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Question:

Prepare a report on new technologies available to rural health care providers for post-hospitalization follow-up care and monitoring. In your report, summarize the issues, identify and explain technologies, and recommend evidence-based strategies to improve outcomes. 

Answer:

Introduction

Research has given evidence of inadequate health care services in rural areas. Health care services have always been critical for rural residents leading to serious disparities. There are several barriers to health care access in rural areas as these places are underserved by primary care providers. In spite of the advancement in technology, rural people are highly represented in death and disease. There has been a considerable change in the health care delivery system in rural areas which intensified the need for innovative approaches to improve the clinical outcomes. About this issue, the report will provide an insight into various factors contributing to the above problem. Further, the use of information management tool will be explained and recommend new technologies to be adopted to improve the rural health outcomes.

Challenges do health care providers face in rural areas

In U.S one-fifth of the total population resides in rural areas. The 2000 or so hospitals in the nonurban region provide treatment to the patients who are mainly sicker, older and less affluent in comparison to the urban population (Dykes & Collins, 2013).  As per Granger et al., (2013) the health care services are bereft in vast stretches of rural America. According to (Johansson et al., 2014) the primary reason for the health crisis in the rural setting is the regional challenges.

 The rural population is highly disadvantaged as they have to travel the large distance to reach hospitals and clinics as physical topography is the effecting factor with mountains, forests and other transportation difficulties and complications added by climatic conditions. The communication system is also highly variable in remote areas. Hospital in remote locations has high difficulty in retaining and recruiting highly qualified medical professionals due to limited funding and constraint of resources. Unlike cities, the rural areas do not have many population health requisites such as more primary care doctors or specialists. Moreover, they have less money to spend on expensive treatment processes, information technologies and have lesser economies of scale for leveraging and purchasing with payers and vendors (Traynor, 2011). 

The low health status in rural areas of Latin America and South Africa correlates with the concentration of poverty. According to Kronenfeld, (2014) per capita income of these rural populations is $7,317 less than urban counterparts. According to Jones et al., (2015) majority of the residents in rural areas do not have health care coverage provided by an employer or the prescription drug coverage and the Medicaid benefits. According to the statement of “National Rural Health Association” in U.S, 56 rural clinics have closed, and 223 are on the verge of closure. There are only 36 dentists per 100,000 population in rural areas compared to that of 56 in the urban location.

Chronic conditions like diabetes, cancer, AIDS are not well monitored or reported in rural areas due to lack of adequate equipment, instruments for diagnosis and imaging (Carrington & Tiase, 2013). Evidence-based research has highly enhanced the health outcomes in several parts of the world as it includes the use of treatment methods that are approved by eminent researchers and physicians. In rural areas, Evidence-based research is less likely implemented.

How can technology increase access to specialists

Facilities such as Telemedicine or video conferencing help specialists in a secured transfer of data (Hirakawa, 2014). It enhances the remote interaction between patients and caregivers. It is highly beneficial in rural areas due to the shortage of physicians. Lack of training in rural areas affects the implementation of this technology.

Use of Electronic health records helps the providers to access accurate and complete health information of patients. Hence, the chance of the medical error is greatly reduced, and the diagnosis of patients problems becomes faster. Research evidence has confirmed the increase in patient outcome and safety with the use of EHRs (Blais, 2015). According to Baird & Miller, (2015) the patient heath information once recorded in the EHR, informs the physician during emergency operation about patient allergies that may be life threatening. This message helps in adjusting care even when a patiently is unconscious. Recently, Robotic surgeries are highly gaining importance as these are useful in performing complicated surgeries diligently. But these are highly expensive and time-consuming (Peate, 2013).

“Interactive voice response (IVR) telephonic communication to improve transition”- In the IVR system, communication between patient and the caregivers is enhanced. Automated calls inform about post-discharge health concerns. Automated telephone response was found to improve the health outcomes of diabetic patients. This model consists of pre- and post-discharge components along with structured patient forms for a record and maintaining their data such as forms for medications reconciliation, discharge preparation list and personal health records (Hirakawa, 2014). An experimental trial conducted by (Blais, 2015) this system has reduced “30-day re-hospitalization by 50%”.

Barriers prevent providers from adopting new technologies that increase access to care

The primary obstacles to introduction of Telemedicine or Telehealth system are:

Lack of coverage of private insurance, public assistance or health plans of state employee and lack of funds

Strict requirements and standards of Medicare for Telehealth

Lack of knowledge among rural patients and health providers regarding potential benefits and risks associated with emerging technologies

Lack of obligate networks between urban and rural areas including laboratories, mental health, child health, diagnostic imaging

Lack of sufficient e-health infrastructure

Providers lack the willingness to administer health services via new technologies but fail due to “risk of consent-based claims” and “malpractice laws”.

Lack of compatibility of modern operation equipment to implement robotic surgery. The first barrier to this includes poor technology. Cost is the other barrier in addition to time and lack of assistance (Kronenfeld, 2014)

Recommendations for technologies to improve the patient outcomes post-hospitalization

Being a worker of rural health care center my aim will be to further develop community care teams and.

I am going to use the fund received from health care foundation for making available new technologies for patients for the quick accession of emergency health services. 

Firstly, I will recommend the introduction of “Telemedicine”- it is the use of information technology and telecommunication to help health provider in monitoring chronic diseases, without traveling distances. 

Secondly, I will recommend the implementation of Electronic health records 

Thirdly, I will recommend the introduction of “Interactive voice response (IVR) telephonic communication to improve transition.” 

References

Baird, L. M., & Miller, T. (2015). Factors influencing evidence-based practice for community nurses. Br J Community Nurs, 20(5), 233-242.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Carrington, J. M., & Tiase, V. L. (2013). Nursing informatics year in review.Nursing administration quarterly, 37(2), 136-143.

Dykes, P., & Collins, S. (2013). Building linkages between nursing care and improved patient outcomes: The role of health information technology. OJIN: The Online Journal of Issues in Nursing, 18(3).

Granger, B. B., Zhao, Y., Rogers, J., Miller, C., Gilliss, C. L., & Champagne, M. (2013). The Language of Data: Tools to Translate Evidence for Nurses in Clinical Practice. Journal for nurses in professional development, 29(6), 294-300.

Hirakawa, Y. (2014). Current Situation and Challenges Surrounding the Communication Gap Among Health-care Professionals: Outlook of Rural Health-care Professionals and Medical Students. Journal of Rural Medicine,9(1), 43-44. 

Johansson, A. M., Söderberg, S., & Lindberg, I. (2014). Views of residents of rural areas on accessibility to specialist care through videoconference.Technology and Health Care, 22(1), 147-155.

Jones, M., Martinez, L., Muyambi, K., & Murison, J. (2015). Supporting rural mental health practitioners to practice evidence based care. Australian Nursing and Midwifery Journal, 23(4), 42.

Kronenfeld, J. J. (Ed.). (2014). Technology, Communication, Disparities and Government Options in Health and Health Care Services (Vol. 32). Emerald Group Publishing.

Peate, I. (2013). Health care technologies and working with rural communities. Journal of Paramedic Practice, 5(11), 610-611.

Traynor, K. (2011). Health care reform means challenges, opportunities in rural areas. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists, 68(2), 102-104.

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