Telehealth Strategies for Cardiovascular Nurses

Telehealth Strategies that Ensure Access for All Patients

Thank you to Diana Baptiste, DNP, RN, CNE, FAAN & Janelle Akomah, DNP, CRNP, FNP-BC for this article on telehealth strategies for cardiovascular nurses.

Since the COVID-19 pandemic, health care systems in the United States are facing challenges with sustaining capacity for health care delivery.^1,2 In this very “new normal”, telehealth services have been rapidly integrated into usual care practices. As the need for social distancing continues, health care providers are embracing the use of telehealth services for the management of patients with chronic conditions, specifically for those with underlying cardiovascular disease (CVD) risk factors.^1,2 Although there is still much to be learned about COVID-19, the detrimental effects of the disease on the cardiovascular systems have been well-documented.3,4 As a result, the implementation of protective public health and social measures will benefit the health and well-being of all patients, especially those with underlying cardiovascular conditions of hypertension, heart failure, coronary heart disease, and stroke.⁴

The Paradigm Shift in Telehealth

The rapid expansion of telehealth over the last year has stimulated a new paradigm for expanding access to care since the enactment of the Affordable Care Act in 2010.^5-7 The Centers for Medicare and Medicaid Services and many other payers have expanded their reimbursement to telehealth and telephone visits, further promoting access to care.^6,7 Additionally, the Department of Health and Human Services has temporarily suspended regulations for use of non-HIPAA compliant videoconferencing platforms to retain access to health care for those with limited access, further increasing access to care.⁶

Advantages and Disadvantages of Telehealth

Telehealth provides the opportunity for patients to engage in remote health visits, targeted to address non-urgent matters, promote medication adherence, and reduce the use of emergency department visits.⁷ There are many advantages for both patients and health care providers who use telehealth services. For patients, telehealth increases access to quality health care, preventive care, patient education, and lifestyle counseling, and results in fewer hospitalizations.^8,9 Additionally, these efforts can increase access for patients who face barriers such as limited access to transportation and childcare; telehealth may, therefore, eliminate barriers to timely care. For health care providers, telehealth can increase provider-to-patient interactions, improve the use of interpretation services for non-English speakers, minimize possible exposure to COVID-19 (for both patients and health care providers), and improve utilization of the cardiovascular care team.¹

Telehealth is designed to create a seamless transition from in-person visits to healthcare encounters via telephone, remote monitoring, wireless communications, or videoconferencing.⁷ In this era of advanced technology at our fingertips, it is easy to assume that all patients have access to a phone and computer. However, there are social, structural, and economic barriers for many who have low health and digital literacy or limited internet or computer access.^1,3 More importantly, we cannot assume that those who have access to technology always know how to use it.³ Additionally, disadvantages of telehealth include a greater incidence of undiagnosed cardiovascular disease cases and less monitoring for certain risk factors such as hypertension and high cholesterol.² Therefore, when considering the use of telehealth, cardiovascular nurses must not only consider the appropriateness of and any available environmental support for telehealth but challenges that are associated with telehealth access. Such challenges may include^3,6,7:

• Low health and digital literacy
• Poor access to electronic devices, webcams, and other audiovisual apparatus
• Lack of patients’ “buy-in” regarding the use of telehealth as an alternative to in-person visits
• Unstable internet, especially among those living in rural, underserved, or weather-stricken areas
• Patient privacy for those who live in communal living situations, close quarters, or multi-generational households
• Providers’ ability to perform assessments, monitoring, and observations via webcam
• Inadequate lighting and interference with background noise
• Hearing, visual, and/or cognitive impairment

With these challenges, nurses and various healthcare providers must embrace innovative approaches to ensure equitable telehealth access for patients. Due to the increasing fear and concern the pandemic instilled in patients, there is a growing need to advance technologically supported ways to manage individuals with chronic conditions and to minimize cardiovascular events.⁴

Strategies for Promoting Efficiency in Telehealth

As telehealth becomes a forefront solution to challenges experienced during the pandemic, it is imperative to generate strategies that enhance clinical experiences through the use of telehealth. Strategies for enhancing the clinical experience using telehealth include^6,7:

• Providing detailed instructions and guidance on utilizing telehealth
• Utilizing technology platforms that provide simplistic directions and user-friendly access
• Use of translation and sign language interpretation services
• Allowing nurses and providers various ways to contact a patient including via phone, text, or email
• Providing resources for patients to obtain affordable internet access, including utility companies offering free internet/hotspots to underserved areas
• Encouraging family-centered care, especially for individuals residing in multi-generational households
• Use of technology platforms that provide access to individuals with disabilities
• Employing support staff to assist/troubleshoot information technology issues

Cardiovascular nurses have always demonstrated dedication to improving the health of patients through advancing nursing practice and science. Utilizing the aforementioned telehealth strategies can afford the same opportunities to patients who are disadvantaged due to lack of access and resources. The COVID-19 pandemic has highlighted the importance of implementing innovative approaches to providing safe, quality care and reducing health disparities.³ Telehealth has provided cardiovascular nurses the opportunity to effectively care for and monitor patients during a difficult time when in-person visits are limited.^8,9

References

1. Jia X, & Kohli, P. Telehealth and Cardiovascular Disease Prevention: A Discussion of the Why and the How. 2020. Accessed February 20, 2021.
2. Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US. JAMA Network Open. 2020;3(10):e2021476-e2021476.
3. Dennison Himmelfarb CR, Baptiste D. Coronavirus Disease (COVID-19): Implications for Cardiovascular and Socially At-risk Populations. J Cardiovasc Nurs. 2020;35(4):318-321.
4. Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;75(18):2352-2371.
5. Goodman A, Fleming K, Markwick N, Morrison T, Lagimodiere L, Kerr T. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Soc Sci Med. 2017;178:87-94.
6. Warner JJ, Benjamin IJ, Churchwell K, et al. Advancing Healthcare Reform: The American Heart Association’s 2020 Statement of Principles for Adequate, Accessible, and Affordable Health Care: A Presidential Advisory From the American Heart Association. Circulation. 2020;141(10):e01-e614.
7. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585-1592.
8. Bhatt AS, Moscone A, McElrath EE, et al. Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;76(3):280-288.
9. Association AH. Expanding Access to Care Through Telehealth; Policy Position Statement. 2020. Accessed February 17, 2021.