Web-based Health Intervention
The Committee on the Quality of Health Care in America was founded within the institute of medicine to enumerate the various strategies that would be used to improve the quality of healthcare within the country. In part, Bloomrosen and Detmer (2011) wrote that the committee published a critical report focusing on the issues relating to the quality of healthcare in the country. It was concluded that, the United States never consistently delivered the sort of high quality and adequate health care that the citizens deserved and expected. The report would also include a framework and strategies to ease the rendering of high-quality health-care. Specifically, the committee recommended that information technology would be used to ameliorate evidence based decision making and support access to information (Bloomrosen & Detmer, 2011). A national commitment toward building informational frameworks was called by the committee directed toward improvement of quality measurement, delivery of health care research into health and clinical aspects, clinical education, and support for consumer health (National Research Council, 2012).
The current healthcare system is characterized by extensive use of IT Solutions within its structure. Clancy and Cronin (2011) note that the past decade, specifically, has seen an emphasis on clinical processes and new technological knowledge concepts formed around patient care. In primary care, IT can be exemplified by use in: support of clinical decisions; computerized provider order entry; applications tailored for consumer health; prescriptions made electronically; telehealth and recording of health records electronically (Clancy & Cronin, 2011). This paper provides an examination and synthesize of current Internet health interventions in addition to proposing a sample interactive web-based health intervention, entailing a description of characteristics – participants, length, content, health interventions and duration – for Coronary Heart Disease (CHD).
Christensen, Griffiths, and Jorm (2014) note that cardiac rehabilitation (CR) is a proposed secondary prevention web-based health intervention offering education and support for patients diagnose with CHD to make lifestyle adjustments. For patients diagnosed with CHD, an effective internet-based health intervention would include a recruitment phase, followed by a registry period that culminates in patient follow-up. Eligible patients would be around 100 participants recruited from two large hospitals within the city, randomized into control (50), and intervention (50) groups. The age bracket for the participants would effectively range between 45 years and 60 years. A personalized lifetime medical health program would be framed around the theory of social cognition where daily short message services would be sent to the patients in conjunction with a supportive website. Recommended lifestyle behaviors to be adhered to would include: physical activity, smoking cessation, non-harmful alcohol use, and a healthy diet (Anderson & Taylor, 2014; Mezzani, et al., 2013). Exercise specialist and doctors’ appointments, for example, can be taken through video calls or prescriptions get filled through mobile applications. The predicted primary outcomes would be adherence to positive, healthy practice measured on a self-reported composite scale every two months. Secondary outcomes would then include adherence to medication, perceptions of illnesses, and episodes of depression or anxiety.
PICOT
The PICOT question hypothetically would state, “for persons aged 45 to 65 years suffering from Congestive Heart Disease (CHD) (P), does cardiovascular rehabilitation, and thereof cardiovascular (I), for patients at hospital compared to home attendees (C), have an effect on the peak oxygen exercise capacity and frequency of adverse outcomes (O) within six months (T)?” The question would significantly enable the researcher to determine the discrepancies of options available to encourage home attendees to adhere to the therapy; and if not so, could the home therapy be adapted to their need.
Population
The researcher will focus on patients aged 45-65. Being a nurse, it is easier to pick patients with recent episodes of Congestive Heart Condition (previous heart attack, heart surgery) and ask them to join the rehabilitation program. Eligible patients would be ideally being aged between 45 and 65 years.
One hundred patients are to be conveniently sampled from post-myocardial infarction patients who had reported to our metropolitan hospital. Patient inclusion criteria would be of those hospitalized between 5 days to 10 days and of age between 45 and 65 years, and a sex predicted maximum MET level based on a progressive cycle ergometry exercise test at baseline (Fletcher, et al., 2013). They should also write and read English. Patients who had undergone heart surgeries, those who are cannot attend the rehabilitation therapy at least twice per week, cannot participate in physical activities due to bodily limitations, have a previous participation in an out-patient cardiac rehabilitation program, or patients with artificial pace makers and a positive graded exercise test will be excluded from this study (Anderson & Taylor, 2014).
The 100 participants will be randomly grouped into two groups: 50 within the hospital and 50 home based. The hospital group will attend a minimum of 2 weekly rehabilitation exercises and supervised by a kinesiologist and an exercise specialist for at least 4 months.
Intervention: Cardiac Rehabilitation
Eligible patients, thereof, will get an exercise plan specifically designed for individual patients to help them improve their habits. Recommended lifestyle behaviors to be adhered to would include: physical activity, smoking cessation, non-harmful alcohol use, and a healthy diet (Anderson & Taylor, 2014). The cardiac rehabilitation intervention will present patients a chance to undertake in various physical activities to include treadmill, running stirs, low impact aerobics, and cycling on stationary bicycles (Mezzani, et al., 2013).
Each warm up exercise session will last for a minimum of between 10 to 15 minutes followed by a cooling down session of stretching and walking. A 35 to 40-minute aerobic exercise on an arm or cycle ergometer, stair climbing, walking on a track, and a treadmill running will follow. Importantly, hospital participants are to be encouraged to do train for at least five days per week. The home group will be encouraged to attend a one-on-one session for one hour at baseline with an exercise specialist after a 2-month period of exercise training. Additionally, participants are to be recommended to exercise for a minimum of five days a week if possible. The five-day training would follow the routine of a 15 minute warm up, followed by a cooling of stretching and slow walking, 30 minute of self-paced aerobics, and walking.
Comparison
Home-Based Cardiac Rehabilitation. The home participants are to be encouraged to keep an exercise log, or enter their results in the web based application (Anderson & Taylor, 2014). They will have to key in information on the length of the sessions and recorded session heart rates. Importantly, the participants are to be telephoned after every week by the exercise specialist to monitor progress and assess adherence, and if necessary modify exercise protocols.
Prescriptions for exercises will be relevantly obtained from the peak MET and peak levels obtained during baseline grading exercises at the beginning and end of 2 months. At the intervention program, patients from the two groups are to be encouraged to adhere to dietetic guidelines provided and continue to participate participating in their maintenance program.
Outcomes: Frequency of Adverse Events (Aerobic Capacity)
The outcomes of the study are to be ideally measured after two months. A baseline measurement of aerobic capacity will be taken after 2 months followed by another one after four month of the intervention. The outcomes measure most relevant to the clinical questions would include the number of adverse cardiac events and peak exercise oxygen capacity and the health-related QOL (HR-QOL) (Guiraud, et al., 2012). Differences in Minimal Clinically Important Differences (MCID) for peak VO2 will be noted. An effective size difference of 0.2 to 0.4 for the SF-36 would be a significant MCID. On literate review, an effective MCID was nonexistence as literature into patient peak oxygen uptake for cardiac rehabilitation attendees (Guiraud, et al., 2012).
Time
The first stage of cardiac rehabilitation would be carried out over a period of six months. During the period, measurement of patient parameters, outcomes, and other support activities will be carried out. The period marked by patients working closely with health professionals: dietitians, nurse educators, and exercise rehabilitation specialists. The first phase will entail medical evaluation. The health team will check the physical abilities of the patients, any medical limitations and underlying medical conditions (Neubeck, et al., 2012). The second phase is physical activity: walking, treadmill, and all events highlighted above will be carried out here. The third phase will entail lifestyle education: Patients will be guided by nutritionist on how to shed weight and make healthier food choices (Guiraud, et al., 2012). The fourth and final phase will entail patient support: Patients will receive education of lifestyle changes and ways to adjust to healthy living. Management of pain and fatigue will be taught to patients. Support for anxiety, depression, and lack of touch will be effected (Guiraud, et al., 2012).
Reflection
According to Weston and Roberts (2013), the continued hospital readmission is one of the most occurrences for patients suffering from CHD. Available is a novel of ways to avoid these occurrences. The first way to decrease the hospital readmissions is to increase the knowledge of nurses concerning these diseases and further advance their technical abilities in patient handling (Neubeck, et al., 2012). CHD patients get readmitted to hospital because of the basic fact of lack of appropriate adequate education on the various management techniques they can employ or never implemented proper control techniques for exacerbations of the disease (Anderson & Taylor, 2014).
Recent investigations have pointed out that ensuring that Coronary Artery Disease (CAD) and CHD patients are properly educated and have an understanding of the situation lowers such adverse events (Anderson & Taylor, 2012; Mezzani, et al., 2013; Neubeck, et al., 2012). Education administered by nurses can help mitigate these readmissions. Orally instruction, in conjunction to written material and mobile applications (plus reference websites) are vital to improving patient self-care (Lees & Rock, 2014). A nurse using such devices to enlighten patients must in the first place also have a deeper understanding of the disease process for the creation of an effective face-to-face interaction prior to discharge (Anderson & Taylor, 2014).
Lavin, Harper, and Barr (2015) point out that the internet has proved as a promising medium for both patient empowerment and improvement of patient physical activity. Up to date and easily accessible patient-tailored information can be provided over the internet often in the most interactive way. A patient, for example, can be asked to pose questions or give examples to trigger either tailored or standardized feedback from the health care systems. Many eHealth systems have been availed for cancer patients, and such include online patient education programs, online support groups, mobile applications and various informative tools for decision support that all could be used independently of provider activities (Clancy & Cronin, 2011).
In a clinical setting, Kelders et al. (2013) note that the internet has proved useful in enabling caregivers to get a fast access to information that can assist in the diagnosis and development of suitable healthcare plans for a myriad of diseases. From an examination room, test results, patients record, and practice guidelines can be easily accessed over the internet. Healthcare providers can electronically consult with each other and discuss operational procedures or treatment plans for patients.
Kuijers et al. (2013) point out that the internet has supported a radical move toward more patient-centered healthcare, which has enabled patients and the public access to health-related information without assistance from health professional; consult with healthcare providers, other consumers, and administrators of health plans electronically; or best of it all receive healthcare at home. The internet has also proved vital in support of healthcare activities beyond the direct provision of care: Biomedical research, professional education, administrative and financial transactions, and public health surveillance are all other benefits accrued from the use of the internet (Bloomrosen & Detmer, 2011).
Conclusion
In essence, the nature of web based healthcare system that would be provided by the care plan is both patient focused and rich, where evidence based practices and information will transform patient actions from reactive to proactive. An ideal system in the 21st century requires the avail of actionable information to both patients and clinicians in time, with continued refinement of by-product of effective health-care delivery. The aim is not producing scientifically proper evidence for the sake, but address the challenging debates on how achieve this sufficiently without excessive invigorating as to forget what the actual goals are. The achievement of a patient focused, information rich is the real stumbling block core to the value of the project. The future as our ultimate heading, of course, will entail the establishment of the notion widely discussed over the past decade of integration of IT into patient care and creation of a learning healthcare system. The system will generate evidence as a byproduct, and the evidence will be ploughed back to feed healthcare providers so that they may become more skill sets and smarter with time.
References
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