Telehealth is part of the solution to the maternity care desert in Fillmore County

The Post Bulletin reports

In its 2022 report , March of Dimes calls Fillmore County a maternity care desert, defined as having zero hospitals or birth centers offering obstetric (OB) care and zero OB/GYN physicians or certified nurse midwives based in the county. This lack of close-to-home maternity care impacts hundreds of Fillmore County families each year — in 2020, 222 infants were born to county residents. A majority of those babies (57.1%) were delivered in Olmsted County, with only 44 recorded home births in Fillmore County that year.

“I think the maternity care desert thing is only going to get worse and worse, and it very much plays into our maternal mortality rates, unfortunately,” said Katie Duerr, a certified nurse midwife at Winona Health in Winona. “It’s scary.”

Telehealth (as well as easier access to insurance coverage beyond borders) is offered as part of the solution…

For health care providers in Minnesota, telemedicine can help reduce the frequency of in-person visits without compromising care for pregnant patients. At Mayo Clinic, Butler Tobah is the research program leader for OB Nest , a telemedicine model for low-risk pregnancies. OB Nest shifts about half of a pregnant patient’s visits to virtual ones, and providers show patients how to use self-monitoring devices, such as fetal heart rate Dopplers, to monitor their pregnancies from home.

 

Telehealth care effective alternative for lowering blood pressure

Main Site News reports

For the new study, researchers compared two types of care for moderately severe, uncontrolled high blood pressure: traditional clinic-based care, using face-to face visits with doctors and medical assistants, and telehealth care, with home blood pressure telemonitoring and home-based care coordinated via telephone by a pharmacist or in some cases, a nurse. The research was conducted on 3,071 people, whose average age was 60, in a randomized trial involving 21 primary care clinics in Minnesota and Wisconsin.

The telehealth and the clinic-based care were both successful in lowering blood pressure on average by about 18 mmHg on the systolic blood pressure, the “top number” in a reading, and 10 mmHg on the diastolic measurement, or “bottom number.” But there was no significant difference in the change over time in systolic or diastolic blood pressure between the two groups, researchers found.

The study was published Tuesday in the American Heart Association journal Hypertension.

“These results suggest telehealth team care by pharmacists is an effective and safe alternative to clinic-based care for uncontrolled hypertension,” said Dr. Karen Margolis, the study’s lead author.

Inbound Health, an Allina Health offshoot, offers hospital-at-home services

According to a press release on Business Wire

Allina Health and Flare Capital Partners today announced the launch of Inbound Health, a new company that enables health systems and health plans to offer hospital-at-home and skilled nursing-at-home programs. These innovative new care models create the ability to care for patients requiring facility-level acute or post-acute care in their home, thereby improving patient access, satisfaction, and outcomes while lowering total cost of care.

Inbound Health provides the full stack of capabilities that are required to scale at-home care models including home-based care pathways, virtual care teams, engagement and workflow technology, analytics, supply chain partnerships, operational oversight and payment models. The company’s flexible partnership structure enables customers to leverage their existing assets and capabilities while relying on Inbound Health to fill the gaps required to scale these programs across their service area

To date, more than 4,200 patients across 185 primary diagnoses have been cared for through the Inbound Health platform, which has been operational in Allina Health’s service area since May 2020. The program has allowed Allina Health to manage a wider swath of the continuum of care for its patients, thereby ensuring that care is delivered in a safe, coordinated and patient-centric manner. The company combines biometric monitoring, digital surveillance, in-home nursing and therapy, virtual visits with hospitalists and geriatricians, and a comprehensive supply chain to deliver a safe and high-quality care program.

Inbound Health has proven that the program lowers total-cost-of-care by 30-40% on a risk-adjusted basis while achieving similar or improved clinical outcomes when compared to traditional facility-based care. These outcomes have enabled Inbound Health and Allina to develop unique episodic-based payer contracts with multiple Commercial and Medicare Advantage payers in Minnesota, a payment model that the company plans on replicating with partners in other markets.

Telemedicine associated with 79% reduction in odds of no-show visits

A recent study set out to look at the impact of telemedicine on no-show patients…

Telemedicine provides patients with a convenient method of communication with providers. However, little is known about accessibility of telemedicine among surgical patients. We aimed to assess the association of telemedicine use with patient no-show visits.

The results…

Telemedicine is associated with 79% reduction in odds of no-show visits, which are more frequent among historically vulnerable populations. Telemedicine’s convenience may serve as an intervention to improve health equity and access.

The details…

There were 553,475 visits, of which 11.3% were no-show. Most visits were in the historical control (54.1%) compared to contemporary control (41.5%) and case visits (4.4%). No-show visits were most frequent among in-person (11.7%) compared to telemedicine visits (2.5%, p<0.001). On logistic regression, no-show visits were more common among male (aOR:1.12, 95%CI:1.09-1.15) patients, Black (aOR:1.68, 95%CI:1.64-1.73) and Asian (aOR:1.32, 95%CI:1.21-1.44, ref: White) patients, patients insured with Medicaid (OR:2.0, 95%CI:1.94-2.06, ref: Private), patients from counties with higher Social Vulnerability Index (OR:1.13, 95%CI:1.06-1.21), and Friday visits (OR:1.15, 95%CI:1.1-1.2, ref: Monday). No-show visits were less common among older patients (OR:0.98, 95%CI:0.98-0.98), those insured with Medicare (OR:0.83, 95%CI:0.76-0.91), and telemedicine visits (OR:0.21, 95%CI:0.19-0.24) and contemporary control (OR:0.93, 95%CI:0.91-0.95, ref: retrospective control) cohorts.

37 percent of adults have used telemedicine in the last year

The US Department of Health and Human Services looks at telehealth use in 2021

Data from the National Health Interview Survey

  • In 2021, 37.0% of adults used telemedicine in the past 12 months.
  • Telemedicine use increased with age, and was higher among women (42.0%) compared with men (31.7%).
  • Non-Hispanic White (39.2%) and non-Hispanic American Indian or Alaska Native (40.6%) adults were more likely to use telemedicine compared with Hispanic (32.8%), non-Hispanic Black (33.1%), and non-Hispanic Asian (33.0%) adults.
  • The percentage of adults who used telemedicine increased with education level and varied by family income.
  • The percentage of adults who used telemedicine varied by region and decreased with decreasing urbanization level.

Turns out we’re a little behind in the race in the Midwest…

North Dakota gets grant for telehealth counseling for farmers

The Post Bulletin reports

A federal grant undergirds “Farm to Farm Services” — a counseling partnership with North Dakota State University that delivers “telehealth” aimed at farmers and ranchers struggling with mental or emotional health issues.

Sean Brotherson, an NDSU Extension family life specialist, said the program is offering a range of needed help.

“We all know that — for example — suicide rates and rates of stress-related physical and mental health concerns for folks working in agriculture are much higher than any of us would like to see,” he said. North Dakota’s suicide rate increased 57% over the past 20 years, and farmers are part of that.

The program’s telehealth sessions are used by about 40 to 50 clients a month through Farm to Farm, a branded program of Together Counseling, a group of therapists. Clients can be a range of individuals, from youths to adults.

I know it’s North Dakota but the statistics (suicide rate increased 57% over the past 20 years) are staggering and I can’t imagine things are that different for farmers in Minnesota. The article includes a video that makes the program seem very appealing to potential patients.

Hospital at Home Programs gaining popularity

Minnesota Monthly reports

Rachel Riedesel, population health manager at Allina Health, was in her final year of the Masters of Healthcare Administration program at the University of Minnesota School of Public Health in 2019. For her team capstone project, she partnered with leaders at Allina Health to design a program that would allow patients to receive hospital care in the comfort of their homes.

At the time, funding models and abundant hospital capacity meant there was little urgency to implement the program. All that changed when the pandemic hit. By then, Riedesel was working at Allina Health in the hub of the system’s COVID-19-related activity. “This came forward as an opportunity to increase hospital capacity while we were trying to serve our community and their needs,” Riedesel says. The Hospital at Home plan she had previously worked on was put in motion. “We were able to deploy the program in less than a month because of the plans we’d already prepared.”

Instead of being checked into the hospital, patients who participate in the program are sent home with biometric monitoring equipment. The kit includes a tablet, blood pressure cuff, pulse oximeter, and thermometer—all Bluetooth-enabled. Patients are continuously monitored, and their data is sent to a centralized nursing hub along with personalized parameters. If their biometric markers go outside of a preset zone, nurses are alerted to check on them. If needed, a nurse, physician, or paramedic may also be dispatched to the patient’s home. “We have an escalation process in place to ensure the patient is safe,” Riedesel says.

Allina’s program is now one of the fastest growing Hospital at Home programs in the country. To date, it has served roughly 3,700 patients in the Twin Cities metro and a few regional areas throughout the state. When the program started, 60% to 70% of the Hospital at Home patients were COVID-19-positive. In 2022, it’s closer to 40%. The bulk of the patients are now being treated primarily for other conditions, such as sepsis, chronic heart failure, chronic obstructive pulmonary disease (COPD), and post-surgery recovery.

“We continue to see equal- or better-quality outcomes for people who get to recover in their homes, with their loved ones,” Riedesel says. While in-patient hospital care is necessary for some acute conditions, hospitals are not without risk. The Centers for Disease Control and Prevention (CDC) estimates hospital-acquired infections account for 1.7 million infections and 99,000 deaths each year. “We want to make sure we’re providing the safest care in the safest place, and that can often be the patient’s home,” Riedesel says.

Telehealth saved lives of patients with opioid addiction

The Voice of Alexandria reports

Telehealth flourished during the pandemic, and now a new study shows it saved lives: The practice meant more people struggling with opioid addiction stayed in treatment longer and thereby lowered their risk of dying from an overdose.

For the study, researchers analyzed data among nearly 176,000 Medicare beneficiaries from September 2018 to February 2021. The analysis looked at telehealth services, medications for opioid use disorder, and medically treated overdoses among patients starting a new round of care before the pandemic compared to those during the pandemic.

More info

What did the study find? Patients in the pandemic group were more likely to receive telehealth services (19.6% versus 0.6%) and were more likely to receive medications for opioid use disorder (12.6% versus 10.8%). The findings were published online Aug. 31 in JAMA Psychiatry.

Even better than that, using telehealth services was linked to better adherence to medications, as well as a lower risk of having to be treated for an overdose, the investigators found.

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” according to senior study author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse (NIDA).

FCC takes back Auto Safety Spectrum for Wi-Fi

In an extreme case of use it or lose it, C|Net reports

The US Federal Communications Commission won an important battle in a fight to free up more unlicensed wireless spectrum for Wi-Fi devices.

A federal appeals court on Friday sided with the FCC in its decision to reallocate a big chunk of key spectrum for an expansion of unlicensed Wi-Fi use. The spectrum had previously been set aside for auto safety.

The US Court of Appeals for the District of Columbia rejected a legal challenge from the Intelligent Transportation Society of America and the American Association of State Highway and Transportation Officials seeking to reverse the FCC’s 2020 decision to repurpose about 60% of the 5.9GHz band spectrum block for unlicensed indoor use to help improve speeds and reduce congestion on 5GHz Wi-Fi networks.

UMD is bringing back telehealth counseling by popular demand

Fox21 Duluth reports

Back by popular demand, the University of Minnesota Duluth will offer telehealth counseling again this school year.

During the pandemic, many schools connected virtually with students. Last year, UMD launched its telehealth program, that offers remote mental health counseling.

Now, the university is bringing it back, after seeing how well-received it was by students.

Virtual, in-person, and hybrid counseling sessions will be available. Free of charge and covered by tuition.

People seemed to like it…

“Last year we did our initial appointments virtually and then we talked to students about what it was they wanted moving forward. We were a little surprised, we thought that everybody would want to be back in the in-person in the office, but that wasn’t necessarily the case for all people.”

Baribeau-Thoennes went on to say, it’s important to keep virtual options available, especially during the cold, Minnesota months.

“Our no-show rates for appointments went down. Somebody might be like “oh no my car is blocked in and I have to shovel,” and normally they might have canceled the appointment, but now they just call and say can I switch my appointment to virtual.”

There are policy hiccups…

The kicker is — providers can only give services in their licensed state. Meaning UMD students have to be in Minnesota to use the telehealth option.

Access to telehealth is a digital equity issue

I’ve been seeing an increase in articles on telehealth these days and they usually report that access to technology increases comfort and use of telehealth and that leads to easier access to healthcare – for doctor and patient. Rheumatology Advisor reports

For patients to participate in telehealth encounters, they have to use a number of proprietary, health system-specific portals and platforms. That can be challenging for many older adults and minority groups. Effective virtual care depends on digital fluency, meaning they need to be able to engage in all aspects of digital technologies, from accessing the internet to navigating telehealth applications and performing basic troubleshooting. Many people cannot do this, creating significant barriers to care and telehealth disparities for a large segment of the population.

Boston researchers say the technology has the potential to reduce health disparities, but it also is exacerbating structural inequities. “Telehealth is here to stay, and has the potential to actually improve care outcomes, enhance the patient experience, reduce costs, and address health care inequities,” said Rebecca G. Mishuris, MD, MPH, an assistant professor of medicine at Boston University School of Medicine and Chief Medical Information Officer of the Boston Medical Center Health System in Massachusetts. “This, of course, will only be realized if we can address equity in engagement with telehealth, and fully incorporate it into a holistic care delivery model that employs both virtual and in-person care.”

Some of the numbers…

At her institution, which is a safety net hospital, 21% of Black/African American patients, 20% of Hispanic/Latino patients, and 22% of White patients reported lacking access to a connected device with a camera or microphone. The study on telehealth disparities, published in the Journal of General Internal Medicine, also showed that 67% of White patients opted to schedule their telehealth visits by video compared with only 60% of Black and Latino patients.

Telehealth visits a boon to vets with opioid addiction

It’s hard to compare the last two years with anything before, given the impact of COVID but even given that difference (or maybe because of it) the stats on veterans in recovery and their use of technology. Southern Minn reports

There are many obstacles to opioid addiction treatment, but a new study shows one that one outgrowth of the COVID pandemic — telehealth — is enabling more U.S. veterans to get help.

Researchers examined care given to vets before and after a transition to telehealth visits in early 2020 for treatment of their opioid use disorder. Telehealth for patients receiving the prescription drug buphrenorphine to treat opioid dependence was relatively new in the Veterans Affairs health system before the pandemic, said lead author Dr. Allison Lin.

“The rapid switch to virtual visits for most patients kept people from dropping out of care, and telephone visits [also] played a key role,” said Lin, an addiction psychiatrist at the Ann Arbor VA in Michigan and investigator at the VA Center for Clinical Management Research.

In 2020, phone appointments significantly outnumbered video and in-person visits, the study found. Even in early 2021, phone visits made up 50% of monthly visits for vets using buprenorphine; video visits, 32%; and in-person care, 17%.

Compared to March 2019, on a monthly basis there was a 14% increase in number of vets receiving buphrenorphine treatment in February of last year. Over that same period, 6% fewer vets overall received any kind of addiction treatment.

Research shows telehealth helps with prenatal and maternal care

The Grand Rapids Herald (via HealthDay News) reports

Researchers from Oregon Health & Science University reviewed 28 randomized clinical trials and 14 observational studies that included more than 44,000 women. The goal was to determine the effectiveness and any harms of telehealth strategies for maternal health care.

Many of the telehealth strategies included were used to treat postpartum depression or to monitor diabetes or high blood pressure during pregnancy. They also served as an alternative to general maternity care for low-risk pregnancies.

Researchers found these appointments resulted in mostly similar, or sometimes better, outcomes compared with in-person care.

The authors said this may mean that telehealth can be a supplement to usual care for postpartum depression. Telehealth interventions were more likely to improve mood symptoms in the short term compared to in-person care alone, they said, though the effects might not be sustained.

What a gift to not have to go into the doctor’s office for every prenatal visit! Less time off work, or for those of us with a few kids, less taking time off work to bundle up a baby for a routine visit to check out the baby-to-be. And that’s coming from someone with only a 10 minute drive to the doctor’s office. The caveat of course is that sufficient broadband is required.

The Roadmap to Telehealth Efficacy – broadband is essential to good health

It was amazing, and lifesaving, to see how quickly healthcare could move online during the pandemic. Healthcare facilities stepped up their game by bringing in the technology, patients stepped by learning how to use it and government stepped up by relaxing rules on reimbursement and licensure. To keep up the momentum we must continue to have engagement from all three players – and the one that seems most precarious is the relaxed rules.

The folks at Brookings recognized this and came up with a report that makes recommendations to help continue use and growth of telehealth…

  1. Federal and state governments must continue telehealth availability and use in a post-pandemic environment through codifying its use, especially in legislation.
  2. Modality neutrality must become a standard practice to adequately address digital disparities, and ensure full use of remote health care.
  3. The U.S. must adopt a federal privacy standard to ensure patient/ provider confidentiality and reduce risks to data
  4. The larger health care community must understand that they, too, are part of efforts to close the national digital divide through training, device availabilities, and online consumer engagement.
  5. States and localities must prioritize telehealth in their broadband plan and include local stakeholders.
  6. Telehealth should be incorporated in value-based payment initiatives.
  7. The incorporation of AI into telehealth must prioritize equity and fairness.

I think it’s helpful for those of us outside of healthcare and/or policy field to see all that is required to make or sustain such a social shift in how we do things. But it’s really the fourth and fifth points that will relate to most readers. Access to healthcare is a compelling reason to strive for better broadband, especially in areas where physical healthcare facilities are not nearby. Remember to invite healthcare folks to your broadband planning meetings and remember to include telehealth training into your digital equity efforts.

New app connects Patients and Pharmacists in Minnesota

Global Newswire reports

ImpactPharm, Inc., the new medication consulting service founded in Minnesota, officially launched its first mobile application, ImpactPharm, on July 14, 2022. The app mainly focuses on medication consultation, especially for patients with special medication needs, such as cancer patients, pregnant or breastfeeding women, as well as patients who live in rural areas of Minnesota. The application will put patients’ minds at ease to connect, discuss, and consult with qualified pharmacists about their medication issues. The app provides functions that benefit all users from 1-on-1 messages, sharing past medical records, retrieving past conversations, and choosing pharmacists based on patient preferences. With ImpactPharm, patients can consult with a pharmacist anywhere, anytime they prefer.

ImpactPharm is innovating how they connect patients with pharmacists. While it is comparatively easier to find a telehealth app for patients to talk with doctors, ImpactPharm found that patients also care about the dosage of a medication, side effects, and further questions relating to the pharmacist’s expertise.