Abstract
Technology has become an essential part of modern life, as well as of modern medicine. Nowadays, technology is essential to ensure high-quality patient care in both inpatient and outpatient settings. The impact that healthcare technologies have within different medical specialties and subspecialties may vary, since not all their effects have been studied and evaluated yet. Treating mental disorders co-occurring with obesity is a field that is increasingly applying technological advances as well, but the impact of different technologies might need further evaluation.
Health Care Technology in Treating Obesity
While a comprehensive approach consisting of appropriate medications, diet and physical activity program is necessary, remote communication with specialists is often applied to ensure adequate weight loss. Telemedicine is one of the most common ways to deliver healthcare services to patients suffering from obesity accompanied by mental disorders, such as depression. It is mostly used by health-care professionals to provide medical supervision during patient’s self-monitoring sessions. However, the study by Marešová and Hruška has shown that “the mobile applications and modern technologies should be considered as a tool with great potential for preventing obesity rather than its treatment” (2020, par. 4). Such supervision is especially important for patients with depression and anxiety, because they need constant mental support to continue following their weight loss programs.
Another research has examined 14 studies on the connection between the use of technology and successful treatment of obesity, none of which proved that there is any dependence (Rivera et al., 2016). However, mobile applications and other technologies have appeared to be useful in preventing mental disorders accompanied by obesity. This was particularly evident among young people, as they use mobile applications and telecommunications more. It can be suggested that using mobile applications for supervision and recommendations provided to patients with obesity is not going to present any significant costs, since the majority of people today use smartphones daily. The barriers, however, may include the fact that information and communication technologies, such as mobile applications, messengers and social media are often among the factors that either cause or contribute to mental disorders.
Care Coordination
One of the activities within patient care that are increasingly using technology is care coordination. For example, electronic health records (EHRs), used by the majority of clinicians, allow patients and health professionals to have better communication, ensuring easier access to health care for all patients. Care coordination is also used to solve the problems that patients with obesity and mental health issues face. Its advantages include “shared access of patient information between providers; high satisfaction with screening for mental health; and utility in promoting human rights for patients with mental illness in the correctional system” (Falconer et al., 2018, p. 2346). Since the health care system continues to change and become more complex, coordinated care is expected to remain necessary.
However, there are also some barriers to the use of care coordination in the treatment of patients with obesity accompanied by mental disorders. They include cultural barriers, underperforming EHR templates, costs and funding for health information technologies. The quality of such factors as “the functionality of clinical information technology; the availability of community resources; interactions with clinicians and patients; and self-care practices for mental health and wellness” plays a significant role (Friedman et al., 2016, p. 93). The study by Friedman et al. has shown that several factors can act both as barriers and facilitators in organizing care coordination activities.
Community Resources
Community resources play an important role in treating obesity and depression as well. First, medical professional societies regularly issue evidence-based recommendations and guidelines for health care professionals to use in the treatment of obesity accompanied by mental disorders. Some examples of these organizations include “the American College of Endocrinology, the Endocrine Society, the American College of Cardiology/Obesity Society” (Casanova et al., 2021, par. 3). In addition, organizations like the National Alliance on Mental Illness, American Psychological and Psychiatric Associations, Anxiety and Depression Associations provide help and support to people suffering from these conditions.
The main barriers to the use of community resources by the patients who need them are caused by the fact that they are not always easily available. For example, it can be “especially challenging in rural areas” to get access to community-based resources for obesity and mental health management (Casanova, 2021, par. 12). Therefore, societies and associations providing support to these patients might consider using telecommunications to integrate a more broad approach to obesity and mental health management in those regions.
Evidence Consistency
Most of the evidence on the use of health information technology, care coordination and community-based resources was consistent with what I see in my nursing practice. Health information technologies, such as EHRs and computerized physician order entry have revolutionized health care system and become an integral part of daily practice in all medical facilities. These technologies appear to facilitate and improve care coordination in my practice as well. For example, physicians often use telecommunications to support their patients, and due to the pandemic, this has been especially common and useful over the recent months. In turn, community resources have not been as present in my practice as in some other institutions, with an exception of recommendations of the major health organizations, which I receive as general treatment guidelines.
Policies and Standards
In recent decades, governments have begun to increasingly develop policies and provide resources to treat and prevent obesity accompanied by depression and other mental disorders. There is a number of programs currently in place that address the issue at the federal, state and local levels. Policies implemented on the federal level include “the Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC) Program, Child and Adult Care Food Program (CACFP) and the Healthy Food Financing Initiative” (Newman, 2019, par. 3). One of their main goals is to make healthy foods more available to people suffering from obesity in underserved communities.
The use of technology in healthcare is also regulated on the federal level. For example, health care organizations have to comply with the HIPAA rules, which include rules about information encryption, monitoring the use of PHI, and an automatic log offs to “prevent unauthorized access to PHI” (HIPAA Journal, 2016). Since the use of mobile devices and other technologies in patient care is becoming more and more common, it is important to address the issue of their compliance with HIPAA rules. Other changes implemented by the government include national programs like Medicare and Medicaid, which have a significant impact on care coordination. These programs can cover some treatments of obesity and mental disorders; for example, “Intensive Behavioral Therapy and bariatric surgery” (The National Council on Aging, 2021, par. 6). However, they do not provide any coverage of anti-obesity medications.
All initiatives implemented by federal, state and local governments that are connected to the use of technology, care coordination and community resources, have a considerable impact on my nursing practice. Together with nursing ethics, they define all the aspects of my work, because it has to comply with the laws and regulations introduced. However, despite the benefits that these policies have or may potentially have, it can be argued that they are still more effective in terms of preventing the problem, rather than treating it.
Interviewing the Patient
During the second 2 hours of my practicum, I talked to a person suffering from obesity accompanied by depression about their use of health technology, views on care coordination and community-based resources. A portion of the interview was conducted in the presence of their family, and another part of it was completed in private. The technology that the patient reported using most often was their smartphone. Like in cases mentioned above, this patient uses various mobile applications and telecommunications to manage their condition. For example, they use specific applications to manage the number of calories consumed every day, saying that it helps them feel in control of what they eat and when. They also use telecommunications for regular discussions with their therapist.
The patient was satisfied with care coordination they have been receiving, although there is not an immediate need for home care or transportation to the appointments. In connection to community resources, the patient said they do not use any of them, although several options are available in their area. The main reasons for it seem to be the stigmatization issues and insecurities that the patient has not overcome yet.
All this allows the conclusion that further policies might need to focus on the ways to remove the stigma that patients with obesity often face, and that only aggravates their physical and mental state. Another issue to be considered by further research is the fact that most measures still focus on preventing obesity co-occurring with mental disorders, rather than the ways of treating it. While prevention is essential, the clinical progress for patients suffering from these conditions needs considerable attention as well.
References
Casanova, D., Kushner, R. F., Ciemins, E. L., Smolarz, B. G., Chambers, E., Leaver-Schmidt, E., Kennedy, J., & Garvey, W. T. (2021). Building successful models in primary care to improve the management of adult patients with obesity. Population Health Management.
Falconer, E., Kho, D., & Docherty, J. P. (2018). Use of technology for care coordination initiatives for patients with mental health issues: A systematic literature review. Neuropsychiatric Disease and Treatment, 14, 2337-2349.
Friedman, A., Howard, J., Shaw, E. K., Cohen, D. J., Shahidi, L., & Ferrante, J. M. (2016). Facilitators and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators’ perspectives. The Journal of the American Board of Family Medicine, 29(1), 90-101.
HIPAA Journal. (2016). The use of technology and HIPAA compliance.
Marešová, P., & Hruška, J. (2020). Management of overweight and obesity: Technology-based interventions among Generation Y. Smart Homecare Technology and TeleHealth, 7, 1-8.
Newman, K. (2019). Everything you need to know about obesity in America. US News & World Report.
Rivera, J., McPherson, A., Hamilton, J., Birken, C., Coons, M., Iyer, S., Agarwal, A., Lalloo, C., & Stinson, J. (2016). Mobile apps for weight management: A scoping review. JMIR mHealth and uHealth, 4(3), e87.
The National Council on Aging. (2021). Obesity Treatment and Medicare: A Guide to Understanding Coverage.
