Feb 01 2018

Telehealth Plays a Key Role in Improving Urban Pediatric, Neonatal Care

Videoconferences are playing a huge role in improving asthma treatment, mental health and neonatal care in metropolitan areas.

While rural populations have already benefitted greatly from telehealth, urban populations could stand to gain equally as much from the technology.

Videoconferencing technology has made waves in less populous areas by bringing providers and experts to patients, which also decreases healthcare and travel costs. But urban populations stand to gain from the technology as well. Virtual visits can introduce new modes of care to metropolitan populations where, in many cases, patients also find it difficult to make it to the doctor or access appointments.

In fact, since 2014, the wait time for new patient appointments in 15 metropolitan areas has increased by 30 percent, according to a 2017 study by healthcare professional placement company Merritt Hawkins.

Researchers from Princeton and Thomas Jefferson University argue on a Health Affairs blog post that by synchronizing rural and urban care for telehealth, all patients will see a better outcome.

Already, some health organizations are tapping telehealth to improve care and offer expanded access to those in urban areas.

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Virtual Visits Help Students Get Ahead with Asthma

In Rochester, N.Y., school-based telemedicine has been shown to "significantly" improve outcomes for children with asthma, according to a new study published in JAMA Pediatrics.

Conducted by the University of Rochester Medical Center, the study looked at several hundred students from across the city's school district and offered the children, aged 3-10, access to enhanced usual care via telemedicine in a randomized trial. Children who participated in the telehealth portion of the study received three school-based telehealth visits in addition to preventative asthma medication, which all students received.

Those receiving telehealth care saw significantly improved symptoms and had less emergency room visits, according to the study. "Increased symptom-free days and fewer emergency department visits or hospitalizations were seen among children receiving the intervention compared with usual care," the study's authors note.

Telemedicine visits allowed for better coordination between students, nurses and other healthcare professionals.

"We suspect that the benefits related to supervised medication administration reach beyond simply assuring adherence to effective preventive medications and include the therapeutic relationships that were built between students and school nurses as well as the opportunities for ongoing monitoring and education," the study's authors add.

Telemental Health Bridges Gaps in Pediatric Care

Telehealth program benefits for children in urban areas also extend to mental health. A program in New Jersey aims to connect pediatricians with psychiatrists, counselors and other behavioral health experts in order to improve mental healthcare access for teens, mHealthIntelligence reports.

The program, executed by Rutgers University Behavioral Health Care (UBHC) and New Jersey Medical School, offers online and telephone consults to Essex County pediatricians.

"If we can increase pediatricians' capacity to identify and treat their patients' emotional and behavioral challenges, it would fill a need for many families who are not getting services," Evelyn Orozco, the program's director, said in a news release. "In a perfect world, you would have a psychiatrist who works at every pediatric office. That's not realistic, but this model comes close."

With mental health providers proving scarce, the tech could fill a much-needed gap in adolescent care.

"Urban youth are at a higher risk for exposure to trauma, which can result in emotional and behavioral symptoms that can be easily misdiagnosed," Orozco added. "Early treatment is essential in preventing disorders from becoming more chronic and debilitating."

Payment Hurdles for Urban Telehealth Initiatives

While rural telehealth services hit their own barriers, such as connectivity issues, metropolitan programs have their own hurdles. The net neutrality repeal could place a strain on urban telehealth access by complicating bandwidth availability. In the meantime, payment and reimbursement continue to be a challenge.

Princeton and Thomas Jefferson University researchers argue in the Health Affairs blog that changing reimbursement policies in urban areas to reflect need could help remedy this problem:

Current Medicare payment policies target geography, and therefore do not focus on the real problem, which is access. The ability to use healthcare resources virtually (that is, via telemedicine) would allow for improved access to care in the same way that virtual connectivity has decreased access barriers in other industries, such as banking and commerce. To successfully transform healthcare through telemedicine, expectations and incentives must be aligned across payers, health systems, providers and patients.

The researchers point to telemedicine adoption in the Antenatal and Neonatal Guidelines, Education and Learning Systems (ANGELS), which has enabled pregnant women everywhere to access neonatal consults with specialists via Medicaid-covered video visits.

"The best way to care for patients in rural environments is to build programs that synchronize rural and urban care," the Princeton and Thomas Jefferson University researchers write. "Health systems, patients and providers are all poised to interact with the healthcare system differently; aligning payment structures to focus on the availability of timely care instead of historic geographic constructs is essential."

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