Riding the Bus or Taking the Wheel - The Telemonitoring Choice
Friday, June 19, 2009
| Kathy Duckett, BSN, RN
About the author - Kathy Duckett, BSN, RN is the Director of Clinical Programs at Partners Home Care
Mr. I is 95 years old and is on the remote Telemonitoring program at PHC. He's doing this because he loves his home care nurse and she convinced him that this remote monitoring would help him stay out of the hospital for more than 3 weeks at a time.
Mrs. S told me, "I fired my cardiologist because of you girls. Because of you I realized that I would have stayed out of the hospital the last time if he had listened to me. Now I have a cardiologist who listens to me."
When most patients are told they have a chronic disease like heart failure, they put themselves on the “Chronic Disease Bus”. They think they know what to expect from the journey because Uncle Mike, or Aunt Alice, or Grandma, or Dad had the same disease and they watched what happened. With heart failure they “know” their journey will mean frequent trips to the doctor’s and to the hospital (about every few weeks) and they will get weaker and weaker until eventually their heart gives out and they die. They also know it will happen sooner rather than later because Grandma only lived a couple of years after her diagnosis. They know they should “watch the salt” because they heard Uncle Mike say that’s what the doctor told him to do, but it didn’t seem to make much difference for him, so why will make much difference for them? Besides, they like ham and they are going to die pretty soon anyway. Might as well make the most of the time they have left. They’re on the Chronic Disease Bus and the road before them is well laid out.
We hear that telemonitoring changes lives. That’s the hype, but the reality is different. Telemonitoring, in and of itself, doesn’t change lives. Telemonitoring is really just a 21st century biofeedback service. Remote monitoring combined with the “just in time” teaching provided by our telemonitoring nurses give our patients the information they need to decide if they want to change their lives. Increasingly, our patients decide whether their chronic illness controls them or whether they, as much as possible, control it. Telemonitoring doesn’t cure disease, but it gives them another way to understand the information that we, the healthcare clinicians, have been giving them for weeks, months, and sometimes, years.
Biofeedback is nothing new, but with telemonitoring, the delivery method has changed in a dynamic way. It helps them make connections they never made before so they can have the “aha” moment, connecting the hot dog they had while watching the Red Sox game to the 4 lb weight gain they have the next morning, or that bagel with cream cheese and caramel latte with their 350 blood sugar.
I’ve rarely had a patient say; “No one ever told me that I should decrease my salt” or “limit my fluids”, or “take my water pill”. They all know what they are supposed to do. What telemonitoring does is make them clearly understand why. Almost every patient has said in one way or another; “Now I understand what my doctor/nurse practitioner was telling me.” Or they will say; “I didn’t know I could feel this good and have heart failure.” They could tell you what they were told. They read the booklets we gave them; they just didn’t really believe us.
Telemonitoring gets them to believe what we’ve been saying, but telemonitoring is more than just the box, peripherals and questions they answer and send to us. The secret ingredient is really the human contact that makes it even more personal for the patient. It’s our staff who calls them up and prompts them to verbalize the connection, makes them say they see it. It’s Mary, who knows that Mr. B. has to talk about his kids and his garden before he’s ready to talk about his vital signs. Then he’s ready to listen to her help him make the connection between what he puts in his mouth and what he sees on the screen. It’s Jane, Sue, Elaine, and Betty who convinced Mrs. S that she knew the symptoms that told her she was getting worse and that she should call her cardiologist and tell him what she knew because she and her cardiologist were partners in her healthcare. And Mr. I? He was amazed that he could feel so good with his heart failure. He learned to love low-salt Italian sausage, take his weight every day and he stayed out of the hospital 117 days – the longest time since he was diagnosed.
We work hard to get our patients to stop just riding the bus of their chronic disease, and to take the wheel and control where that bus is going. It’s their health and each decision they make affects their health. We use telemonitoring and our clinical staff to show them how those decisions affect their journey. Not every one wants to take the wheel, but for those that do, we know we’ve helped them take back control.