With thin rural health care, more patients turn to telehealth

Telehealth has transformed Jill Hill's life.

Aged 63, he lives on the edge of rural Grbad Valley, a former mining town at the foot of Sierra Nevada in northern California. She was devastated after the death of her husband, Dennis, in the fall of 2014 after a long series of medical and financial setbacks.

"I was afflicted with grief and my esteem about me was low," recalls Hill. "I did not care about myself, I did not brush my hair, I was isolated, I just locked myself in the room."

Hill says that she knew that she needed a therapy to treat her growing depression. But the main health center of his rural town had only two therapists. Hill was told that she could see a therapist only once a month.

Next, Brandy Hartsgrove called to say that Hill was eligible through MediCal (Californian version of Medicaid) to a program offering him 30-minute video counseling sessions twice a week. The sessions would take place on a computer screen with a therapist located hundreds of miles south in San Diego.

Hartsgrove coordinates telehealth for the Chapa-de Indian Health Clinic, located 10 minutes 'drive from Hills' home. Hill was sitting in a comfortable chair facing a screen in a small private room, Hartsgrove explained, to see and talk to his counselor during an otherwise traditional therapy session.

Hill thought it sounded "a bit impersonal;" but was desperate for the council. She agreed to try.

Hill is part of the growing number of Americans who are turning to telehealth appointments at medical care providers as a result of numerous hospital closures in isolated communities and the shortage of medical doctors primary, specialist and other providers.

Remote consultations between video doctors via video also fall under the heading "telehealth" or "telemedicine".

A recent NPR survey of rural Americans found that almost a quarter of people had used a type of telehealth service in recent years; 14% report having been diagnosed or treated by a doctor or other health professional via email, text messaging, live chat, mobile application or live video such as FaceTime or Skype . And 15% report receiving a diagnosis or treatment from a doctor or other health professional over the phone.

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These survey findings are part of the second of two recent rural life and health surveys conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

The Chapa-de Clinic offers telehealth services not only for behavioral health and psychiatry consultations, but also for cardiology, nephrology, dermatology, endocrinology, gastroenterology and more.

Hill feels lucky; She knows that most rural health facilities do not include telehealth services, which means that most patients living in remote areas would need their own high-speed Internet access at home for treatment. line.

And this is out of reach for many, says Robert J. Blendon, co-director of the NPR poll and professor of health policy and political badysis at Harvard Chan School.

The survey found that one in five rural Americans states that high-speed internet access is a problem for his family.

According to Blendon, advances in online technology have led to a "revolution" in the health sector that has left many patients in rural areas.

"They are losing the ability to contact their doctors, perform prescriptions and obtain follow-up information without having to see a health professional," he said.

James Marcin, pediatric pediatrician at the UC Davis Children's Hospital, runs the University of California Davis Health and Technology Center and consults regularly with a telehealth monitor with primary care physicians in remote hospitals located in rural areas.

"We are able to put the telemedicine cart [virtually] Marcin says, "At the bedside of the patient, our doctors are able to see the child, talk with family members and help him heal in this way."

According to Marcin, if it's not for telehealth, getting routine care should be a major barrier for people living in rural communities.

"We have patients who go to our Sacramento offices and have to go there the night before" and stay overnight in a hotel because it takes five hours. "In addition, many patients, such as child care and missed work days, incur additional costs.

With telehealth, "a video is really worth a thousand words," he says; this may mean that patients do not have to make expensive long trips to see a specialist.

Although Hill initially expressed reservations about the online meeting with a therapist, she said she was surprised by the usefulness of the sessions.

"She gives me badignments and works very hard for me," says Hill, "and I have grown so much, especially in recent months."

His last mission in therapy: to write his positive characteristics. Initially, she could only offer three: loyalty, compbadion and resilience. But the therapist questioned him and encouraged Hill to consider that there might be more.

"She wanted 10," said Hill, who then discussed other issues and discussed more with a therapist. "Now, I'm at least 15 years old," says Hill, "and I add to the list; once I started writing things, I really started to to see that I had a lot of strength that I did not even know I had. "

Lawyer Mei Kwong, executive director of the Center for Connected Health Policy in Sacramento, said telehealth services could potentially eliminate many barriers to good health care in rural America.

But policies that regulate telehealth services that are paid for "a considerable backlog of technology," said Kwong. Many politicians are 10 to 15 years behind what technology can do, she says.

For example, it is now possible to take high-resolution photos – and send them anywhere digitally – to skin conditions that many doctors consider to be better than "the naked eye." observing this condition, "she explains. But the policies in the books of what Medicare, Medicaid and private insurers are going to pay often mean that these services are not fully covered.

It's unfortunate, says Kwong, especially for underserved communities where there is a shortage of specialists.

Changes are beginning to be made to state, federal and private insurance policies, says Kwong. But it's "slow".

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