Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases

Dr. Rashid Bashshur PhD Director of Telemedicine University of Michigan Health System Emeritus Professor of Health Management and Policy University of Michigan, School of Public HealthMedicalResearch.com Interview with:
Dr. Rashid Bashshur PhD

Director of Telemedicine
University of Michigan Health System
Emeritus Professor of Health Management and Policy
University of Michigan, School of Public Health 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bashshur: The impetus for this research derives from the confluence of several factors, including the increasing incidence and prevalence of chronic diseases, their associated morbidity and  mortality and their high cost. The search for solutions has taken center stage in health policy.  Patients must be engaged in  in managing their health and health care, and they must assume greater responsibility for adopting and maintaining a healthy life style to reduce their dependence on the health system and to help themselves in maintaining an optimal level of health.  The  telemedicine intervention promises to  address all these issues and concerns, while also providing ongoing monitoring and guidance for patients who suffer from serious chronic illness.

The preponderance of the evidence from robust scientific studies points to the beneficial effects of the telemedicine intervention (through telemonitoring and patient engagement) in terms of reduction in use of service (including hospital admissions/readmissions, length of hospital stay, and emergency department visits) as well as improved health outcomes.  The single exception was reported in a study among frail  elderly patients with co-morbidities who did not benefit from the telemedicine intervention.

There is an ever-growing and complex body of empirical evidence that attests to the potential of telemedicine for addressing the triad problems of limited access to care, uneven distribution of quality across communities, and cost inflation.  Research demonstrates the effectiveness of the telemedicine intervention in addressing all three problems, especially when patients are engaged in managing their personal health and healthcare.  The enabling technology can be used to promote healthy life styles, informed decision making, and prudent use of health resources.

Unintended consequences of delaying mortality for older adults may also increase the use of resources, especially in the long run, and society must decide on the ultimate values it chooses to promote.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bashshur: Clinicians  can appreciate the limits of the traditional in-person chronic care process in managing chronic diseases, as well as their current  and potential role in the management of chronic diseases, and the need for the type of innovation that is rendered by telemedicine by enabling the provision of appropriate care at the appropriate time and place instead of relying on the long-standing  “revolving door”  arrangement whereby chronically ill patients are scheduled for repeat visits at fixed arbitrary intervals, and often being forced to use the emergency department for interim disease exacerbations and problems.

Patients can learn and  appreciate the role of telemedicine in contributing to the adoption of healthy life styles and compliance with medical regimen, including proper diet, exercise and smoking cessation (among smokers) as well as medication compliance, behaviors which enhance their health and wellbeing, and also decrease their dependence on the health system.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bashshur: Future research must be concerned with

(a) methodological rigor (robust research designs, valid measurement, adequate statistical power for sub-group analysis, etc.),

(b) the fidelity of the intervention, choice of  the appropriate settings (in terms of maturity) with the appropriate level of strength and integrity, including type and range of clinical applications (type and range of services, technological configurations (telephone, video, cameras, scopes sensors, wearables, implantables… automated and non-automated, wired and mobile, communication mode (synchronous and asynchronous), manpower mixes (physicians, nurses, therapists managers, as well as organizational structures and protocols).  In other words, in order to ascertain the true effects of telemedicine, the concept (the independent variable) must be operationalized in explicit terms, preferably in optimal terms as a complex programmatic intervention, in order to assure cause and effect attribution.

Citation:

Telemed J E Health. 2014 Sep;20(9):769-800. doi: 10.1089/tmj.2014.9981. Epub 2014 Jun 26.

The empirical foundations of telemedicine interventions for chronic disease management.

Bashshur RL1, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, Bashshur N, Brown EM, Coye MJ, Doarn CR, Ferguson S, Grigsby J, Krupinski EA, Kvedar JC, Linkous J, Merrell RC, Nesbitt T, Poropatich R, Rheuban KS, Sanders JH, Watson AR, Weinstein RS, Yellowlees P.

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Dr. Rashid Bashshur PhD (2015). Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases 

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