August 26, 2015

Mobile Health, Part II: Bringing Care to Underserved Communities

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
health app

In today’s society, we are awash with health and fitness information on our mobile devices: apps, text reminders for doctor appointments and medical websites. Less often discussed is the phenomenon of mobile health clinics.

These clinics-on-wheels can provide an efficient and effective way of delivering medical care to disadvantaged communities, raising health awareness and providing impoverished patients with preventive care, diagnoses and treatment.

Like health apps, mobile health clinics aim to reach more people with more conveniently delivered health care. Some mobile health clinics are privately operated and others are hospital-funded. They originated to serve rural, isolated and low-income areas.

In addition to administering routine check-ups and blood tests, some of these clinics also offer dental and ob/gyn care, counseling services and imaging. Since many are supported through grants, their services are usually provided at low to no cost to patients.

Orlando Health’s Teen Xpress, part of the Arnold Palmer Hospital for Children in Florida, is hospital-funded. It features a well-equipped, 40-foot bus capable of providing primary-care services to adolescents and teens including physicals, immunizations, mental health and nutritional counseling.

Kaiser Permanente brings its medical van to the offices of its corporate clients to provide adult and pediatric care, chronic care, blood and urine collection and processing, glucose testing, audiometry, gynecological care and immunizations.

While apps are relatively new, the mobile health concept has been around for decades. Arizona was an early proponent and finds the concept still works well today. The University of Arizona Mobile Health Program serves about 2,400 uninsured and under-insured people, plus those that don’t have regular access to health facilities. The program also offers group prenatal care appointments for expectant mothers.

In Boston, mobile health units called The Family Van, sponsored by Harvard Medical School, provide an alternative to emergency room visits for patients with routine medical needs. Based on an average emergency department visit cost on average $474 in Massachusetts, the vans could save about $1.4 million in costs based on 2,851 avoidable emergency department visits annually, according to a report by WBUR-FM.

In 2012, the Massachusetts Department of Public Health published a five-year plan to address chronic disease prevention that recommended increasing the number of mobile health clinics.
Harvard Medical School developed a Mobile Health Map that pinpoints 2,000 mobile clinics serving 7 million people annually.

Some cite health reform as an opportunity to put more mobile health clinics into action. According to Mobile Health in the Era of Reform, published in the American Journal of Managed Care, recent reforms to the delivery system and health insurance coverage “have the potential to improve the integration of mobile clinics into existing care delivery structures.”

Mobile health clinics also may yield collateral benefits. According to an article in Slate, patients who have their blood pressure checked may “open up more and talk about other health concerns” as well as social and mental-health issues and family problems. As Nancy Oriol, a professor of anesthesia at Harvard Medical School and co-founder of the Family Van points out, “people come on the van with their lives.”

August 20, 2015

Mobile Health Part I: There’s An App for That

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
health app

When you hear the words “mobile” and “health” these days, you might envision a smartphone application, fitness wristband or text-based appointment reminder. But some studies are saying oversight – and, just as important, results – are not keeping up with the deluge of health apps and devices entering the market.

Everyone agrees that mobile health technology has its place. The “Best Health and Fitness Apps of 2015” includes software applications addressing yoga and allergies, a diagnostic app developed by emergency room doctors to help triage patients, one that provides a way to connect with doctors via text, a sleep app, an ovulation-tracking app and a brain exercise app.

While some apps and devices serve as valuable tools and others offer novelty and convenience, they generate lots of data, and there is no consensus on what to do with it. So at the same time as the medical community is questioning the tangible medical benefits of health apps, it is wondering how to interpret the flood of information. Some experts worry that apps could lead to complacency or incorrect self-diagnosis.

Reporting on the findings of a British medical journal, The New York Times notes the medical community’s additional concern that “apps could even cause harm by stoking unneeded anxiety among the worried well,” adding: “Doctors don’t yet have definitive answers, partly because smartphone apps are so new and partly because government health authorities regulate consumer health apps at their own discretion, depending on the possible risks to users.”

While the National Institutes of Health generally supports mobile health, or mHealth, as it has come to be called, a NIH article published in 2013 worries about “growing concerns in the research community about the lack of evidence and evaluation of mHealth approaches.”

The article notes that many of the successes described by global health experts were related to maternal health, particularly in rural regions of developing countries where cellphones provide an inexpensive connection between new or expectant mothers and health professionals.

Another recent opinion in The New York Times is even more skeptical, saying “roughly a decade after the start of mHealth, expectations are far from being met.  The delivery system is there.  But we don’t yet know what to deliver. When programs have tested health outcomes, the results have usually been dismal.”

An analysis of mHealth studies from 1990 to 2010 found that a number of trials resulted in only moderate benefits, and not so much with apps as with texts for appointment reminders. In less-developed countries, where mobile technology is scarce, texting and some choice apps could make a big difference. One success story in Zambia involved using SMS messages for rapid delivery of test results for infant HIV.

Indeed, it could be that mobile devices may make the most difference in a global market, where even basic health data in underdeveloped areas can mean life or death. In the U.S., most apps may offer slight incentives or helpful appointment reminders. A 2014 article in Cardiology News cited only “mild benefits” for diabetes apps and text reminders.

A veritable explosion of asthma apps have appeared on the market, designed to help track pollen count or show how to use an inhaler as well as track personalized data on the user’s asthma triggers. Yet the journal BMC Medicine notes that while the numbers of asthma apps more than doubled between 2011 and 2013, “Newer apps were no more likely than those available in 2011 to include comprehensive information, such as the use of action plans, or offer guidance consistent with evidence.” Worse, 39 percent of apps intended to manage acute asthma ended up recommending self-care procedures that were “unsupported by evidence.”

Other studies hint that with better research and oversight, safer and more effective apps can be developed. For now at least, apps should not be used as a substitute for traditional medical care.

August 3, 2015

Sleep, Part III: It’s About Much More Than Just Feeling Rested

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
sleepless sheep jumping over fence

This the third part of a three-part series on sleep. Part I set forth the general issues. Part II looked at new research showing the benefits of sleep. This part reviews treatments for sleep disorders.

Sleep medicine is gaining traction as more people around the world seek relief from sleep deprivation. Unfortunately for them, research to date has yielded no magic bullets.

Sleeping pills, while very popular, are no panacea. According a special issue of Time magazine, “The Power of Sleep,” research shows no medicine can replicate all of sleep’s benefits – despite decades of attempts in pharmaceutical labs. Moreover, some of sedatives now on the market are addictive or just don’t work very well.

There are plenty of sleep hygiene tips online. Most represent just basic common sense: “Don’t drink coffee or alcohol in the evening! Exercise more! Avoid night shift work!” There are also a number of “sleep apps.” But in the end, you have to do the work.

The pursuit of good sleep, it seems, is more like a weight-loss program, i.e.: It depends on changing behavior, and the body will follow.

Some are turning to psychology instead of pharmacology, including relaxation techniques and mediation. CBT-I, or cognitive behavioral therapy for insomnia, involves regular visits with a sleep clinician, who methodically tracks the patient’s activities and bad habits in a quest to develop better sleep routines.

Naps are a traditional remedy for those who don’t get enough sleep. Now “power nappers” can find napcabs and sleeping pods in airports and even some offices.

The ongoing National Healthy Sleep Awareness Project, jointly run by the Centers for Disease Control and Prevention and the American Academy of Sleep Medicine, aims to increase awareness of better sleep habits.

Then there is the great taboo subject faced by many couples: What to do about a bed partner who snores, tosses and turns or hogs the bed covers all night? The Snooze or Lose survey in Today’s Health last year found that about one third of couples resolve the problem by sleeping in separate beds.

When all else fails, you could try Sprayable Sleep, a new product that applies melatonin to the skin with a little blast of aerosol. It’s made by the same company that produces Sprayable Energy, which contains caffeine. Just make sure you’re spraying the right one!

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