Literature Review

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Literature Review
HSAD 5253 Health Services Research

According to the American Telemedicine Association, “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health care (ATA, 2012). The Association also notes that telemedicine is associated with telehealth which is used to encompass a broader definition of remote healthcare that does not always include clinical services. This may include video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers. These functions are all considered part of telemedicine and telehealth. Hebda and Czar state that “telehealth can be done via teleconferencing, video conferencing and desktop video conferencing” (2009). Hebda and Czar note that video conferencing is a real time encounter that uses specially equipped personal computers with telephone line hookups, DSL, or cable connections to allow people to meet face to face over a secure video line, view patient medical history papers and medical images simultaneously. These types of conferencing can be used in real time or stored and forwarded to outside facilities.   This literature review will incorporate many different studies with data that provides information on whether telemedicine is viable for diabetic care. I believe with the research presented and the research to be conducted, diabetic telemedicine will be a useful tool in treating patients with this chronic illness. Telehealth group therapy, in-home treatment and one-on-one telehealth appointments will lower health problems of diabetic patients. The continued monitoring of these diabetic patients through a telehealth program will lower A1c, lipid, blood pressure, and other chronic medical conditions associated with diabetes. Telehealth uses many different types of care to help screen these patients as noted below. Telemedicine uses Store and Forward, Clinical Video Telehealth, and in-home patient device monitoring to accomplish patient care. Store and Forward appointments consist of imaging patients and then storing those images electronically and forwarding them to another treatment facility or provider in another healthcare facility. An example of Store and Forward would be diabetic teleretinal imaging. This is where the patient has pictures of their retina taken to look for any signs of diabetic neuropathy, glaucoma, macular degeneration (dry or atrophic), bleeding and other symptoms of blindness caused by diabetes. Clinical Video Telehealth consists of patients being seen in a remote clinic by a provider through live streaming video. This live stream is captured by a Global Education Cart that has special “peripherals” that help the provider on the other end of the transmission hear and see the patients focused medical issues. The Global Education Cart peripherals include a stethoscope, doppler, ear, nose and throat camera, dermatology camera, pulse oximetry monitor and several other specialty peripherals if necessary. The in-home patient device monitors include special digital glucometers that help patients upload their daily glucose readings to their provider. In-home patient devices are “sophisticated technologies that allow for the use of digital glucometers along with internet-based disease management portals and retinal imaging capabilities. From voice and e-mail to high-resolution images and video, the goal is to take advantage of every technology so that patients with diabetes can control their disease and lead normal lives” (Blanchet, 2008). The focus of the research in this literature review is predominantly on Clinical Video Telehealth and in-home patient device monitoring. The articles reviewed range from data and statistics of rural telehealth programs and the need for telehealth...
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