House calls or phone calls when to use telenursing
How one company makes the call
You’ve heard plenty about telemedicine and telenursing, but that very well may be your only exposure to the topic. You should have noticed, though, that the home care industry is slowly but surely embracing the concept.
As a home infusion provider, it’s difficult to know if telenursing is practical to your patients. Jean Foltin, RN, BSN, vice president, clinical services for Cardiac Solutions, a disease management company based in Buffalo Grove, IL, says telenursing has numerous benefits to patients, physicians, and payer sources that providers can’t afford to overlook.
In fact, telenursing is integral in Cardiac Solutions’ business. Hired by health plans to provide the most effective, cost-efficient care for heart failure and post-cardiac event patients, last year Humana reported $9.3 million dollars in savings using Cardiac Solutions’ program. Foltin points out that Cardiac Solutions’ methodology sets it apart from most other disease management companies.
"While in person home visits are used to complete a baseline assessment, we use the common everyday tool the telephone to deliver the education, monitor the patient, and provide ongoing support," says Foltin. "Of our patients, 75% to 85% exclusively receive telephone care. The rest receive telephone care plus nursing visits, some of which are for emergent intervention like IV Lasix administration."
She adds that Cardiac Solutions uses very structured, detailed interview tools to solicit information about the patient’s condition and status as part of its monitoring process. Even with such structure to the program, Foltin notes that the amount of contact Cardiac Solutions has with each patient is catered to the individual’s needs.
Establishing telenursing candidates
Most home infusion patients require at least intermittent in-person care. But looking at how Cardiac Solutions evaluates patients as telenursing candidates can help you reduce your own unnecessary visits when a phone call would be just as adequate and much more inexpensive.
After collaborating with the disease manager nurse to evaluate the physical and psycho-social data collected at the home visit, a determination is made about whether the patient’s needs can be met strictly through phone support or phone support in addition to visits.
After the initial in-person assessment is done by a nurse, any additional nursing visits are kept focused and to the point.
"There can be many different treatments a patient may require, and if the only way to get that particular need addressed is by touching the patient, then the patient will be put on an ongoing home visit care plan," says Foltin.
But that’s not always necessary, even for home infusion patients. Kinked lines and changing a pump’s program may have required a visit in the past, but that is not always the case now. Proper equipment and patient education can significantly reduce the number of visits your nurses have to make. (See related stories, p. 29; Home Infusion Therapy Management, August 1997, p. 104; and HITM, July 1997, p. 93.)
Education assistance in making necessary lifestyle changes is a key component of the many services provided by Cardiac Solutions.
"We not only help people achieve lifestyle changes, we coach and counsel patients to sustain them," notes Foltin.
And when educating a patient on their prescribed treatment, she says the phone can help a nurse avoid many of the distractions encountered in a house call.
"In person, you compete with the TV, the pets, sometimes there’s a spouse or someone else in the house that can be a distraction," she says. "But when you talk to someone over the phone it’s just you and the patient, and the patient really has to concentrate. Our nurses have learned that it can be a more effective way to teach than in person because you get a person’s focused attention."
Becoming a patient’s cheerleader
Many times patients can provide their own therapy, such as simple infusions and regularly flushing their lines. By regularly monitoring patients, Cardiac Solutions can ensure each is following their particular care plan and the schedule for such therapies and services.
"Patients have to be educated, but their behaviors also have to be noticed so they can be applauded or modified," says Foltin. "We also have to be there for questions and to triage and troubleshoot. All that can be done in person, but in this day and age that tends to be an expensive way to get things done."
And with such monitoring, patients are thus more likely to adhere to their schedule and as a result become healthier faster.
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