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".

LULU GARCIA-NAVARRO, HOST:

For people living in rural communities, accessing health care can be a challenge. Hospitals closed. Doctors are rare. Technological advances can help solve some of these problems. A survey conducted by NPR reveals that many rural Americans use and love technologies for diagnosis and treatment, even when the health care provider is not in the room where the patient is. Patti Neighmond, of NPR, reports on the results of the survey conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

PATTI NEIGHMOND, BYLINE: Jill Hill describes where she lives, beautiful but isolated. Grbad Valley is a former mining town at the foot of Sierra Nevada in northern California. Jill makes me visit her garden, framed by a hand-made fence with pieces of old wooden slats and gnarled tree branches.

JILL HILL: We have kale, lettuce and parsley. We will have tomatoes. And we grow pumpkins and cantaloupe.

NEIGHMOND: Hill learned to love this here. But at 63, she had never thought that her life would be like that.

HILL: We lived in Arizona. My husband was under construction.

NEIGHMOND: project manager for a multi-million dollar housing construction company.

HILL: We had health insurance. We had life insurance. We had the American dream.

NEIGHMOND: The housing crisis erupted in 2008. Her husband lost his job and health insurance. He became ill and found himself on dialysis. They decided to return to California and rebuild their lives, but her husband died a few years later.

HILL: I was grieved. And my esteem about me was down. I did not care about me. I did not brush my hair. I have isolated. I just locked myself in the room.

NEIGHMOND: She knew that she needed a therapy, but the community health center located nearby in this rural area had only two therapists. She could see it once a month. She knew that she needed more.

HILL: So Brandy called me and said, hey. We have this telehealth program, where the therapist is brought on a computer screen, like Skype. And you want to try it?

NEIGHMOND: Brandy Hartsgrove coordinates telehealth for the Chapa-de Indian Health Clinic. Telehealth seemed a bit impersonal for Hill, but she said she was desperate and willing to try it.

HILL: This is my chair.

NEIGHMOND: It has been almost a year since Hill is sitting on this chair in front of a big computer screen. Twice a week for 30 minutes she talks to a clinical psychologist hundreds of miles away in San Diego. His last mission in therapy; write down its positive features.

HILL: And I had three.

NEIGHMOND: What were they?

HILL: Oh, loyalty, compbadion and resilience. She said, only three? She wanted 10. And I said, well, I'm just starting. So, she and I started talking. And now I'm probably at least 15. And I – keep adding to the list. But once I started writing, I started to see that I had a lot of strength.

NEIGHMOND: Hill says she's lucky. The Chapa-de clinic offers telehealth services. Many clinics do not have one, which means that people have to rely on their own resources. And in many rural areas, it's almost impossible, according to Robert Blendon, a Harvard professor, who co-led our poll on the life and health of rural Americans.

ROBERT BLENDON: The majority – essentially 8 out of 10 people living in rural America – have access to broadband internet. But 1 in 5 people really struggle to access it. And that means that they do not have the ability to get critical information in today? S world.

NEIGHBOR: This includes information such as the diagnosis of a problem, the provision of treatment or obtaining a medical opinion.

BLENDON: They lose the ability to contact their doctor, perform prescriptions and obtain follow-up information without having to consult a health professional.

NEIGHBOR: In our survey, a large majority of those who were able to use telehealth reported being satisfied with the diagnosis or treatment they received. An important note here – telehealth takes many forms. It can be a case of a patient who talks directly to a health care provider via SMS, email or on screen, like Jill Hill. It can also be done from one doctor to the next, as is the case for the pediatrician at James Morrison's critical care of UC Davis Children's Hospital. , where patients often face long and expensive trips for specialized care.

JAMES MARCIN: We have patients going to our Sacramento offices who have to drive the night before, spend the night in a hotel because it takes five hours. And if you're talking about taking time off work or studying, the costs of getting care that would otherwise be routine care are significant barriers for people living in rural communities.

NEIGHMOND: Telehealth can eliminate these barriers, says Marcin, bringing UC Davis specialists to the bedside, hundreds of miles away.

MARCIN: In the emergency department, they can place the telemedicine cart at the bedside. And in minutes, our doctors are able to see the child, talk with family members and help to help them that way.

NEIGHMOND: It's not just emergency care. It can also be cardiology, gastroenterology, dermatology – any number of specialized services. Lawyer Mei Kwong, Center for Connected Health Policy, agrees that telehealth could help reduce disparities. But she said payment policies for telehealth services lag well behind technology.

MEI KWONG: Most existing policies are probably 15 to 10 years behind, unlike what technology can do now. So it makes sense that 10 or 15 years ago the proposed technology makes no sense because technology was not where it is today and what it can do and what she can do it safely.

NEIGHMOND: For example, services such as high-resolution photos, retinal screening for diabetic patients or consultations between a specialist and a primary care physician may not be paid for by Medicaid, Medicare or private insurance. Today, change is happening, says Kwong, but it is moving slowly.

Patti Neighmond, NPR News.

("5 MIN CALL" FROM THE INSPIRATION OF THE INSPIRED LAKE) Transcript provided by NPR, Copyright NPR.