Utilizing Telehealth to Combat Childhood Obesity

Title: Utilizing Telehealth to Combat Childhood Obesity

Idea: Telehealth has made a profound evolutionary impact on the healthcare industry and has been successfully implemented by many healthcare specialties. Additionally, these programs have been associated with strong patient satisfaction (Shaikh, Cole, Marcin, & Nesbitt, 2008). Telehealth use can encompass disease prevention, health promotion, diagnosis, consultation, therapy and education (Hebda & Czar, 2013). Most importantly, traditional barriers to healthcare such as distance, mobility, and time constraints can be eliminated because the provider can directly interact with patients over great distances. In August 2011, as a process improvement project in compliance with the National Committee for Quality Assurance (NCQA) standards, Admiral Joel T. Boone Branch Health Clinic (Boone Clinic) within the Naval Medical Center Portsmouth health care system implemented the All About Me (AAM) program in an effort to improve the recognition, diagnosis and treatment of childhood obesity. We have currently enrolled over eighty plus patients. The attrition rate for weight management programs nationally, can be as high as 55-73% (Skelton & Beech, 2010) and fortunately for our patients, our rate is slightly lower than the national average. However, a lot of work still needs to be done to ensure greater compliance to correlate with better outcomes for our patients.
Our experience revealed common barriers specific to our patient population, which increased their rate of attrition and adversely affected their level of success. Transportation was a concern for some of the families who rely on one vehicle due to economic constraints. Military deployments also posed a barrier, often times leaving a single parent with multiple children and minimal social support. This further complicated any issues already faced with childcare and time constraints. Parents were understandably concerned over missed work days and missed school days, which can result in increased social and economic burdens. These barriers can hinder parents from seeking care, can delay care, and can contribute to missed appointments and increased rates of attrition.
Therefore, we propose an initiative utilizing telehealth to help combat childhood obesity in our military beneficiary population.

How it will work/pilot/timeline: Patients will be screened and referred by their primary care provider to the program. The initial evaluation will be conducted by the obesity champion provider and will include a thorough history, obesity related focused exam, review of baseline physical activity and dietary surveys, review of fasting laboratory results, and introduction into the program, including education on the telehealth process. The telehealth program will include a link from our clinic website that will focus on structured educational materials to help guide them during the program.
We will elicit the help of the school nurse to obtain clinical data. All program participants will be provided a prescription to include blood pressure, weight, and height measurements every three weeks for three months to complete the primary phase of the program. The parents or patient can email these readings to the provider every 3 weeks via Relay Health along with the patients’ dietary and physical activity logs. The provider or nurse educator will be given time to review the logs and measurements and can follow up with a conference telephone call with patient and parents to reset goals, provide positive reinforcement and trouble shoot potential setbacks. Our dietician could be consulted to provide counseling which could take place over the telephone or via Relay Health if needed. Follow up labs can be ordered and obtained at the families’ convenience, and results can be shared over the phone or through Relay Health. Once the primary phase is complete and progress is being made, patients can transition into the maintenance phase where follow up communication can occur every 1-2 month respectively. Face to face appointments can be made at any time based upon the needs of the patients or at the patients’ request. Reimbursement has been made possible due to The Telemedicine Act which encourages health insurers to establish reimbursement policies for telehealth providers to help facilitate the expansion of telehealth services (Atkins, 2011). We would need to be proficient and knowledgeable in coding to capture the time spent utilizing this system. This is currently the best alternative we have with the technology available to us. However, with funding, an additional option could consist of adopting a program consisting of a home monitoring system that includes a scale, BP cuff, and a computerized unit with a digital monitor. Information obtained will download directly to our computer system. The system is wireless and functions as long as the main unit is within 20 feet of the equipment. The computerized unit is capable of being programmed to deliver over 200 educational programs, which we can program to include nutritional and physical activity counseling. This unit can also be used to record dietary and physical activity logs as well. This system is utilized by other healthcare facilities to minimize hospital readmissions for their chronic patients and has proven worth the initial investment and has potential to help manage childhood obesity along with other chronic illnesses among our patient population.

Cost estimates: Funding could also be utilized to improve our MWR gyms to provide some kid friendly activities/programs. For example, swim lessons for kids is a great way to promote physical activity. Additionally, a cardio cinema room for both parents and kids with family oriented (ex: Disney) movies shown on a schedule would be useful and fairly inexpensive to maintain. We would need a dedicated area, a flat screen TV, surround sound, a few cardio machines, low lighting to mimic a theater environment, DVD player, somewhat similar to what adult fitness facilities have to offer. The younger children would benefit from an interactive video exercise room containing the latest advancements, such as, Dance Dance Revolution or any interactive high energy medium. Pedometers will be provided to help our patients get started on a walking program. Laptop lunch boxes could also be given as rewards to help promote packing healthy school lunches.

Readiness support: This initiative will indirectly support readiness by lessening the burdens placed on active duty parents. Additionally, deployed parents can stay more focused on their mission with the knowledge that their non-deployed spouse is better equipped to handle the needs of their family.

Significance and future consideration: Future trends in telehealth that can significantly impact our practice environment involve the use of sophisticated mobile electronic devices, such as, smart phones and tablets. Pediatric patients have grown up in a life exposed to technology and are more likely to use these services if they are technologically interesting. Therefore, we envision more expansion of applications and software for mobile devices that can facilitate telehealth not just in the patients’ home, but wherever they may be. Additionally, the increase in mobile capabilities provides more versatility to providers allowing them the opportunity to be engaged directly with their patients even if they are out of the office.
In our current clinical setting, we would appreciate applications for mobile devices in which the patients could maintain and track their own nutritional and physical activity data. Ideally, these applications would automatically download that data into their electronic health record for review. Currently, this process is done via paper documentation; however, the younger generation of patients would increase their level of participation and track their data better if it is digitally based and accessible to them at all times. An electronic system of this nature would also allow for future modifications to meet changing practice requirements. One thing is for certain, telehealth is here to stay and healthcare delivery will never be the same. We anticipate the younger technologically advanced generation will embrace this delivery of care without hesitation.

References: Atkins, C. (2011). A 2011 Recap of the 1996 Telemedicine Development Act. The Therapist, November/December 2011. Retrieved from http://www.camft.org/am/template.cfm?section =alpha_list&contentid=11108&template=/cm/contentdisplay.cfm

Hebda, T. & Czar, Patricia (2013). Handbook of informatics for nurses & healthcare professionals. (5th ed.). Pearson: Boston. ISBN: 13:978-0-13-257495-2

Shaikh, U., Cole S. L., Marcin, J. P., & Nesbitt, T. S. (2008). Clinical management and patient outcomes among children and adolescents receiving telemedicine consultations for obesity. Telemedicine and e-Health, 14 (5), 434-440. doi:10.1089/tmj.2007.0075

Skelton, A., & Beech, B.M. (2010). Attrition in Pediatric Weight Management: A Review of the Literature and New Directions. Obesity Reviews, 12, 273-281. doi:10.1111/j.1467-789x.2010.00803.x

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