Remote Collaboration and Evidence-Based Care

Remote Collaboration and Evidence-Based Care

Hello and welcome. My name is Samson. Thank you for joining me today as I share a detailed, evidence-based care plan for a 50-year-old woman with hypothyroidism. The patient resides in a rural community and faces significant challenges in accessing specialized care. She is now living with ongoing symptoms such as fatigue, depression, and weight gain. These problems not only negatively affect her quality of life but also emphasize the role of coordinated, patient-centered care. In this session, I will take you through the proposed care plan, the evidence-based practice (EBP) model that I applied to make my clinical decisions, the most helpful pieces of evidence that informed the intervention, and lastly, the advantages and drawbacks of remote cooperation in her treatment.

Let me begin with the evidence-based care plan I developed.

My plan of care involves the enhancement of the safety and health outcomes of the patient through a multidisciplinary approach that comprises pharmacological treatment, lifestyle change, education, and remote monitoring. The underlying theory in this plan is the existing evidence-based guidelines modified to fit her living area and the restrictions in access to endocrinology care.

The first medical treatment is the introduction of levothyroxine, a synthetic hormone used on the thyroid, through titration starting with 1.6mcg/kg/day according to her weight stimulated. It is the conventional first-line treatment of hypothyroidism in line with the 2021 American Thyroid Association (ATA) guidelines. The endocrinologist recommended that TSH and free T4 should be monitored every six weeks and accordingly resupply the dose, which is supported by Bible et al. (2021). The pharmacist also gave proper medication counseling besides medication provision so that she knows she needs to take levothyroxine on an empty stomach and cannot use supplements of calcium and iron near the administration period of medication.

The nutritionist played a critical role in approaching her nutritional behavior. Emphasis was given on supplementing iodine and selenium with natural fatty fish, dairy, and Brazil nuts and teaching her to reduce in intake of goitrogenic food sources such as raw cabbages and soy. To be more specific, the patient was provided with meal plans and virtual check-ins to stay on track.

Since the patient lives in a geographically remote area, we incorporated telehealth visits as an ongoing means of follow-up. Notably, remote check-ins every month enable pharmacists to conduct lab reviews, PHQ-9 screening of depression, and check compliance with medications, as well as nutritional coaching. To help with the use of technology, we provided her with a simple patient portal that allows setting appointments, sending messages, and checking lab results.

This is a solid plan with room for improvement. It would be useful to determine the patient’s baseline lab values, particularly of TSH, free T4, and T3, to be able to more easily give the correct dose of levothyroxine. Also, her digital literacy, access to stable internet, and technology comfortability would guarantee an easier switch to a model of remote care. Lastly, the presence of a behavioral health provider may aid in treating her depression symptoms at large.

Let me now discuss how I Used the Iowa Model to develop the care plan.

To guide the creation of this care plan, I employed the Iowa Model of Evidence-Based Practice. This model was especially helpful in systematically addressing the clinical problem, prioritizing interventions, and facilitating interprofessional collaboration. The process began by identifying a problem-focused trigger: a rural patient with hypothyroidism experiencing poor symptom control and lacking access to endocrinology services. This was identified as a priority issue impacting her long-term quality of life.

The Iowa Model emphasizes the importance of team-based approaches. Our interdisciplinary team included a primary care nurse (myself), an endocrinologist, a pharmacist, and a nutritionist. We convened virtually to appraise and synthesize the best available research and practice guidelines on hypothyroidism management. We focused on three core interventions: hormone therapy, nutrition, and education delivered through telehealth.

The model can also be used in piloting interventions and evaluating them. Outcome measures in our case are patient-reported improvement of symptoms, normalization of thyroid hormone, improvement of PHQ-9 scores on depression, medication adherence percentage, and patient satisfaction with telehealth. Such data are useful to understand whether the care plan needs improvement or whether the same care plan can be used with similar patients in rural areas where care scale-up is possible.

Now, let’s reflect on the evidence that informed my decisions.

In evidence-based practice, various forms of evidence came in handy during designing the care plan. The 2021 ATA Guidelines were the most important clinical reference. The recommendations offer proper diagnosis testing, starting and continued dosing of levothyroxine, and observation. They are peer-reviewed, are widely adopted, and are frequently updated with the intent to reproduce the most recent research findings. In addition, Eghtedari and Correa’s (2023) study backed the initiation dosing of levothyroxine at 1.6 mcg/kg/day and discussed the crucial concerns that should be taken into account when defining dose titration and management. The study pointed at the dangers of under and over-treatment, such as adverse symptoms in the form of lingering fatigue and cardiovascular problems on the one hand and the development of osteoporosis and arrhythmia on the other.

Another valuable article, authored by Brunt and Morris (in 2023), showed that the Iowa Model could support the interdisciplinary application of evidence-based practice in clinical practice. The fact that they used the model in perioperative care was similar to our case as they also considered evidence, input of the team, and evaluation of the outcomes. To substantiate the remote care solutions, I referred to Peyroteo et al.’s (2021) research on managing chronic diseases through remote monitoring systems. The authors demonstrated that technology-augmented nurse monitoring had important benefits on medication adherence as well as reporting of symptoms in patients with limited access to face-to-face services.

It is worth noting that these sources were selected because of their methodological rigor, recent publication dates, relevance to hypothyroidism, and direct application to rural and telehealth care models. They provided a credible and comprehensive foundation for every component of the plan.

Let’s now talk about remote collaboration—the good and the difficult.

Remote collaboration was essential to the creation and delivery of this care plan. It allowed us to bring together professionals from different disciplines and locations to provide cohesive, comprehensive care for the patient. One of the greatest benefits was the speed with which we could share insights and reach consensus. For instance, the pharmacist’s immediate input on potential drug interactions helped us avoid errors and refine the timing of levothyroxine administration.

However, remote collaboration came with challenges. The patient experienced some internet connectivity issues that disrupted early video visits. Scheduling interdisciplinary meetings was also difficult due to providers’ varying availability. Additionally, the lack of in-person interaction made it harder to pick up on nonverbal cues that might have informed emotional or psychological needs. To address these issues, we implemented the SBAR (Situation, Background, Assessment, Recommendation) communication tool during all meetings and notes. This helped structure communication and reduce misinterpretations. We also designated a nurse case manager to ensure follow-up tasks were completed and to serve as the patient’s point of contact.

In the future, we plan to introduce a shared care platform that integrates messaging, scheduling, documentation, and video conferencing into a single interface. This will streamline workflows and improve efficiency. Adding a behavioral health provider to the care team would also better support the patient’s psychological health, which is often affected by chronic endocrine conditions.

What could we improve next time?

As we consider the plan, we can make a few improvements to make it more successful. To start with, we could introduce a standardized technology assessment tool that will allow us to measure the digital preparedness of a patient and modify the telehealth strategy accordingly. Not every patient living in rural communities can enjoy the same level of access to stable broadband, and some might be comfortable with speaking to a doctor via phone rather than by video. Second, we could include a mental health referral earlier in the treatment process. Hypothyroidism is characterized by depression, and this could be screened and referred to a telepsychiatrist, who in turn may resolve it sooner rather than at a later stage. Lastly, family caregivers can be engaged in virtual education sessions, which can increase adherence rates and decrease the feeling of isolation experienced by the patient. Evidence-based compassionate and digital innovation is a patient-centered strategy that guarantees continuity and long-term success.

References

Bible, K. C., Kebebew, E., Brierley, J., Brito, J. P., Cabanillas, M. E., Clark, T. J., Di Cristofano, A., Foote, R., Giordano, T., Kasperbauer, J., Newbold, K., Nikiforov, Y. E., Randolph, G., Rosenthal, M. S., Sawka, A. M., Shah, M., Shaha, A., Smallridge, R., & Wong-Clark, C. K. (2021). 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid, 31(3), 337–386. https://doi.org/10.1089/thy.2020.0944

Brunt, B., & Morris, M. (2023). Nursing professional development evidence-based practice. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK589676/

Eghtedari, B., & Correa, R. (2023). Levothyroxine. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539808/

Peyroteo, M., Ferreira, I. A., Elvas, L. B., Ferreira, J. C., & Lapão, L. V. (2021). Remote Monitoring Systems in Patients with Chronic Diseases in Primary Health Care: a Systematic Review (Preprint). JMIR MHealth and UHealth, 9(12). https://doi.org/10.2196/28285

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Remote Collaboration and Evidence-Based Care

For this assessment, you are a presenter! You will create a 5–10-minute video using Kaltura or similar software. In the video:

Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the case study presented in the Assessment 04 Supplement: Remote Collaboration and Evidence-Based Care [PDF] Download Assessment 04 Supplement: Remote Collaboration and Evidence-Based Care [PDF]resource. Add your thoughts on what more could be done for the patient and what more information may have been needed.

Remote Collaboration and Evidence-Based Care

Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decisions about the plan you proposed
Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario.
Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your video. Discuss why these sources of evidence are credible and relevant. Important: You are required to submit an APA-formatted reference list of the sources you cited specifically in your video or used to inform your presentation. You are required to submit a narrative of all your video content to this assessment and to SafeAssign.

Length of video: 5-10 minutes.
References: Cite at least three professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video. Be sure to format the reference page according to current APA style. Submit a narrative of all of your video conten.

Assessment 04 –
Remote Collaboration and Evidence-Based Care
Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve the outcomes the patient in the provided case study below, and examine how remote collaboration provided benefits or challenges to designing and delivering the care.
Before you complete the instructions detailed in the courseroom, first review the case study below.
INTRODUCTION
Gender dysphoria is a medical condition that occurs when there is a conflict between the sex assigned at birth and the gender with which an individual identifies. To provide quality care to patients with gender dysphoria who live in rural settings or have difficulty with transportation to a care site, healthcare professionals must sometimes collaborate with other professionals indifferent zip codes or time zones. This case study will observe how healthcare professionals collaborate remotely and virtually to provide care for a patient with gender dysphoria.
PATIENT INFORMATION
The patient is a 25-year-old transgender male who lives in a rural area and has limited access to healthcare services. He was diagnosed with gender dysphoria based on a behavioral health evaluation conducted by his healthcare provider. The patient has expressed interest in receiving hormonal and surgical treatment for gender dysphoria.
COLLABORATION PROCESS
The patient’s healthcare provider, Dr. Smith, collaborated remotely with a team of experienced experts, including mental health professionals, endocrinologists, nurses, and surgeons, to provide evidence-based care for gender dysphoria.
• Dr. Smith: “Hello, everyone. Thank you for joining me today to discuss the care of our patient with gender dysphoria. I have reviewed the patient’s medical records and conducted a behavioral health evaluation. Based on my assessment, I believe that the patient would benefit from hormonal and surgical treatment. However, I would like to hear your thoughts and recommendations on the best course of action.”
• Mental Health Professional: “Thank you, Dr. Smith. I have reviewed the patient’s psychiatric evaluation and agree that the patient would benefit from hormonal and surgical treatment. However, I recommend that we conduct a more in-depth evaluation to exclude other conditions that might mimic gender dysphoria.”
2
• Endocrinologist: “I agree with the mental health professional. We should conduct a more in-depth evaluation to confirm the diagnosis of gender dysphoria and exclude other conditions. Once we have confirmed the diagnosis, we can discuss the best hormonal treatment options for the patient.”
• Nurse: “I concur with the mental health professional and endocrinologist. We should conduct a more in-depth evaluation to confirm the diagnosis of gender dysphoria and exclude other conditions. Once we have confirmed the diagnosis, we can discuss the best surgical treatment options for the patient with our local surgeon.”
• Dr. Smith: “Thank you for your input. I will schedule a more in-depth evaluation to
confirm the diagnosis of gender dysphoria and exclude other conditions. Once we have confirmed the diagnosis, we can discuss the best treatment options for the patient.” Consider additional consultations that might be necessary as you develop your plan of care for this patient.