“As the interne…

“As the internet plays an increasingly central role in connecting Americans of all ages to news and information, government services, health resources, and opportunities for social support, these divisions are noteworthy—particularly for the many organizations and individual caregivers who serve the older adult population.”

–PewResearch Internet Project, Older Adults and Technology Use, April 2014

Read my blog post on Older Adults and the Digital Divide at the Center for Health, Media & Policy.

Will Virtual Consults Solve the Provider Shortage?

I’ve attended several health conferences over the past couple of months and whether the conversations are about the Affordable Care Act allowing more people to get preventive care, using more home care instead of institutional care, or caring for our aging population, one topic that consistently comes up is the projected shortage of primary health care providers.

There are numerous ideas on the table to address this: expand scope of practice for nurse practitioners and physician assistants, provide incentives or loan forgiveness for med students willing to go into primary care, or use telemedicine to improve efficiency. All reasonable ideas… but I wonder about the latest telemedicine venture from a company called Doctor on Demand..

laptop and stethoscopeThis virtual venture allows anyone to have a face-to-face consult with a physician for $40 per visit — about the same as many insurance co-pays. Users can access a licensed US provider 24/7 from any computer, tablet or smartphone. They can discuss symptoms, ask questions, get answers to non-emergency medical questions, specialist referrals, and even obtain short-term prescriptions or refills.

“We created Doctor On Demand to help modernize and transform the health care system,” Adam Jackson, co-founder and CEO, Doctor On Demand said in a press release. “Our main goal is to ease the stress patients encounter while navigating the U.S. health care system and bring the focus back to quality and convenience for both patients and doctors. We’re helping patients receive high-quality medical care without having to leave their homes or offices, therefore cutting down time, cost and worry.”said in a press release,

Some of the common health issues the company says it can address include colds, rashes, coughs, sinus infections, muscle and sports injuries, pediatric care including fever and vomiting, eye problems, and urinary tract infections. All this without a provider ever laying hands on a patient. Instead, patients can upload high-resolution photos to help with diagnosis.

I’m a strong proponent of telemedicine — under the right circumstances. Maybe I’m just skeptical by nature, but I question this approach.

Telemedicine works well when there is an existing relationship between a patient and a provider who knows and understands that patient’s quirks, pre-existing conditions, compliance issues, outliers or other important factors affecting a his or her well-being.

Telemedicine works when there’s clinical documentation that supports referral to a specialist who may be 100 miles away from a rural clinic, or when a home health care nurse has an opportunity to check up on that patient in his or her home and make a comprehensive visual assessment. The VA, among others, has been using telemedicine successfully for many years – as an adjunct, not a total replacement.

When a clinician knows and understands a patient’s dynamics, routine observations and video chats absolutely can save time and costs. There are currently several bills in Congress that support expansion of virtual visits. But I don’t know if this is what they had in mind.

Can telemedicine work like it’s supposed to when a clinician has no knowledge of the patient aside from what’s presented via Web cam in a 10 minute chat?

There are still many unanswered questions.

How does a professional diagnose an unfamiliar patient without actually doing some of the physical assessments — checking for swollen lymph nodes, for example, or peering down a patient’s sore throat or into the sinuses? How many prescriptions will be handed out unnecessarily? What if that “minor” issue is really more serious than the patient lets on?

Many people will see this type of “virtual” care as a plus — no travel or waiting times, instant gratification. Fast has its place. What about thorough?

I’ll be following the concept of virtual practices with curiosity. Perhaps they will prove to be just the panacea the health care world needs. Perhaps not. Stay tuned.

Photo credit: jfcherry / Foter.com / CC BY-SA

Tagged: access, health IT, linkedin, physician shortage, providers, telemedicine, virtual visits

Red meat consumption may increase risk of diabetes

This one is for all of the carnivores out there:

Roast beef cooked under high heat

Eating even a half-serving more of  red meat over time is associated with an increased risk of type-2 diabetes mellitus (T2DM) in a follow-up of three studies of about 149,000 U.S. men and women, according to a report published Online First by JAMA Internal Medicine.

While previous studies have related red meat consumption to greater risk of T2 diabetes, they only measured consumption at  baseline — a single point in time.  There has been limited follow up of longer-term eating behaviors, according to a press release from JAMA.

An Pan, Ph.D., of the National University of Singapore, and colleagues analyzed data from three Harvard group studies and followed up 26,357 men in the Health Professionals Follow-up Study; 48,709 women in the Nurses’ Health Study; and 74,077 women in the Nurses’ Health Study II. Diets were assessed using food frequency questionnaires.

During more than 1.9 million person-years of follow-up, researchers documented 7,540 incident cases of T2DM.

“Increasing red meat intake during a four-year interval was associated with an elevated risk of T2DM during the subsequent four years in each cohort,” according to the study.

The results indicate that compared with a group with no change in red meat intake, increasing red meat intake of more than 0.50 servings per day was associated with a 48 percent elevated risk in the subsequent four-year period. Reducing red meat consumption by more than 0.50 servings per day from baseline to the first four years of follow-up was associated with a 14 percent lower risk during the subsequent entire follow-up.

The authors noted the study is observational so causality cannot be inferred.

“Our results confirm the robustness of the association between red meat and T2DM and add further evidence that limiting red meat consumption over time confers benefits for T2DM prevention,” the authors concluded.

Something to consider before ordering your next Big Mac.


Red meat consumption may increase risk of diabetes

This one is for all of the carnivores out there: Eating even a half-serving more of  red meat over time is associated with an increased risk of type-2 diabetes mellitus (T2DM) in a follow-up of three studies of about 149,000 U.S. men and women, according to a report published Online First by JAMA Internal Medicine. While […]

Just a little heart attack

Before leaving to attend this week’s Association of Health Care Journalists conference, I wanted to share a video from the Go Red for Women campaign.

With no disrespect to the men out there,   women are under enormous stress — juggling career, family, perhaps school or volunteer work too. Our culture expects us, as Sheryl Sandberg said, to Lean In, and just work harder  to get ahead.

Unfortunately most of us don’t have her financial resources at our disposal. So we figure out how to manage, somehow. The thing is, stress has a major impact on our health, including our hearts — and we may not even realize it.

As this video from the Go Red campaign shows,  the warning signs can be powerful.

Take a few minutes each day to de-stress. I’m off to find out how to sharpen my skills as a health journalist.