Annual physicals do not reduce morbidity or mortality, and they waste time and money. To address their overuse, relationship-building visits could be created, preventive care could be updated in ...other ways, and reimbursement could be changed accordingly.
The past few decades have seen numerous calls to eliminate the annual physical examination. In 1979, the Canadian Task Force on the Periodic Health Examination recommended “that the annual checkup, as practised almost ritualistically for several decades in North America, be abandoned.” In 2013, as part of the Choosing Wisely campaign, the Society of General Internal Medicine recommended against annual preventive examinations in asymptomatic patients.
Nevertheless, about one third of U.S. adults receive an annual physical (also called an annual preventive exam or periodic health exam) in any given year, and that trend has not abated (see graph). This ongoing . . .
Despite the potential benefits of telehealth applications, little is known about their overall impact on care. This is critical because rising health care costs and a shortage of primary care ...providers make it likely that telehealth services will play an increasingly important role in health care delivery. To help fill this gap in knowledge, we describe early experiences with Teladoc, one of the largest telemedicine providers in the United States, which provides care directly to patients over the telephone or via the Internet. We analyzed claims data for a large California agency serving public employees that recently offered Teladoc as a covered service. The 3,701 Teladoc "visits" we studied were for a broad range of diagnostic categories, the most common of which were acute respiratory conditions, urinary tract infections, and skin problems. Compared to patients who visited a physician's office for a similar condition, adult Teladoc users were younger and less likely to have used health care before the introduction of Teladoc. Patients who used Teladoc were less likely to have a follow-up visit to any setting, compared to those patients who visited a physician's office or emergency department. Teladoc appears to be expanding access to patients who are not connected to other providers. Future research should assess the impact of Teladoc and other telehealth interventions on the quality and cost of care.
Coronavirus disease 2019 (COVID-19) spurred a rapid rise in telemedicine, but it is unclear how use has varied by clinical and patient factors during the pandemic. We examined the variation in total ...outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020. During the pandemic, 30.1 percent of all visits were provided via telemedicine, and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Across specialties, the use of any telemedicine during the pandemic ranged from 68 percent of endocrinologists to 9 percent of ophthalmologists. Across common conditions, the percentage of visits provided during the pandemic via telemedicine ranged from 53 percent for depression to 3 percent for glaucoma. Higher rates of telemedicine use for common conditions were associated with smaller decreases in total weekly visits during the pandemic.
The 2019 coronavirus pandemic (COVID-19) has resulted in tremendous growth in telehealth services in Australia and around the world. The rapid uptake of telehealth has mainly been due to necessity - ...following social distancing requirements and the need to reduce the risk of transmission. Although telehealth has been available for many decades, the COVID-19 experience has resulted in heightened awareness of telehealth amongst health service providers, patients and society overall. With increased telehealth uptake in many jurisdictions during the pandemic, it is timely and important to consider what role telehealth will have post-pandemic. In this article, we highlight five key requirements for the long-term sustainability of telehealth. These include: (a) developing a skilled workforce; (b) empowering consumers; (c) reforming funding; (d) improving the digital ecosystems; and (e) integrating telehealth into routine care.
Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage).Design Audit ...study.Setting Publicly available, free symptom checkers.Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection).Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations).Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations.Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.
The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by ...close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
The shift away from fee-for-service payment puts pressure on hospitals to reduce low-value care and to manage care delivered outside their walls. Thus far, hospitals have found savings by using an ...unusually consistent strategy: reducing institutional postacute care.
This cohort study compares rates at which patients with type 2 diabetes received diabetes-related health services prior to and during the COVID-19 pandemic.
In 2016, Medicare started mandatory bundled payment for joint-replacement surgery in randomly selected areas. Hospitals receive bonuses or pay penalties based on spending through 90 days after ...discharge. In the first 2 years, there was a slight reduction in spending.
PDF
