Tag Archives: health care

UNC Lineberger Comprehensive Cancer Center study: Will telehealth services become the norm following COVID-19 pandemic?

30 Jul

The Mayo Clinic explained Telehealth in Telehealth: Technology meets health care: See how technology can improve your health care:

What is telehealth?

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services.

Consider, for example, the ways telehealth could help you if you have diabetes. You could do some or all of the following:

  • Use a mobile phone or other device to upload food logs, medications, dosing and blood sugar levels for review by a nurse who responds electronically.
  • Watch a video on carbohydrate counting and download an app for it to your phone.
  • Use an app to estimate, based on your diet and exercise level, how much insulin you need.
  • Use an online patient portal to see your test results, schedule appointments, request prescription refills or email your doctor.
  • Order testing supplies and medications online.
  • Get a mobile retinal photo screening at your doctor’s office rather than scheduling an appointment with a specialist.
  • Get email, text or phone reminders when you need a flu shot, foot exam or other preventive care.

The goals of telehealth, also called e-health or m-health (mobile health), include the following:

  • Make health care accessible to people who live in rural or isolated communities.
  • Make services more readily available or convenient for people with limited mobility, time or transportation options.
  • Provide access to medical specialists.
  • Improve communication and coordination of care among members of a health care team and a patient.
  • Provide support for self-management of health care.

The following examples of telehealth services may be beneficial for your health care.

Patient portal

Your primary care clinic may have an online patient portal. These portals offer an alternative to email, which is a generally insecure means to communicate about private medical information. A portal provides a more secure online tool to do the following:

  • Communicate with your doctor or a nurse.
  • Request prescription refills.
  • Review test results and summaries of previous visits.
  • Schedule appointments or request appointment reminders.

If your doctor is in a large health care system, the portal also may provide a single point of communication for any specialists you may see.

Virtual appointments

Some clinics may provide virtual appointments that enable you to see your doctor or a nurse via online videoconferencing. These appointments enable you to receive ongoing care from your regular doctor when an in-person visit isn’t required or possible….

Remote monitoring

A variety of technologies enable your doctor or health care team to monitor your health remotely. These technologies include:

  • Web-based or mobile apps for uploading information, such as blood glucose readings, to your doctor or health care team
  • Devices that measure and wirelessly transmit information, such as blood pressure, blood glucose or lung function
  • Wearable devices that automatically record and transmit information, such as heart rate, blood glucose, gait, posture control, tremors, physical activity or sleep patterns
  • Home monitoring devices for older people or people with dementia that detect changes in normal activities such as falls…

https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878

Resources:

What is Telehealth?                                                                                                                https://www.aap.org/en-us/professional-resources/practice-transformation/telehealth/Pages/What-is-Telehealth.aspx

What Is Telehealth?                                                                                                             https://www.goodrx.com/blog/what-is-telehealth/

How Does Telemedicine Work?                                                                                                 https://www.webmd.com/lung/how-does-telemedicine-work#1

Science Daily reported in Will telehealth services become the norm following COVID-19 pandemic?

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems — including remote video communications platforms, such as Zoom — and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety….                                                                                        https://www.sciencedaily.com/releases/2020/07/200716144727.htm

 

Citation:

Will telehealth services become the norm following COVID-19 pandemic?

Date:      July 16, 2020

Source:  UNC Lineberger Comprehensive Cancer Center

Summary:

Experts address whether the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

Journal Reference:

Trevor J. Royce, Hanna K. Sanoff, Amar Rewari. Telemedicine for Cancer Care in the Time of COVID-19. JAMA Oncology, 2020; DOI: 10.1001/jamaoncol.2020.2684

Here is the press release from UNC Lineberger Comprehensive Cancer Center:

Home / News from Lineberger / Will telehealth services become the norm following COVID-19 pandemic?

Will telehealth services become the norm following COVID-19 pandemic?

July 16, 2020

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems – including remote video communications platforms, such as Zoom – and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety.

“There is a lot we don’t know about telehealth, and how its rapid adoption will impact our patients,” Royce said. “How will the safety and quality of care be impacted? How will we integrate essential components of the traditional doctor visit, including physical exam, lab work, scans and imaging? Will patients and doctors be more or less satisfied with their care? These are all potential downsides if we are not thoughtful with our adoption.”

He said appropriate oversight of care is critical. There will be a continued need for objective patient assessments, such as patient-reported outcomes, physical examinations and laboratory tests, and to measure care quality and monitor for fraud. There are also a number of standard measures of care quality that can be implemented during the transition to telehealth, including tracking emergency room visits, hospitalizations and adverse events.

Telehealth presents other challenges, as well. Though technology and internet access are now more widely available, they are not universally accessible. Where one lives, their socioeconomic status and comfort level with technology can be barriers to using telehealth services. A reliance on telehealth might lower participation in clinical trials, which can require regular in-person appointments.

“Telehealth can be used to improve access to care in traditionally hard-to-reach populations. However, it is important to acknowledge that if we are not thoughtful in its adoption, the opposite could be true,” Royce said. “For example, will lower socioeconomic groups have the same level of access to an adequate internet connection or cellular services that make a virtual video visit possible? Telehealth needs to be adopted with equity in mind.”

Media Contact: Bill Schaller, bill_schaller@med.unc.edu

 

Mikhail Varshavski wrote in Pros and Cons of Telemedicine & Telehealth:

Advantages of Telemedicine

  1. Higher level of flexibility
  2. Convenience
  3. Reduction of risk for infections
  4. Less waiting time
  5. Better medical support for rural areas
  6. Telehealth is more efficient
  7. Telemedicine can reduce doctor’s shortage
  8. More patients can be treated on average
  9. Information sharing between doctors
  10. Reduction in travel expenses
  11. Lower costs for minor issues
  12. Patients may be more eager to get medical advice
  13. Can give doctors a competitive advantage

 

Problems of Telehealth

  1. Privacy issues
  2. Hacking
  3. Technical problems
  4. No physical examination possible
  5. Doctor’s may have problems to adapt
  6. Excessive consultations
  7. Specific software and training may be needed
  8. Number of wrong diagnoses may increase
  9. Doctors may be sued more often
  10. Varying levels of regulations regarding telehealth
  11. May not be affordable for small doctor’s offices
  12. May not be covered by health insurance yet
  13. Job losses

 

Resources:

Telemedicine Pros and Cons                                                                                     https://healthresearchfunding.org/telemedicine-pros-cons/

What Are the Benefits and Advantages of Telemedicine?                                                    https://www.healthline.com/health/telemedicine-benefits-and-advantages#1

Clinicians see pros, cons to telehealth                                                                                        ‘We’re doing whatever we can to get the service to our folks’                                                http://www.hmenews.com/article/clinicians-see-pros-cons-telehealth

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Northwestern University study: Heavier babies do better in school

27 Oct

The Ontario Ministry of Children and Youth Services explains why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

The New York Times reported in the article, Heavier Babies Do Better in School:
A study of children in Florida found that those who were heavier at birth scored higher on math and reading tests in the third to eighth grades.
Like so many other parts of health care, childbirth has become a more medically intense experience over the last two decades. The use of drugs to induce labor has become far more common, as have cesarean sections. Today, about half of all births in this country are hastened either by drugs or surgery, double the share in 1990.
Crucial to the change has been a widely held belief that once fetuses pass a certain set of thresholds — often 39 weeks of gestation and five and a half pounds in weight — they’re as healthy as they can get. More time in the womb doesn’t do them much good, according to this thinking. For parents and doctors, meanwhile, scheduling a birth, rather than waiting for its random arrival, is clearly more convenient.
But a huge new set of data, based on every child born in Florida over an 11-year span, is calling into question some of the most basic assumptions of our medicalized approach to childbirth. The results also play into a larger issue: the growing sense among many doctors and other experts that Americans would actually be healthier if our health care system were sometimes less aggressive.
The new data suggest that the thresholds to maximize a child’s health seem to be higher, which means that many fetuses might benefit by staying longer in the womb, where they typically add at least a quarter-pound per week. Seven-pound babies appear to be healthier than six-pound babies — and to fare better in school as they age. The same goes for eight-pound babies compared with seven-pound babies, and nine-pound babies compared with eight-pound babies. Weight, of course, may partly be an indicator of broader fetal health, but it seems to be a meaningful one: The chunkier the baby, the better it does on average, all the way up to almost 10 pounds.
“Birth weight matters, and it matters for everyone,” says David N. Figlio, a Northwestern University professor and co-author of the study, which will soon be published in the American Economic Review, one of the field’s top journals… http://www.nytimes.com/2014/10/12/upshot/heavier-babies-do-better-in-school.html?abt=0002&abg=0&_r=0

Citation:

The Effects of Poor Neonatal Health on Children’s Cognitive Development (WP-13-08)
IPR-WP-13-08
David Figlio, Jonathan Guryan, Krzysztof Karbownik, and Jeffrey Roth
This working paper makes use of a new data resource—merged birth and school records for all children born in Florida from 1992 to 2002—to study the effects of birth weight on cognitive development from kindergarten through schooling. Using twin fixed effects models, the researchers find that the effects of birth weight on cognitive development are essentially constant through the school career, that these effects are very similar across a wide range of family backgrounds, and that they are invariant to measures of school quality. They conclude that the effects of poor neonatal health on adult outcomes are therefore set very early.
David Figlio, Orrington Lunt Professor of Education and Social Policy and of Economics, and Director and Faculty Fellow, Institute for Policy Research, Northwestern University
Jonathan Guryan, Associate Professor of Human Development and Social Policy, and Faculty Fellow, Institute for Policy Research, Northwestern University
Krzysztof Karbownik, Visiting Scholar, Institute for Policy Research, Northwestern University
Jeffrey Roth, Research Professor of Pediatrics, College of Medicine, University of Florida
Download working paper PDF http://www.ipr.northwestern.edu/publications/docs/workingpapers/2013/IPR-WP-13-08.pdf

Other articles have questioned whether heavier babies are healthier:

Bigger Baby Trend Worries Doctors As Health Concerns Mount Over Supersized Deliveries http://www.huffingtonpost.com/2013/08/19/bigger-baby-trend_n_3780699.html

Everyday Research blog analyzes the study in Heavier babies do better in school:
Questions
a) How do we know this is a correlational study? What are its variables?
b) Here’s a quote from the article:
Mr. Figlio estimates that, all else equal, a 10-pound baby will score an average of 80 points higher on the 1,600-point SAT than a six-pound baby. Another way to see the pattern is to look only at top-scoring students: Among the top 5 percent of test scorers in elementary school, one in three weighed at least eight pounds at birth, compared with only one in four of all babies.
Does this quote address statistical validity? Construct validity? External validity? or Internal validity?
c) Here’s a great addition. Underneath the main figure in the article, are tables of results for education, race, and age. The caption reads:
The effect of being heavier is similar across many different types of mothers.
Is this caption addressing potential moderators? potential mediators? or potential third variable problems?
d) Here’s another quote from the piece:
Florida offers a window on the issue because the state tracks children from birth through college…. The authors of the new study….used the data to compare birth weight with test scores from third through eighth grades, as well as with kindergarten readiness scores. They controlled for, among other factors, the health and sex of the baby, the length of the pregnancy and the health, age, race and education of the mother
Looking at the last sentence of this quote, is this statement addressing potential moderators? potential mediators? or potential third variable problems?
http://www.everydayresearchmethods.com/2014/10/heavier-babies-do-better-in-school.html

The question many parents ask is what is a healthy weight range.

The What to Expect article, Your Newborn’s Weight: What’s Normal, What’s Not discusses healthy weight:

So just what is average for a newborn? At birth, the average baby weighs about 7.5 pounds — though the range of normal is between 5.5 and ten pounds (all but five percent of newborns will fall into this range).
What makes your baby weigh more or less than the newborn in the next bassinet? Several factors come into play:
• Your own diet and weight, both before and during pregnancy (If you’re overweight, you may have a heavier baby. If you don’t get enough nutrients while you’re pregnant, your baby may be smaller.)
• Your prenatal health, including whether you drink, smoke, or have diabetes
• Your own birth weight, plus genetics (your size at birth, plus your and your hubby’s size now, can both play a role)
• Whether your baby is a boy or a girl (boys tend to be heavier)
• Whether this is your firstborn (they tend to be smaller than subsequent children)
• Whether your baby is a twin or triplet (multiples tend to be smaller than singletons)
• Your baby’s race (Caucasian babies are sometimes larger than African-American, Asian, or Native American infants)… http://www.whattoexpect.com/baby-growth/newborn-weight.aspx

The key is regular prenatal care.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development reports in What is prenatal care and why is it important?

Prenatal Care
Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother’s health, the infant’s health, and any questions about the pregnancy.
Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:
• Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and ensure the infant’s health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to avoid serious complications in pregnancy such as preeclampsia.
• Reduce the infant’s risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones.2 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.3

In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%.4 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need.1,5 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.
• Help ensure the medications women take are safe. Certain medications, including some acne treatments6 and dietary and herbal supplements,7 are not safe to take during pregnancy.
Learn more about prenatal and preconception care. http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx
http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

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