How Big-Box Retailers Can Revitalize Rural Health Care

There's a surefire, and perhaps unlikely, way to bolster access to health care for underserved Americans—at the shopping mall.

Millions of Americans struggle to get affordable, timely medical care. Roughly one-quarter of rural Americans haven't been able to get needed care at some point in recent years, according to a May 2019 poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health.

The main reasons? Affordability. Trouble scheduling an appointment. Having to travel a long distance.

Retailers can help overcome these barriers. In many rural communities, the local Walmart or CVS is not just an economic anchor but a civic institution. It's a gathering place for far-flung residents. And it may be the most convenient place for historically underserved populations to seek health care.

Adding telehealth capabilities to our existing retail infrastructure could significantly expand access to top-notch care—and reduce costs for patients and the healthcare system.

The full Forbes article can be viewed at this link.  

Reaching People With Disabilities in Underserved Areas Through Digital Interventions: Systematic Review

People with disabilities need rehabilitation interventions to improve their physical functioning, mental status, and quality of life. Many rehabilitation interventions can be delivered digitally via telehealth systems. For people with disabilities in underserved areas, digitally delivered rehabilitation interventions may be the only feasible service available for them.

The objective of this study was to evaluate the current status of digital intervention for people with disabilities in remote and underserved areas.

A systematic review was conducted on this topic. Keyword searches in multiple databases (PubMed, CINAHL, and Inspec) were performed to collect articles published in this field. The obtained articles were selected based on our selection criteria. Of the 198 identified articles, 16 duplicates were removed. After a review of the titles and abstracts of the remaining articles, 165 were determined to be irrelevant to this study and were therefore removed. The full texts of the remaining 17 articles were reviewed, and 6 of these articles were removed as being irrelevant to this study. The 11 articles remaining were discussed and summarized by 2 reviewers.

These 11 studies cover a few types of disabilities, such as developmental disabilities and mobility impairments as well as several types of disability-causing disorders such as stroke, multiple sclerosis, traumatic brain injury, and facio-scapulo-humeral muscular dystrophy. Most of these studies were small-scale case studies and relatively larger-scale cohort studies; the project evaluation methods were mainly pre-post comparison, questionnaires, and interviews. A few studies also performed objective assessment of functional improvement. The intervention technology was mainly videoconferencing. Moreover, 10 of these studies were for people with disabilities in rural areas and 1 was for people in urban communities.

A small number of small-scale studies have been conducted on digital interventions for people with disabilities in underserved areas. Although the results reported in these studies were mostly positive, they are not sufficient to prove the effectiveness of telehealth-based digital intervention in improving the situation among people with disabilities because of the small sample sizes and lack of randomized controlled trials.

The full article can be downloaded below.  

Urbanization Leaves Rural America In A Health Care Crisis

Declining birth rates and an aging population have impacted American migration patterns for decades. But according to the USDA’s Economic Research Service, between 2010 and 2017, almost 1,000 rural counties in the U.S. recorded more deaths than births. Add in migration patterns of people moving from rural areas of the country to more urban and suburban regions, and we find that in 2019 only 20% of Americans live in rural areas - which accounts for a surprising 97% of U.S. land mass.

But the implications of these population shifts greatly exceed the economic and housing needs of the region. Population change also means significant changes in health care need, demand and access. According to the National Institute for Health Care Management (NIHCM), “As urbanization increases, an older, sicker and poorer population remains in rural America.” What this really means is that those Americans living in rural areas of the country have much greater health issues, and far fewer health resources.

The full Forbes article can be found at this link.  

The Use of Telehealth in School-Based Health Centers

Telehealth is a growing model of delivering health care. School-based health centers (SBHCs) provide access to health care for youth in schools and increasingly use telehealth in care delivery. This article examines the recent growth of telehealth use in SBHCs, and characteristics of SBHCs using telehealth, including provider types, operational characteristics, and schools and students served. The percentage of SBHCs using telehealth grew from 7% in 2007-2008 to 19% in 2016-2017. Over 1 million students in over 1800 public schools have access to an SBHC using telehealth, which represents 2% of students and nearly 2% of public schools in the United States. These SBHCs are primarily in rural communities and sponsored by hospitals. This growing model presents an opportunity to expand health care access to youth, particularly in underserved areas in the United States and globally. Further research is needed to fully describe how telehealth programs are implemented in school settings and their potential impacts.

The full article can be downloaded below.  

Virtual Visits: Telehealth and Older Adults

Telehealth allows patients to have visits with health care providers remotely using video technology. Such visits are increasingly available and have the potential to make health care more accessible and convenient for patients. In May 2019, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their experiences with and opinions of telehealth.

The full report can be downloaded below.  

Doctors turn to thumbs for diagnosis and treatment by text

Dr. Anna Nguyen spoke with none of the five patients she treated on a recent weekday morning. She didn’t even leave her dining room.

The emergency physician nevertheless helped a pregnant Ohio woman handle hip pain, examined a Michigan man’s sore throat and texted a mom whose son became sick during a family trip to Mexico.

Welcome to the latest wrinkle in health care convenience: the chat diagnosis.

The full article from the Associated Press can be viewed at this link. 

Looking Through a Different Lens: Patient Satisfaction With Telemedicine in Delivering Pediatric Fracture Care

Telemedicine may transform health care by overcoming geographical and travel-associated barriers to patient care. This study assesses patient satisfaction with telemedicine for fracture care.

Two groups of patients were compared from suburban/ rural Pennsylvania. One group reported to a regional medical center for real-time video consultation with a pediatric orthopaedic surgeon facilitated by a physician’s assistant. The other group underwent conventional outpatient clinic visits at a tertiary care hospital. The distance between the tertiary care hospital and the regional medical center was 69 miles. New or follow-up fracture patients not living in the vicinity of either medical center were included. A satisfaction survey and questionnaire were administered to both groups at the end of their visit.

One hundred sixty-seven patients returned the questionnaires (66 conventional and 101 telemedicine). Telemedicine visits decreased indirect and direct costs (P = 0.032). Travel costs and travel times were lower (P , 0.001) in the telemedicine group. Patient satisfaction was similar. Only 8 of 101 patients in the telemedicine cohort preferred their next visit to be a conventional follow-up.

Utilization of video consultation and trained physician assistants to provide pediatric orthopaedic care across suburban/rural areas can increase pediatric orthopaedic surgeon access and decrease travel costs while maintaining patient satisfaction.

The full article can be downloaded below.  

U.S. Opioid Epidemic: Impact on Public Health and Review of Prescription Drug Monitoring Programs (PDMPs)

In recent years, the devastating effects of U.S. opioid epidemic has been making news headlines. This report explores background information and trends on opioid misuse, overdose fatalities and its impact on public health. In addition, various efforts to improve surveillance, timeliness of data and Prescription Drug Monitoring Program (PDMP) integration and interoperability are reviewed.

PubMed and internet searches were performed to find information on the U.S. opioid epidemic. In addition, searches were performed to retrieve information about PDMPs and state-specific mandates along with presentation slides and learnings from the 2018 National Rx Drug Abuse & Heroin Summit in Atlanta, GA.

It is clear that the U.S. opioid epidemic has a tremendous impact on public health including the next generation of children. Various data, surveillance & technology-driven efforts including CDCFunded Enhanced State Opioid Overdose Surveillance Program (ESOOS) and use of telemedicine for opioid use disorder treatment aim to improve prevention, treatment and targeted interventions. In addition, PDMP integration and interoperability efforts are advancing to provide prescribers meaningful decision support tools.

The opioid epidemic has a complex impact on public health intertwined with variable factors such as mental health and social determinants of health. Given the statistics and studies that suggest many of the illicit opioid users start with prescription opioids, continued advancement in the area of PDMP integration and interoperability is necessary. The PDMP integrated clinical decision support systems need to supply to healthcare providers access to complete, timely and evidence-based information that can meaningfully inform prescribing decisions and communication with patients that affect measurable outcomes.

While Prescription Drug Monitoring Programs (PDMPs) are valuable tools for providers in making informed prescribing decisions, the variable state mandates and varying degrees of integration and interoperability across states may limit their potential as meaningful decision support tools. Sharing best practices, challenges and lessons learned among states and organizations may inform strategic and systematic use of PDMPs to improve public health outcomes.

The full article can be downloaded below.  

Liberating Telemedicine: Options to Eliminate the State-Licensing Roadblock

Aside from the ideal of eliminating government licensing of clinicians, or the second-best option of relying on states to open their borders to physicians licensed in other states, the most feasible option for expanding telemedicine is for Congress to define the location of the practice of telemedicine as that of the physician, treating digital patients like patients who physically make a trip across state or national borders to secure medical care.

Under such a law, a physician would need only one license to engage in the practice of telemedicine, and would be responsible for only one set of licensing rules—those of the state in which the physician practices. Existing telemedicine providers would be able to recruit physicians in greater numbers and to provide higher-quality and lower-cost services to far more patients. The ability of patients in emergent situations or with rare illnesses to obtain care from top specialists would expand dramatically. New entrants into a national market for telemedicine would drive down prices for both telemedicine and in-person medical services.

The full article can be downloaded below.  

In-Depth: Telehealth providers working with colleges to supplement students' behavioral health, physical care

Fall has arrived, and with it comes the annual migration of millions of young adults leaving their homes for the promises of higher learning. For a substantial portion of these students, the trek means a transition from their family’s usual healthcare provider to their campus’s health services or other nearby sources for care — a gap that telehealth vendors are eager to fill.

“These students are often far away from home,” Robbie Cape, CEO and co-founder of texting-based primary care startup 98point6, told MobiHealthNews. “As a demographic, [they] have the lowest percentage affiliation with a primary care physician. Over 55% of college students, Gen Z, have a PCP, so that means over 45% do not. They do not have a relationship with a PCP at all, which makes 98point6 a great option for them. Not only that, but … 1.7 million university students don’t have any access to healthcare coverage, which again makes our offer very, very compelling for them.”

What's more, with the rate of college enrollment ticking upward with each passing year, several universities and student groups will likely need a scalable solution to fit their healthcare needs, said Alon Matas, founder and president of BetterHelp, a Teladoc subsidiary that provides behavioral health and counseling services.

“I think there’s actually a crisis in the student population,” Matas told MobiHealthNews. “The schools have gotten bigger, more students, but the capacity of the counseling centers and health centers hasn’t changed. We hear all the time about campuses with 10,000 students and one counselor. They cannot handle that much, so there have to be solutions like telehealth that come in, otherwise this will escalate."

The full Mobi Health News article can be viewed at this link.