Dean Holzemer

The Dean’s Desk | Thoughts from Rutgers Nursing Leadership

Rutgers Study Shows Promise of Telemedicine In Bringing Health Care Services to Underserved Urban Settings

Tuesday, May 2, 2017

William L. Holzemer, RN, PhD, FAAN
Rutgers University School of Nursing

For decades, technology has steadily expanded our ability to diagnose and treat patients. But we are still in the early stages of seriously leveraging communications and other technologies to provide better access to care – particularly for those who cannot easily reach a doctor’s office or hospital.

Telemedicine – using modern communications to examine a patient in one location and have doctors or nurses elsewhere make an assessment and decide on treatment – has been widely tested in rural areas and through the Veterans Administration. But there has been little experience in underserved urban settings

Looking to change that, the Rutgers School of Nursing recently launched a pilot study using telemedicine to provide wellness services in Newark’s Pennington Court – one of three public housing developments served by our school’s federally-qualified Rutgers Community Health Center. Like the center’s core operations at the bricks-and-mortar Focus Clinic and aboard a mobile van, services are provided by doctorally-prepared nurse practitioners and other nurses.

Results of the study were analyzed and detailed in a new report, Telemedicine Delivery for Underserved Populations in Greater Newark. The co-authors included Ann D. Bagchi, PhD, BSN, RN, an Instructor in our school’s Division of Nursing Science, and myself – along with several representatives of the Rutgers Business School and Rutgers School of Public Affairs and Administration. (If you would like to review the full report, please contact Dr. Bagchi at ann.bagchi@rutgers.edu.)

The team behind this study wanted to determine whether residents with low computer literacy and healthcare access needs (e.g., transportation barriers) would view telemedicine as a viable alternative to in-person, non-acute care.

Center personnel at Pennington Court used a laptop computer and telemedicine equipment – including a pulse oximeter, stethoscope, blood pressure cuff, and a pen light/camera – to collect patients’ vital signs and other clinical information and transmit them to a nurse practitioner located off-site through a secure system with videoconferencing.

Overall, patients gave favorable ratings to the quality of the visits, with the majority giving favorable ratings to the accessibility of telemedicine (ability and time to be seen) and the provision of care by the nursing staff.  Nine out of the 10 respondents said they were “likely” or “very likely” to recommend telemedicine services to friends and family.

Patients told us they liked the system’s efficiency and convenience, especially for those who have trouble getting out of the house (e.g., the elderly and those with transportation challenges) and the ability to avoid long periods in a waiting room. They also welcomed the freedom to deal with a doctor or nurse on short notice.

However, respondents were more ambivalent on specific questions regarding the utility of telemedicine services and their capacity to improve the quality of care that patients received.
A small number told us that they still preferred face-to-face interactions.

Nurses, for their part, cited the efficiency and convenience of telemedicine encounters as positive features of the system.

Although based on a very small sample of patients, our findings suggest telemedicine holds considerable promise in improving care for these low-income communities. It also shows us several ways the particular system could be improved to enhance care.

At the same time, it’s important to note that many new technology variations are coming on to the market now, and it will be critical for further research to determine which devices and would best meet patient needs in specific settings.

Looking ahead, it is clear that we need a need larger-scale, well-funded projects to test the feasibility, functionality, and acceptability of telemedicine services for underserved, urban communities.

 

 

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