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Telehealth might be best as a supplement to office visits, not a replacement

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.

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Photo by Samantha Borges from Unsplash.com

With the pandemic, there has been a rise in the use of virtual appointments for patients seeking health care. A new study by Tufts researchers, however, suggests that for many older and chronically ill patients, telehealth appointments may be most effective when they augment in-person health-care visits rather than fully replace them.

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.

The study, which focused on older patients with serious and chronic kidney disease, found that not all patients were satisfied with telehealth. People of color, including patients who identified as Black, Native American, or Hispanic, or required additional accessibility features such as interpreters, were largely dissatisfied with telehealth.

Patients of color disproportionately suffer from chronic kidney disease and may more often contend with challenges associated with at-home care, such as inadequate space for home-dialysis and limited broadband access to support video-telehealth visits, said Keren Ladin, associate professor of occupational therapy and community health, who led the study.

Owing to historical and experienced discrimination, “we found that patients of color were less comfortable with telehealth and had more concerns about the quality of the care and being deprived of care in a telehealth setting than white patients did,” said Ladin.

Ladin said she was surprised by these findings, given that the study, which was recently published in JAMA Network Open, was conducted during the height of the COVID-19 pandemic.

“I thought people of color who were at higher risk would prefer to stay out of the health system for longer, but that was not what we found,” she said. Black patients also reported that telehealth appointments prevented them from connecting meaningfully with their doctors, contributing to feelings of mistrust.

“It was really striking,” said Ladin. “One woman told us, ‘I need to see the physician’s eyes to know that they were understanding me,’ underscoring that the persistent impacts of structural racism on health-care experiences of patients of color.”

The patients did appreciate that telehealth facilitated the ability of care partners such as family members to join them for appointments, something that has been limited during the pandemic. Beyond the comfort of accompanying patients, care partner participation can help improve treatment and adherence and patient education for older patients managing complex, chronic illnesses such as kidney disease, Ladin said.

Downsides from the Clinical Perspective

For clinicians, the low regard for telehealth appointments was more pronounced. A majority of the physicians interviewed remotely from Boston, Chicago, Portland (Maine), and San Diego equated telehealth with lower-quality care.

They could not, for example, conduct physical examinations and lab tests virtually, nor could they naturally build and maintain a personal rapport with chronic-disease patients. Patients, too, were worried about this.

“We heard loud and clear from clinicians that they felt that the human aspects of their job that they love so much—the communication with patients and those relationships—were fraught and damaged by this flat interaction style,” Ladin said. She conceded that although clinicians were generally dissatisfied with telehealth in its current form, most agreed that it did provide critical insight into a patient’s home, which was previously unavailable.

“Up until now, the patient’s home environment was really a black box,” Ladin said, “Whatever the patient said when they came into the office was accepted as truth.” During video visits, however, doctors are able to see patient’s homes, the exact medications they are taking, and interact directly with care partners. “That was a positive feature of these types of visits—more holistic care.”

To address the range of obstacles perceived by both patients and clinicians in the study, the researchers recommend doctors share detailed post-visit summaries with patients and care partners, leave time during virtual visits for patients to absorb difficult news, and inquire specifically after patients’ emotions in the absence of nonverbal cues. Structural inequalities require a longer-term but equally important investment beyond simple communication strategies.

“I wish I could say we are doing it perfectly in person, and that telehealth is the only challenge we’re facing,” said Ladin. “We’re not. We need to work on this both in person and for telehealth.”

She stressed the importance of increasing the availability of interpreters during virtual visits and a more diverse workforce throughout the medical training pipeline, including nurses and physician assistants.

“The type of community-building and relationship repair that need to happen in health care will go a long way in improving this aspect,” said Ladin. “Diversifying the health-care workforce is crucial.”

Many telehealth services will stay covered by Medicare through 2023, under current law. After that, the future of remote health care for older Americans remains uncertain. Much of it will depend on whether perceptions among these patients, and in particular those with chronic illness, are positive. For Ladin, the benefits are as clear as the drawbacks.

“At its best, maybe we are getting back to a more patient-centered approach,” she said. “But I would be cautious to use it as a replacement device. For older, complex patients, we want to strive for a balance between seeing somebody in person in the clinic most times and then occasionally seeing them onscreen.”

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NewsMakers

5 Steps for women to reduce their risk of COPD

Women tend to develop COPD earlier in life than men and are more likely to have severe symptoms and be hospitalized with the disease. The good news? According to the National Heart, Lung, and Blood Institute, there are steps you can take to reduce your risk for COPD.

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If you’re a woman who tries to stay healthy, you may exercise several times per week, watch what you eat and get 7-9 hours of sleep each night. But are you listening to your lungs?

Chronic obstructive pulmonary disease (COPD), a leading cause of disability and death in the United States, takes an especially heavy toll on women. You may think problems like shortness of breath, frequent coughs or wheezing are just signs of getting older, but it’s important to pay attention to these symptoms and discuss them with your doctor.

COPD is a serious lung disease that causes breathing problems and worsens over time. It has often been considered a man’s disease. Yet more women than men have been diagnosed with COPD in the past decade, and over the past 20 years more women have died from it, according to the US Centers for Disease Control and Prevention.

Women tend to develop COPD earlier in life than men and are more likely to have severe symptoms and be hospitalized with the disease. The good news? According to the National Heart, Lung, and Blood Institute, there are steps you can take to reduce your risk for COPD.

Don’t Smoke

You probably already know cigarette smoking is harmful  but did you know that women may be more vulnerable to the effects of smoking? Women who smoke tend to get COPD at younger ages and with less cigarettes smoked than men. COPD is the leading cause of death among U.S. women smokers.

If you do smoke, it’s never too late to quit.

If you thought vaping was a healthy alternative to smoking, think again. Researchers are still learning about the long-term health effects of e-cigarettes, but they may contain as many, if not more, harmful chemicals than tobacco cigarettes.

Avoid Pollutants

Among people with COPD who have never smoked, most are women. Women may be more vulnerable to indoor and outdoor air pollution. Women’s smaller lungs and airways mean the same amount of inhaled pollutants may cause more damage.

Working in places like nail salons, hair salons or dry cleaners can expose you to harmful chemicals. If you’re exposed to chemical fumes at your job, talk to your employer about ways to limit exposure. Better ventilation and wearing a mask can help.

Stay Current on Vaccines

People at risk for COPD are more likely to have serious problems resulting from some vaccine-preventable diseases. Ask a health care provider about getting vaccinated against the flu, pneumococcal disease and COVID-19.

Talk to Your Doctor About COPD

Women with COPD tend to be diagnosed later than men when the disease is more severe and treatments are less effective. If you think you could be at risk, or you are having symptoms, bring it up with your health care provider. Treatment can ease symptoms and improve your ability to exercise.

Learn More to Breathe Better

Find more information on COPD from NHLBI’s Learn More Breathe Better program at copd.nhlbi.nih.gov.

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2 Steps to save a life

“By equipping people with Hands-Only CPR training, we are empowering them to spring into action if a loved one needs help, as the majority of cardiac arrests occur at home.”

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More than 350,000 sudden cardiac arrests occur annually outside hospital settings. However, a hands-on emergency intervention like cardiopulmonary resuscitation (CPR), especially if performed immediately, can double or triple a cardiac arrest victim’s chance of survival.

According to the American Heart Association, 70% of cardiac arrests – electrical malfunctions in the heart that cause an irregular heartbeat (arrhythmia) and disrupt the flow of blood to the brain, lungs and other organs – occur at home, but often family and friends who witness a child, spouse, parent or friend going into cardiac arrest hesitate to perform potentially lifesaving CPR for fear of making the situation worse.

“By equipping people with Hands-Only CPR training, we are empowering them to spring into action if a loved one needs help, as the majority of cardiac arrests occur at home,” said Dr. Anezi Uzendu, M.D., interventional cardiologist and American Heart Association volunteer.

As part of its Hands-Only CPR campaign, nationally supported by the Elevance Health Foundation, the American Heart Association aims to increase awareness about the importance of bystander CPR and offers these two simple steps:

1.      Call 911.
2.      Push hard and fast in the center of the chest of the individual experiencing cardiac arrest.

Using the beat of a familiar song with 100-120 beats per minute, such as “Stayin’ Alive” by the Bee Gees, can help you stay on pace with the necessary compressions.

“Being able to efficiently perform Hands-Only CPR in the moment can mean the difference between life and death, and by following these two simple steps we can increase someone’s chance of survival from cardiac arrest,” said Shantanu Agrawal, M.D., board certified emergency medicine doctor and chief health officer at Elevance Health. “As a longstanding supporter of the American Heart Association, we remain focused on working together to improve health inequities in our communities by expanding access to training and increasing the number of people who learn and feel confident performing Hands-Only CPR to save lives.”

To find more information, watch a livestream video demonstration of Hands-Only CPR or download a first aid smartphone app, visit heart.org/CPR.

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NewsMakers

What you eat could contribute to your menstrual cramps

Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain but with limited positive results. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.

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Despite the fact that menstrual pain (dysmenorrhea) is the leading cause of school absences for adolescent girls, few girls seek treatment. An analysis of relevant studies suggests that diet may be a key contributor, specifically diets high in meat, oil, sugar, salt, and coffee, which have been shown to cause inflammation.

Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain but with limited positive results. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.

This analysis was designed to study the effect of diet on menstrual pain and identify which foods contribute to it and which can reduce it. Research was conducted through a literature review that found multiple studies that examined dietary patterns that resulted in menstrual pain. In general terms, these studies found that diets high in omega-6 fatty acids promote inflammation and foods high in omega-3 fatty acids reduce it. The muscles in the uterus contract because of prostaglandins, which are active in inflammatory responses. When measuring the Dietary Inflammatory Index, it was found that those on a vegan diet (that excluded animal fat) had the lowest rates of inflammation.

“Researching the effects of diet on menstrual pain started as a search to remedy the pain I personally experienced; I wanted to understand the science behind the association. Learning about different foods that increase and decrease inflammation, which subsequently increase or reduce menstrual pain, revealed that diet is one of the many contributors to health outcomes that is often overlooked. I am hopeful that this research can help those who menstruate reduce the pain they experience and shed light on the importance of holistic treatment options,” says Serah Sannoh, lead author of the poster presentation from Rutgers University.

“Since menstrual pain is a leading cause of school absenteeism for adolescent girls, it’s important to explore options that can minimize the pain. Something like diet modification could be a relatively simple solution that could provide substantial relief for them,” said Dr. Stephanie Faubion, NAMS medical director.

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