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    Posting Addict GloriaInTX's Avatar
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    Default Telemedicine

    Do you think virtual doctor visits are a good/bad idea?

    Mark Matulaitis holds out his arms so the Parkinson's specialist can check his tremors. But this is no doctor's office: Matulaitis sits in his rural Maryland home as a neurologist a few hundred miles away examines him via the camera in his laptop.

    Welcome to the virtual house call, the latest twist on telemedicine. It's increasingly getting attention as a way to conveniently diagnose simple maladies, such as whether that runny nose and cough is a cold or the flu. One company even offers a smartphone app that lets tech-savvy consumers connect to a doctor for $49 a visit.

    Now patient groups and technology advocates are pushing to expand the digital care to people with complex chronic diseases that make a doctor's trip more than just an inconvenience.

    "Why can't we provide care to people wherever they are?" asks Dr. Ray Dorsey, a neurologist at the University of Rochester Medical Center who is leading a national study of video visits for Parkinson's patients and sees broader appeal.

    "Think of taking your mom with Alzheimer's to a big urban medical center. Just getting through the parking lot they're disoriented," he adds. "That's the standard of care but is it what we should be doing?"

    Among the hurdles: While Medicare covers some forms of telehealth, it doesn't typically pay for in-home video exams. Plus, doctors who practice by video-chat must be licensed in whatever states their long-distance patients live. Some states restrict the kind of care and prescribing available via telemedicine.

    About 40 percent of Parkinson's patients don't see a specialist, in part because they live too far away, even though research suggests those who do fare better, according to the Parkinson's Action Network.

    When Matulaitis first was diagnosed in 2011, his wife had to take a day off work to drive him more than two hours to a Parkinson's clinic. Once he was stabilized on medication, Dorsey enrolled the Salisbury, Md., man in a pilot study of video house calls. Set-up was simple: The doctor emailed a link to video software designed for patient privacy.

    He's thrilled with the care.

    "It's just the same as if you've ever done Facetime on an iPhone," explained Matulaitis, 59, who continues his virtual checkups with Dorsey a few times a year. "It allows the doctor to see the patient at a point where they are at their best."

    Telemedicine is broader than a Skype-like doctor visit. For years, doctors have delivered different forms of care remotely, from the old-fashioned phone call to at-home monitors that measure someone's blood pressure and beam the information to a clinic. Hospitals routinely set up on-site video consultations with specialists.

    But the virtual house call is gaining interest. Some insurers offer versions, such as Wellpoint Inc.'s LiveHealth Online service. Telemedicine provider American Well is making headlines with its direct-to-consumer service, offered in 44 states. Psychiatrists are exploring mental health follow-up counseling from the privacy of a patient's home computer.

    New guidelines from the Federation of State Medical Boards say telemedicine can be OK without a prior in-person visit, a change expected to influence licensing regulations in a number of states, said federation president Dr. Humayun Chaudhry. The guidelines hold virtual visits to the same standards as an office visit, including a full medical history and informed consent, and say patients should be able to choose among participating doctors. The group also is finalizing a plan to make it easier for doctors to practice across state lines.

    But does a virtual exam translate into better outcomes for the chronically ill?

    "There's an evidence gap that needs to be filled," said Romana Hasnain-Wynia of the Patient-Centered Outcomes Research Institute, an agency created under the new health care law to study which medical treatments and procedures work best.

    With a $1.7 million grant from PCORI, Dorsey's study is randomly assigning about 200 Parkinson's patients from around the country to receive either their usual care or added virtual checkups from a specialist. His pilot studies have suggested telemedicine allows needed care such as medication adjustments while saving patients time.

    As for people seeking even a seemingly simple diagnosis, there are other questions such as how to avoid overprescribing antibiotics. Yes, a smartphone camera may spot signs of strep throat. But national guidelines urge a strep test before giving antibiotics, to be sure a virus isn't to blame.

    "You have to be a touch more thoughtful when you're talking about new patient relationships," said Dr. Joseph Kvedar of the Center for Connected Health, a division of Boston's Partners Healthcare. But he predicts at-home infection tests one day could supplement telehealth.

    Then there's cost. The key is whether telehealth replaces doctor visits or adds to them, Dr. Ateev Mehrotra of Harvard and the RAND Corp., said in recent testimony for a House Energy and Commerce subcommittee that is studying how to enhance telemedicine.

    "Telehealth may be too convenient," said Mehrotra, urging that it be implemented in a cost-effective way that provides high-quality care.


    Read more: The doctor will see you now via webcam, smartphone - Dallas News | myFOXdfw.com
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    Posting Addict KimPossible's Avatar
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    I think it would probably be good for some things and not others. Its so new that it seems hard to tell how beneficial/risky this type of care is, but I think its worth trying. I'm sure it will be a learn-as-you-go type process and we'll eventually find the best uses for this type of care. I don't think its ever bad to have more options, its just a matter of using your options wisely.

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    Posting Addict Spacers's Avatar
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    I think it's great when it's one tool to go along with appropriate in-person care, not as a replacement. My pediatrician's office recently began offering webcam appointments for things like following up to make sure a wound is healing well, a rash is clearing up, etc., the things that require the doctor to have visual contact but that don't necessarily require the patient to come to the office & take up a 20-minute appointment for something that takes two minutes. The two scenarios outlined in the article are perfect examples. The stabilized person who needs routine checkups, but for whom getting to the specialist's office is burdensome, or the trip is so stressful the person can't be accurately evaluated once they get there, is a perfect candidate, but a child with suspected strep throat is not.

    I also wonder if webcam appointments might help with better access to mental health care? There is still so much stigma to walking into the Psychiatry building or getting off the elevator on the floor that says, "Psychiatry." If those people could be reached in a way that makes them feel more comfortable about getting the help they need, that can't be a bad thing.
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    There are some aspects of this that are already in use. For example, one time my daughter fell and fractured her skull. There was not a paediatric neurosurgeon near by, so they sent the scans to a doctor in CA who made the diagnose and decided treatment. That in my opinion is a huge benefit to people who do not live in a place that has all of the necessary specialists.

    I do see potential for abuse or misuse of the system though. Balance would be key.

    ~Bonita~

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    Mega Poster mom3girls's Avatar
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    Love this idea. I also wish I could just pay for things like a strep throat test or a UTI test and get the meds I need without seeing a doctor. 9 times out of 10 I know what I have and would love to be able to walk into the pharmacy and get it.
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    Quote Originally Posted by mom3girls View Post
    Love this idea. I also wish I could just pay for things like a strep throat test or a UTI test and get the meds I need without seeing a doctor. 9 times out of 10 I know what I have and would love to be able to walk into the pharmacy and get it.
    OT, but you can buy a UTI test over the counter. They are sold near the pregnancy tests. It won't help you get an antibiotic, but it will help you to know what is wrong.

    ~Bonita~

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    Like Kim (of course we're agreeing), I think there are huge benefits to this, potential issues as well but way too soon to tell.

    Some companies are starting to provide insurance coverage for this. I would love to see how this plays out with patient outcomes.
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    I agree with Kim (big shock). Some tremendous benefits, some danger zones.

    And yes, there are already implementations of this that are beneficial. A few summers ago, my dad was on a heart monitor that he could send results in from over the phone, he called a certain number and they were able to read the information off the monitor without him having to go anywhere.

    But this makes sense in many, many ways, if done properly.
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