Diabetes mellitus is one of the most challenging medical health issues in the 21 st century owing to the complexity and duration of the follow up needed. According to Marcolino et al. (2013), epidemiologically the prevalence of diabetes mellitus has currently reached epidemic proportions. Given that the disease if not properly managed is associated with a high morbidity and mortality rates owing to multi-systemic complications associated with the disease. For diabetes to managed optimally organized, systemic, and coordinated approach is requisite with emphasis on self-care. With the recent uptake of telemedicine as a feature of offering patient care to patients located remotely, videoconferencing offers a great opportunity for the long term follow-up of patients with diabetes (Klonoff, 2009). It is in this regard, that this paper presents the rational to justify the need for implementation of videoconferencing as a telehealth technology tool for the long term follow up of patients with diabetes mellitus.
Relevance and Importance of a Needs Assessment
Conducting a needs assessment prior to implementing a project is important in identifying gaps that need to be filled by the project. According to Lee (2014), in the field of healthcare assessing the population needs before embarking on a project enables the implementers to align the efforts of the project with the existing patients’ needs. Should the organization fail to conduct a needs assessments, the likely consequence is that the project even if well implemented will not result to desirable positive outcomes that address patients’ needs.
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Issues Affecting the Long-term Outcome of Patients with Diabetes
Diabetes mellitus is a chronic condition that is associated with a myriad of complications in many systems over the course of the disease. As such, the patients require continuous follow up for the purpose of assessing the level of long term glycemic control based on the level of hemoglobin A1c (HbA1c), assessing physiological data such as blood pressure, evaluation of behavioral information such as dietary information and exercise patterns, and assessing for complications through examination of feet and retina among other systems (Duke et al., 2016). The access to specialist physician for follow up is a challenge especially for patients who are domiciled in rural areas. According to Klonoff (2009), videoconferencing as a telehealth technology offers a prime opportunity for the follow up of diabetic patients who would not otherwise have reasonable access to healthcare. As such, from a nursing perspective, videoconferencing will be used to offer diabetic education and monitor patients for adherence and compliance, and to offer diabetes education in order to reduce the incidences of complications from diabetes.
Safety requirements and Regulatory Considerations when Using Videoconferencing
Pertinent safety requirements and regulatory considerations need to be adhered to when using videoconferencing as a telehealth technology in the care of patients with diabetes mellitus. The strategy and recommendations on an appropriate, risk-based regulatory framework pertaining to health information technology, including mobile medical apps, that promotes innovation, protects patient safety, and avoids regulatory duplication was part of the Safety and Innovation Act passed by the United States Congress in 2012 (Marcoux &Vogenberg, 2016). Additionally, the Federal Trade Commission aims to protect consumers of telehealth through assessing the effectiveness of teleheath technologies. In line with this regulation, videoconferencing as a telehealth technology needs to be safe for the healthcare provider and the patient.
Patients Confidentiality and Privacy Protection
The maintenance of patient confidentiality and privacy are principles that govern the provision of care to patients in any setting (Marcoux & Vogenberg, 2016). Accordingly, utilizing videoconferencing to follow up patients on diabetic treatment is not any different. In essence, even while using videoconferencing to care for patients, it is imperative that patient information whether expressly revealed or implied should be handled with utmost levels of confidentiality and privacy. The issue of confidentiality is more important in telehealth because patient information is shared across online platform which significantly raises the possibility of patients’ information being accessed by parties that don’t have permission or otherwise should not be accessing (Mallow et al., 2016). In as much as most organizations have taken measures to protect patients’ information in a bid to maintain confidentiality and privacy, regulations such as the Health Insurance Portability and Accountability Act serve to provide a legal backing to such efforts. In this scenario of using video conferencing to offer long term follow up care for patients with diabetes, caregivers will require that patients open up to them with correct information regarding issues such as their adherence to medication, any new symptoms that could be pointers to possible complications, as well as any questions that the patients could be having regarding the nature of care they are receiving. As such, while adopting this technology of telehealth, it will be requisite to carry out the necessary security checks to ensure that proper safety standards of this technology such as secure login passwords are met order to minimize the possibility of sensitive information falling into the hands of other third party users.
Impact of Stakeholders and End Users in the Acquisition of Videoconferencing
Successful application of videoconferencing in follow up of patients with diabetes requires a collaborative input of all the involved stakeholders (Mallow et al., 2016). Notably, in this scenario the stakeholders involved include internal stakeholders such as the health institution’s management and the clinical staff such physicians, nurses, and podiatrist. The role of these internal stakeholders is mainly to facilitate the acquisition of the technology and to use it for the benefit of the patients, who are ultimate target of the technology. On the other hand, external stakeholders include the suppliers of the videoconferencing technology and the local and federal governing bodies. The role of the suppliers is to use the findings of the needs assessment to provide and maintain videoconferencing technology that will be sound, reliable, and cost effective means of communication between patients and caregivers. The regulation agencies play the overseer role of ensuring the technology is used in line with the applicable laws. The end users of the technology are the patients on follow up and the cooperation and commitment to utilize the technology is a key determinant in ensuring the success of the telehealth technology.
The input of all the aforementioned stakeholders needs to be coordinated and geared towards maximizing the benefits from the technology (Marcolino et al., 2013). In order to engage the stakeholders towards a collective vision for change, it must be reiterated that diabetes has a significant morbidity and mortality rates and up close follow up is required for all patients regardless of their access. The management will then facilitate the acquisition of the technology for usage in patient care. In order to sustain the vision, scheduled appraisal for the technology is recommended to evaluate how effective the technology is in meeting the target objectives. The data provided from such reviews showing the beneficial impact of technology in having better outcomes for patients will be a useful tool in addressing any resistance from some stuff.
In conclusion, diabetes continues to be a significant public health challenge owing to the long duration of follow up and the likelihood of developing complications. Telehealth technology of videoconferencing holds at least the possibility of bridging the gap of poor access which will make the monitoring of various aspects of the glycemic control of the patients, In the process of acquisition and utilization of the technology, the input of all stakeholders both internal and external is requisite. Moreover, the issues of safety, patient confidentiality and privacy must be taken into consideration before rolling out the technology.
References
Duke, D. C., Wagner, D. V., Ulrich, J., Freeman, K. A., & Harris, M. A. (2016). Videoconferencing for teens with diabetes: family matters. Journal of diabetes science and technology , 10 (4), 816-823.
Klonoff, D. C. (2009). Using telemedicine to improve outcomes in diabetes—an emerging technology. Journal of Diabetes Science and Technology 3(4): 624–628 doi: 10.1177/193229680900300401
Lee, A., & Wong, W. (2014). The importance of needs assessment in planning health promoting schools initiatives: comparison of youth risk behaviours of two districts in Hong Kong. Asia Pacific Journal of Public Health , 16 (1), 7-11.
Mallow, J. A., Petitte, T., Narsavage, G., Barnes, E., Theeke, E., Mallow, B. K., & Theeke, L. A. (2016). The Use of Video Conferencing for Persons with Chronic Conditions: A Systematic Review. E-health telecommunication systems and networks , 5 (2), 39.
Marcolino, M. S., Maia, J. X., Alkmim, M. B. M., Boersma, E., & Ribeiro, A. L. (2013). Telemedicine application in the care of diabetes patients: systematic review and meta-analysis. PloS one , 8 (11), e79246.
Marcoux, R. M., & Vogenberg, F. R. (2016). Telehealth: applications from a legal and regulatory perspective. Pharmacy and Therapeutics , 41 (9), 567.
