Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

Abstract

BackgroundThe growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity.DiscussionWe describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.ConclusionsRecommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

“…By identifying and including additional recent trials with GDM only, the understanding of TM management of GDM was updated and more significant differences in maternal and neonatal/foetal complications were confirmed, which could provide scientific guidelines for future TM management. The greatest potential of TM lies in its ability to help patients who cannot be easily treated at existing clinics due to geographical constraints [50,51].TM provides a convenient channel for communication between medical staff and patients, where medical staff could monitor the health status of patients in realtime, allowing patients to obtain individual treatment plans and disease-related knowledge of their own conditions, which may greatly improve the compliance of patients and further contribute to lower glycaemic levels [4,14]. Some studies have shown that the psychological status of pregnant women also has a certain impact on pregnancy outcomes [52].…”

Medical service demands of older patients in different age groups in a new model of free Telemedicine

“…Telemedicine has been successfully applied in some medical professions and can be used as a useful way to provide much-needed intensive behavioral therapy in remote and resource-poor environment [9]. The way of applying telemedicine to serve patients' mental health can widen the channels of seeking medical treatment for elderly patients [10].…”

Opportunities for Innovation and Improved Care Using Telehealth for Nutritional Interventions

“…Because effective obesity interventions often require frequent contact with health care providers, telehealth serves as an effective way of following up with patients at short intervals. 3 A broad range of telehealth obesity-related interventions have been tried ranging from web-based learning modules, texts and smartphone applications, and wearable devices with varying degrees of success. 4,5 Malnutrition A recent systematic review showed that telehealth interventions (predominantly telephone consultations with dietitians) were effective and likely to result in clinical improvements in older adults with malnutrition.…”