Posted: March 18th, 2023

Research Critiques and PICOT Format Review

PICOT Format

In the United States, The COP (Chronic obstructive pulmonary) disease is one of top serious diseases that places a great burden on patients and healthcare system because it is associated with high rate of outpatients visit, hospitalization and readmission. In the last few decades, the COP has become the top public health issues with over 65 million cases of COP In the U.S., the direct costs of the COP disease is enormous reaching $32.1 billon because of the associated prevalence of the COP disease. The UK is facing similar problem where 1.6% of the population is suffering from the COP disease, and costs burden reaching £800 million yearly with direct costs of hospitalization reaching £800 million per annum, and direct medical costs reaching £625 million. However, the prevalence of the COP disease is likely to rise because of an increase in the ageing population.

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The telehealth is an effective healthcare intervention to manage the complication of the COP disease since the telehealth can assist in meeting the patients’ healthcare needs. The telehealth is defined as an exchange of information between the healthcare professionals and patients to meet the health needs of people suffering from COP disease using the electronic devices. (Brewster, et al. 2013). Essentially, the telehealth can provide a significant healthcare benefits for patients thereby reducing healthcare costs, mortality rates and departmental visits. (Greenhalgh, Wherton, Sugarhood, et al. (2013).

The purpose of this study is to provide a critique of quantitative and qualitative research that explores the effectiveness of home telehealth in monitoring patients suffering from COPD as well as identifying and analyzing the effectiveness of increased confidence, self-managing, and decreasing COPD exacerbation and hospitalization.

Qualitative Study

This study provides the critique of the research paper completed by Gorst, Coates, Armitage, (2016). While telehealth can provide considerable benefits to people suffering from the chronic obstructive pulmonary disease, nevertheless, many patients do not possess necessary skills to operate the telehealth electronic devices making 20% of patient abandoning the use of technology. Another barrier to the use of the telehealth technology is lack of technical skills of patients.. It has been noticed that many patients face challenges in manipulating the telehealth equipment. Thus, it is critical to identify factors that affect the patients decisions to continuing using the telehealth technology, and this issue is crucial in the mainstream telehealth goal for patients.

Research Problem

Analysis of the study show that the telehealth provides a significant benefits for people based on the scrutiny of different variables that include clinical settings, and demographic setting, nevertheless, patient decision to use the telehealth in the healthcare setting is not standardized. Although, some patients might decide to abandon the home telehealth, there are other participants who will embrace the technology to manage their disease. (Gorst, et al., 2016). These patients will still more at easy knowing that their disease can be managed at home by monitoring their vital signs, knowing when to contact the health professionals after being discharged from the hospital (Gorst, et al., 2016). The frequent transmission of the physiological data collected at home with no direct health professional intervention and the data transmitted to the health care professional for review reveals the ability of patients for self-management. (Gorst, et al., 2016, p. 3).

Research Objective, Hypothesis, or Question

The research objective is to identify the most effective way in using home telehealth to reduce the COPD complications, re-hospitalization and assisting patients in self-monitoring. Self-management of the disease can enhance self-esteem, decrease stress and complication related to the COPD. Although, some patients were not impressed in using home telehealth, however, they still realize the importance of telehealth in self-managing the disease. (Gorst, et al., 2016, p. 7).

The research question is as follows:

Does the use of telehealth reduce the current health problems of patients suffering from COPD?

While this study frames a question related to the research objective, nevertheless, Gorst, et al., (2016) does not provide the research question related to their study, which is one of the shortcomings of the study. The researchers ought to provide the research question or the research hypothesis and collect data towards answering the research question and testing the research hypothesis.

Literature Review

The study provides a comprehensive literature review to enhance a greater understanding of the benefit of telehealth for patients suffering from COPD. One of the examples of the literature used is Greenhalgh, Wherton, Sugarhood, Hinder, et al. (2013) who also explain the barrier of using the home telehealth. The weakness of the research is related to the participants’ cooperation and consistency in using the telehealth monitoring and understanding the importance of self-managing their disease. Greenhalgh et al., (2013), relates the difficulty of older population in using the new technology showing that the participants’ difficulty of adjusting the new technology will have a negative impact in self-management of disease. (Greenhalgh, et al., 2013). Despite a comprehensive literature review provided by the authors, no literature has provided the solutions to the barriers in using the telehealth technology. Typically, solving the barrier to the use of the health technology is pertinent to effectiveness of modern technology, and the solution to the problems is critical in continuing using the new technology.

Frame of Reference

The researchers used the phenomenological theory, and arranged data collected during the interview using six steps. (Gorst, et al., 2016, p. 3). The authors used the frame reference of participants that include age, gender, living situation, time of diagnosed with COPD, and time using the home tele monitor. (Gorst, et al., 2016, p. 2). Furthermore, during the study the table used was used to measure the equipment used, time of monitoring the vital signs, follow up and the health care provider who was involved. (Gorst, et al., 2016, p. 3).

Quantitative Study

Jakobsen et al. (2013) provides the benefit in using home telehealth monitoring in patients suffering from COPD. The authors identify the telehealth benefits that include decrease of re-hospitalization and decline in health care cost, increase self-esteem, and improving quality of life. (Jakobsen et al., 2013). While the authors argued that no risks involved in using the telehealth monitoring, however, participants required education and reinforcement of the symptoms to report to their health care providers regardless of use of telehealth monitor. The participants’ knowledge in using the telehealth monitor to prevent the risk of complications and detect early symptoms of exacerbation is still limited.

Protection of Human Participants

The researchers obtained appropriate consents from the participants. (Jakobsen et al., 2013 p. 6). Even though, the participants were randomly chosen and the specific criteria was used, there is no evidence that they were not voluntarily participated in the trial. The participants were informed about the equipment, the time of using the technology, they were taught in using the equipment and emergency contact was given. (Jakobsen et al., 2013, p. 4). The research was approved by the “Danish Regional Committee on Scientific Ethics and the Danish Data Protection Agency” (Jakobsen et al., 2013 p. 6). However, the researcher did not provide a comprehensive discussion on how the private information of the participants is protected. Typically, a protection of private information of human participants is very critical in healthcare research.

Data Collection

The researchers collected data using the quantitative research, however, the authors did not define in details the independent and dependent variable, but the independent variable can be identified as the patient using the monitor and follow the instructions given and the dependent variable can be identified as patient not readmitted to hospital at least one month after discharged. (Jakobsen et al., 2013). The randomized, open method, using a “inclusive criteria” was used in collecting data and choosing the participants in the study. (Jakobsen et al., 2013 p. 2). The participants were enrolled in a trial for a duration of “18 months.” (Jakobsen et al., 2013 p. 2).

The researchers were trying to identify if the telehealth monitoring helps in decreasing the participants visits to the hospital. (Jakobsen et al., 2013 p. 2). All participants were educated and evaluated prior to discharged, they were monitored daily through the electronic device and through the follow-up visits. (Jakobsen et al., 2013 p. 2).

Problem Statement in PICOT Format

P- The patients with COPD visiting the hospital more frequently. (Jakobsen et al., 2013 p. 7).

I-Improving quality of life, being home and able to self-manage the disease, decrease hospitalization time. (Jakobsen et al., 2013 p. 5).

C-The experience of participants will help in further research and intervention to improve COPD management by using new technology. (Jakobsen et al., 2013 p. 7).

O- The self-managing of COPD and prevent hospitalization.

Data Analysis or Management

Data was collected by monitoring the vital signs, records from the time at discharge, follow up visit, emergency room visits, re-hospitalization, and death. Another form of data that was obtain through the participants’ questionnaire regarding use of telehealth monitor. (Jakobsen et al., 2013 p. 5). The analyses were made using software and “a stratified cox regression.” (Jakobsen et al., 2013 p. 6). The paper trail was used for the survey letter done by the participants. (Jakobsen et al., 2013 p. 6). Even though, the researchers were very careful in preventing the bias related to the study using the “consecutive enrollment and central randomization,” some bias might have been incorporated in the study due to many factors such as the multiple health care professional involved. (Jakobsen et al., 2013 p. 7).

Quality of Study

The study was evaluated and accepted by Universities Hospitals and had peer reviews. (Jakobsen et al., 2013 p. 7). The randomized selection of participants and the criteria used in choosing them explains the importance of the research. (Jakobsen et al., 2013 p. 2).

Implication for Practice

At the beginning of the trial 175 participants were chosen, but the researchers were anticipating that some participants might abandon the study by the end of the trial, others to be re-hospitalized or dead. (Jakobsen et al., 2013 p. 5). The authors did not elaborate about the participants’ numbers at the end of the trial. The participants experience is not evaluated in the research that assist in understanding their view of using the telehealth monitor. Therefore, it is hard to have a clear picture of the research findings without having the participants’ opinion to analyze the data. These research can also be applied for patients with chronic disease such as Heart Failure in monitoring and helping them in self-managing the disease in their home.

Future Research

This study can help in further research for the benefit of using the telehealth monitoring for patients with COPD and other chronic disease. The collaboration of health care providers to monitor patients in their homes can be further evaluated. (Jakobsen et al., 2013 p. 7). Further studies can focus on the coherence of use of telehealth monitor, the motivation adherence to the program, the benefit of using versus of not using the telehealth, and the cost of using the device.

Conclusion

The articles analyzed in this study emphasis the importance of patients with COPD, self-managing their diseases and prevent hospitalization by using the electronic device. There is not enough evidence to support that telehealth monitoring will reduce the hospitalization. Further research is needed to address the barrier in using the telehealth technology. Nevertheless, telehealth monitoring is a tool that will empowers patients to take action in managing their disease. The patients understanding to care for themselves will enable them to take action and fight in improving their quality of life. The modern technology can be a great tool in monitoring the patients at home. Although, the re-hospitalizations might not be avoided entirely, nevertheless, the complications of COPD can be better monitored.

Reference

Brewster, L. Mountain, G. Wessels, B. et al. (2013). Factors affecting frontline staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs. 70(1):21-33. doi: 10.1111/jan.12196.

Greenhalgh, T., Wherton, J., Sugarhood, P., Hinder, S., et al. (2013). What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare. Social Science & Medicine, 93: 86-94.

Gorst, S., Coates, E., & Armitage, C. (2016). “It’s sort of a lifeline”: Chronic obstructive pulmonary disease patients’ experiences of home telehealth. Health Pyschology, 35(1): 60-68. Retrieved from http://www.medscape.com/medline/abstract/26148189

Jakobsen A. S., Laursen L. C., Ostergaard B., Rydahl-Hansen S., & Phanareth K. V. (2013). Open Access Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial: methods of a randomized effectiveness trial. Trials 14:280. http://www.trialsjournal.com/content/14/1/280


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