 2 Digital Transformation Research Center, Universidad Norbert Wiener, Lima 15046, Peru 3 Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima 15102, Peru * Correspondence: [email protected]
Abstract: Despite being a public health problem, less than a third of hypertensive patients manage to control blood pressure (BP). In this paper, we conducted a two-arm randomized controlled trial to investigate the efficacy of an SMS-based home BP telemonitoring system compared to usual care in patients with uncontrolled hypertension from a primary care center. This study was conducted between April and August 2018. Participants in the intervention arm used a custom-designed telemonitoring device for two weeks and were followed up for two additional weeks; controls were followed for 4 weeks. The main objective of this study is to evaluate the impact on blood pressure of a telemonitoring system using a blood pressure monitor adapted to send data via SMS to health providers in primary care centers for 4 weeks. In this trial, 38 patients were included in the analysis (18 in each arm), 68% were women, and the mean age was 68.1 [SD: 10.8 years], with no differences between arms. Among the results we found was that There was no significant difference in the change in systolic BP values between the control and intervention arm (−7.2 [14.9] mmHg vs. −16.3 [16.7] mmHg; p = 0.09). However, we found a significant difference in the change of diastolic BP (−1.2 [6.4] mmHg vs. −7.2 [9.8] mmHg; for the control and intervention arms, respectively p = 0.03). With all this, we conclude that an SMS-based home BP telemonitoring system is effective in reducing diastolic BP by working in conjunction with primary care centers. Our findings represent one of the first interventions of this type in our environment, being an important alternative for the control of high blood pressure.
Keywords: telemedicine; hypertension; primary care; short message system; monitoring
1. Introduction
High blood pressure is a public health problem, resulting in 15 million deaths per year worldwide [1]. The prevalence in Latin America varies from 30 to 50%; only 23% of men and 35% of women with diagnosed hypertension have their blood pressure under control [2,3].
In Peru, it is estimated that only 39.3% of those with hypertension are under treatment, and only 20% have their blood pressure under control [4], but in rural areas, this value can be as low as 4.9% [5]. Due to the low level of control of hypertensive patients, several studies have proposed telemonitoring measures of blood pressure at home, which has managed to increase the proportion of controlled patients. Current hypertension clinical guidelines suggest the use of telemonitoring both for the diagnosis and for the treatment of high blood pressure [6,7].
Home blood pressure telemonitoring is defined as the process by which blood pressure readings at home are transmitted to a central health information center or electronic medical record for use by healthcare providers and patients [8]. There is a large variety of telemonitoring systems, with differences in measurement methods and communication systems, including data transmission via Bluetooth, Wi-Fi, and telephone lines, among
Eur. J. Investig. Health Psychol. Educ. 2023, 13, 440–449. https://doi.org/10.3390/ejihpe13020033 https://www.mdpi.com/journal/ejihpe
Eur. J. Investig. Health Psychol. Educ. 2023, 13 441
others. The use of these devices may be limited in some contexts when they rely on external devices such as smartphones with Bluetooth technology or Wi-Fi hot spots at home [9], emphasizing the need for simple, cost-effective systems that are easy to use and acceptable to both patients and providers.
An alternative for the implementation of telemonitoring at home is the adaptation of blood pressure monitors for home use, enabling them to send data through text messages (SMS), a technology with wide penetration [10]. Some studies have shown the feasibility of adapting blood pressure monitors to send blood pressure data via SMS [11,12]. Despite the technological advantages of using this telecommunication system, there is little information regarding its clinical impact. The main objective of this study is to evaluate the impact on blood pressure of a telemonitoring system using a blood pressure monitor adapted to send data via SMS to health providers in primary care centers for 4 weeks.
2. Materials and Methods 2.1. Study Design
A randomized controlled trial was performed. The intervention arm received the telemonitoring system, while the control arm continued with the usual management. The main outcome was the difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at follow-up. The blood pressure monitors used in this study were adapted to send SMS using the services of a local mobile telecommunications provider.
The data were obtained confidentially. Personal identifiers were stored separately in a password-protected database to which only the researchers had access. The study protocol was registered on clinicaltrials.gov (NCT03524456).
2.2. Participants’ Enrollment
This study included patients with uncontrolled high blood pressure treated at the Condevilla health center in the district of San Martín de Porres, in the province of Lima. Patients with uncontrolled treated hypertension were defined as those with SBP above 130 mmHg or DBP above 80 mmHg [8].
The inclusion criteria were the following: (i) Patients older than 18 years; (ii) Diag- nosis of high blood pressure for at least 3 months; (iii) Uncontrolled blood pressure; and (iv) Under treatment with antihypertensive medication. Exclusion criteria were (i) Patients on hemodialysis or peritoneal dialysis for chronic kidney disease; (ii) Pregnant women, and (iii) Patients planning to travel or change of address within a month of enrollment.
2.3. Randomized Grouping
Patients were referred to the study by the Condevilla health center. If they met the inclusion and exclusion criteria, they were invited to participate in the study and asked to provide informed consent. Randomization was performed in complete blocks of size 4.
2.4. Sample Size
For a significance level of 95% and 80% power, a standard deviation of 10 and 12 mmHg for the control and intervention arm and a sample size of 20 participants per arm would be required to detect differences of at least 10 mmHg [13].
2.5. Intervention 2.5.1. Development of the Telemonitoring System
A commercial Omron Series 10® blood pressure monitor was used, which has USB (universal serial bus) connectivity from the factory. The USB port built into the blood pressure monitor was used to link it to the data capture and delivery module (Figure 1). The monitor itself was not modified. The cost of this equipment was around 70 USD. The accuracy of this monitor is recognized by the AHA (American Heart Association), and it has been used in other studies [14]. The equipment is easy to use and was designed
Eur. J. Investig. Health Psychol. Educ. 2023, 13 442
for home use, with an easy-to-set cuff and a large number display. It shows the values of systolic and diastolic blood pressure, as well as heart rate, on an LCD screen.
Eur. J. Investig. Health Psychol. Educ. 2023, 13 442
2.5. Intervention
2.5.1. Development of the Telemonitoring System
A commercial Omron Series 10® blood pressure monitor was used, which has USB
(universal serial bus) connectivity from the factory. The USB port built into the blood pres‐
sure monitor was used to link it to the data capture and delivery module (Figure 1). The
monitor itself was not modified. The cost of this equipment was around 70 USD. The ac‐
curacy of this monitor is recognized by the AHA (American Heart Association), and it has
been used in other studies [14]. The equipment is easy to use and was designed for home
use, with an easy
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