Thursday, June 30, 2011

Who will Drive Social Media Use in Health Care? Part 1

In his blog post titled Social Media in Health Care:  Barriers and Future Trends, author John Sharp notes that social media has invaded health care from at least three fronts:  startups, patient communities and medical centers. These three groups will continue to drive and expand the use of social media in health care over the next five years.  However, I believe other three other groups will also exert influence and expand use: physicians, pharmaceutical and medical device manufacturers, and the federal government. Over the next three weeks, I'll examine the impact of each of these groups on the future of health care social media.

This week I consider the evolving influence of physicians.  Physicians have not been active in social media for several reasons:  lack of clarity on appropriate use of social media, slow adoption of information technology, and payment schedules that don't reimburse for patient conversations.   These factors are becoming less of a deterrent to the use of social media by physicians.

Crystallizing professional guidance

Major organizations such as the American Medical Association are issuing guidelines to help clarify the appropriate use of social media by physicians. Influential physicians who are active in social media, such as blogger Dr. Kevin Pho of KevinMD and Val Jones of Better Health, also provide useful guidance and lead by example. The newly established Mayo Center for Social Media also explores the appropriate use of social media by health care professionals in its blog series titled Friday Faux Pas and in its video project, The Doctor is Online: Physician Use, Responsibility, and Opportunity in the Time of Social Media.

Impact of telehealth

The American Telehealth Association (ATA) defines telehealth as "remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth."   According to a survey of 2000 US physicians, 7% use online video conferencing to communicate with patients.

Use of telehealth technology is expected to grow because it provides a way to improve physician productivity and enhance the quality of care. A recent study by Kaiser Permanente found that among 35,423 patients with chronic health conditions, those that used email to communicate with their doctors saw a statistically significant improvement in health effectiveness measures.   Dr. Ron Dixon, Director of the Virtual Practice Project at Massachusetts General Hospital, also noted that information technology offers the ability to improve coordination of care among various providers.

Expanded reimbursement

A nationwide phone survey of 72 programs offering telehealth services by AMD Global Telemedicine, supplier of telemedicine technology found that more than half are currently receiving reimbursement from private payers. Private payers currently reimburse for telehealth programs in at least 25 states.   According to the survey over 100 private payers currently reimburse for telemedicine services. 

A survey conducted by the Center for Telehealth & eHealth Law found that 39 states have some reimbursement for telehealth services, though the extent of coverage depends on many factors.  Similarly, the Centers for Medicare and Medicaid Services (CMS) also provides limited coverage for telehealth services. Recently, however,  the ATA sent a letter to CMS Administrator Dr. Donald M. Berwick, asking the U.S. Department of Health and Human Services, of which CMS is a part, to  waive restrictions for telehealth services under Medicare Parts A and B.

Social media safe havens

Additionally, the increasing popularity of secure “communities” where physicians can exchange clinical information will hasten adoption of information technology.  Since its launch in 2006, 20% of all US physicians have become members of Sermo, an online community where practicing physicians discuss clinical issues and practice management.  Doximity is another private network for physicians and other medical professionals.

The rise of e-patients

The emergence of e-patients, patients who are engaged, empowered and active online, will also encourage physicians to use social media.   The Pew Internet and American Life Project found:
  • 80% of internet users (or 59% of adults) have looked online for health information
  • 34% of internet users  (or 25% of adults) have read someone else’s comments about health or medical issues in an online news group, website, or blog.
If physicians are to remain a relevant source of medical information for patients, they will need to establish their presence online as well as offline.  

Next week I'll look consider the factors influencing increased social media use by pharmaceutical and medical device manufacturers.

Wednesday, June 22, 2011

Who's Responsible for Childhood Obesity?

The San Francisco City Council recently banned toys in children’s fast food meals but the ban won’t fix the problem of childhood obesity because it doesn’t address its root causes. Childhood obesity, like adult obesity, is the result of numerous factors converging to create the perfect public health storm.

Children are moving less

Children spend more time engaging in sedentary activities such as playing video games or spending time online.  This is compounded by the fact that physical education programs and recess have been cut from many school programs.  Yet numerous studies have shown that physical activity has a positive impact on the academic performance of children. 

Children are eating fewer home cooked meals

Frequent family meals have been shown to increase fruit and vegetable consumption and reduce consumption of sugar sweetened beverages.  (1)  Yet away from home foods have been associated with foods that are less nutritious (higher in fat, lower in fiber) and have larger portion sizes.  (2)  Despite the unfavorable nutrition profile of away from home foods expenditures on these types of foods has been increasing.  Nearly half of families have reported consuming restaurant food at least once weekly.  (3)   Furthermore, the amount of time spent preparing food among US households has decreased for two reasons:  less time available for food preparation and lower time costs of food preparation.  The Economic Research Service report  Who has Time to Cook found that the amount of time spent preparing food decreased as the number of hours worked increased.

What are the implications?

Childhood obesity can be especially costly since it can lead to serious health conditions that have a lasting impact.  Children who are overweight and obese are at increased risk for hypercholesteremia, dyslipidemia, hypertension, insulin resistance, impaired glucose tolerance, Type 2 diabetes and depression.  The likelihood that these health conditions persist is quite high since the probability of childhood obesity continuing through adulthood increases from 20% at age 4 to 80% in adolescence.  (4)

The solution to childhood obesity will require the efforts of multiple stakeholders:  schools need to serve better food and make physical activity a part of the daily curriculum, parents need to take the time to choose foods more carefully and make family meals a priority, even employers have a vested interest since the children of employees are covered by employer sponsored health plans.  Finally the government, at state, local and federal levels, needs to continue to educate the public through programs such as Let’s Move and create incentives that encourage schools to serve healthy foods. 

Who’s responsible for addressing childhood obesity?   

The answer is easy:  everyone.  The solution is not.

(1) Fulkerson, Jayne et. al. “Family meals:  perceptions of benefits and challenges among parents of 8-10 year old children.” Journal of the American Dietetic Association (April 2008): 706-709. 
(2) Greenwood, Jessica and Stanford, Joseph.  “Preventing or Improving Obesity by Addressing Specific Eating Patterns.”  Journal of American Board of Family Medicine ( March-April 2008): 135-140.
(3) Ayala, Guadalupe et. al.  “Away from home food intake and risk for obesity:  examining the influence of  context.” Obesity (December 2008): 1002-1008. 
(4) American Academy of Pediatrics, “Prevention of Pediatric Overweight and Obesity,” Pediatrics (August 2003):  424-430.


Monday, June 20, 2011

Making Progress on Men's Health

It's Men's Health Month and a good time to consider male health issues.  Men’s health is frequently overlooked despite the fact that men die five years sooner than women and have higher mortality rates from the leading causes of death.   Understanding the health seeking behavior of men, how they communicate and what influences them is key to eliminating the health gender gap.

It's true: men go to the doctor less frequently

A recent report from the Agency for Healthcare Research and Quality (AHRQ) found that men were 24% less likely to visit the doctor than women over the course of a year.  Male cultural values may be a factor in whether men visit their doctors but research suggests patient dissatisfaction with the office visit may also play a role.

A study conducted by researchers at the University of Michigan found that a majority of African American men reported they didn’t go to the doctor because visits were stressful and physicians didn’t provide the information they needed to make lifestyle changes.  Researchers suggested doctors offer more practical information to help all men follow physician recommendations.  Some useful online resources which address men’s health include:
Talk like a man

Understanding the subtlety of male communication is also critical to improving men’s health.  Joe Zoske, a health communication instructor, suggests focusing on numbers and using metaphors that resonate with men.
Additionally, Will Courtenay, PhD, a specialist in men’s behavioral health, has developed the following 6 Point HEALTH Plan to guide clinician’s conversations with men:
  • Humanize: explain to men that their concerns are normal, not a sign of weakness
  • Educate: take some time to explain; men may be less knowledgeable about health issues compared to your female patients.
  • Assume the Worst:  men tend to underestimate the severity of their symptoms; gently probe to gain an accurate assessment of their clinical condition
  • Locate Supports:   work with male patients to identify supportive individuals and groups  who can help them manage their health issues
  • Tailor Plan:  work with patients to create a realistic health plan that focuses on a few achievable goals
  • Highlight Strengths:  take advantage of male patients’ competitive attitudes to help motivate them about their health
Nagging works

The influence of spouses on men’s health should not be overlooked.  According to a survey of male patients from two primary care clinics, researchers concluded that targeting women is an effective way to change the health behavior of men. (1) This conclusion was validated by a second study which used patient reminder mailings from health insurers to encourage men to seek preventive health care.  When reminders were also mailed to spouses or partners there was a significant increase in the number of men scheduling preventive care. (2)

A national health priority

On June 16, 2011 the National Prevention, Health Promotion, and Public Health Council announced the release of the National Prevention Strategy , a  plan whose goal is improve the health of Americans by focusing on wellness.  For this strategy to succeed, all of us, businesses, educators, health care providers, and individuals,  must do a better job communicating with and motivating men about their health.

(1)   Norcross, William, Carlos Ramirez and Lawrence Palinkas. "The influence of women on the health care-seeking behavior of men." Journal of Family Practice (1996): 475.
(2)    Holland, Denise, Don Bradley and Joseph Khoury. "Sending men the message about preventative care: an evaluation of communication strategies." International Journal of Men's Health (2005): 97.