My grandmother is in her 90′s and lives around 200 kilometers north of Manila, Philippines. She’s cared for by a live-in informal caregiver and my little heartache is that I don’t get to visit her often. I’m a doctor and the least I could do is monitor how she’s doing. Her physical therapist drops in once a week, but leaves no beside record of the physical therapy regimen administered to my grandma.
I’ve heard that some households install a CCTV camera in their grandmother’s room, and monitor granny online from London or wherever they work. Others make regular phone calls, or at least sends a SMS to the caregiver to ask for updates. Given the concern and high care we give our grandparents, telehealth services similar to the ones described above could allow for regular monitoring of their condition, which would provide loved ones with security and peace of mind.
Telehealth for the elderly, or telegeriatric services could be provided more widely if local governments would take the lead. It would be great, for instance, if my grandmother could be enrolled in an elderly care program in her town. Aside from being a viable health program, this is also a politically attractive project. The elderly account for around 7% of the population and are influential voters. The question is, how do we induce mayors to include telegeriatrics in their health programs?
Government staff do not readily adopt new technologies for their workflow unless sanctioned by their supervisors. Telehealth is already widely practiced, albeit informally. Doctors and nurses often get SMS and voice calls from family and friends asking them for health advice for little complaints that are too minor to warrant an actual visit to the clinic.
How do we shift from informal telegeriatrics to more programmatic and sanctioned telegeriatrics? Telehealth improves health services when it enhances the interaction between the patient and health care team in between face-to-face visits (Rupper et al 2008). Smith and Clay (2009) recommend that adequate funding be provided by government to jump-start the development of telegeriatric services, and it seems to be the case for the Philippines. Funding is a start, and we also need to figure out the financial details for such services.
First, we can shift informal telehealth to the formal sphere by getting the municipal physician to start officially monitoring three elderly patients using SMS or voice. It could be monitoring blood pressure, blood glucose, or insulin administration, but we should keep the first cellphone-mediated interactions simple and low risk.
After a few weeks, a time and motion study can be done of the first three patients. If it took say five minutes to check on each patient per day via cellphone, then we can multiply that by the number fifty patients with a similar type of hypertension in town, then do the math in terms of financing it as a next phase. The arithmetic on the budget is a rough estimate, but it should help the program managers start designing a program for implementing telegeriatrics on a larger scale.