Home Visits Coming Back? How about Tele-home visits!?

An exiting article aired on NPR Morning Edition today. I really do hope that home visits make a return to physician practice, but I'd like to see tele-home care become part of the model too....

On the program, one physician is making home visits, and accessing the patient's EMR using his laptop. Dr. Eric Beachy, making his home visit mentioned the challenges that remain in remote areas with lack of connectivity, but the advantages are many. There was some mention that newer, younger physicians thought this might be old fashioned. But he could be making the same visit using telemedicine.

I'd like to see this taken a step further... It's great that the physician is visiting face to face, but I think it's the right time for tele-home care to finally open up!

In the late 1990s I worked for a vendor on a home care product. I was lucky to be able to make a home visit to a patient with COPD and Diabetes via telephone and television (no PC was involved with this program). I was in Lawrence KS and the patient was hundreds of miles away in Western KS. The research project which ended around 2000 was able to show a very significant reduction in re-hospitalizations and ED visits when the nurse could visit more frequently via tele-home care. (The patients were remote and more frequent visits were expensive and time consuming)

I still believe that tele-home care, home monitoring and other telemedicine options are going to be important in managing / maintaining the health and wellness of our population in the future.

The Homecare Technology Association of America has been working on this for many years already - http://www.hctaa.org/accomplishments.html

Please check out the radio program:
Old-Fashioned Medicine Needs Assist From WiFi
http://www.npr.org/templates/story/story.php?storyId=113018106

Patient access to medical record

Even though there are now laws to allow patients access to their medical records, it is not an easy task. Physicians still have mixed feelings about allowing patients to see the notes they've written in the chart. Check out the article and link below to review the debate.

Personally I think it is a great idea:
-Patients can see exactly what the Dr said and check their own resources to clarify the information and learn more about their plan of care
-Patients who are checking their records online are apt to be more involved in their care
-As patients review their information, if they discuss with family or friends, the patient has more support for following the plan for longer term benefit
-Generally a more transparent process keeps everyone honest

The article is at NPR.org
Doctors Don't Agree On Letting Patients See Notes
http://www.npr.org/templates/story/story.php?storyId=112971637

“Internet Addiction” is a symptom (?)

I found many and read a few resources on the Internet for "Internet Addiction"; some are research based and some just articles on the topic. Based on this reading and my own experience in life and patient care, I would have to hypothesize (validating with further research) that indeed there are people who appear on the surface to be addicted to the Internet, but the real problem that must be addressed, after symptom control is accomplished is the underlying obsession and compulsive tendency.

While there is a valid tool (Widyanto L and McMurran M., 2004) to identify the problem, I don’t think it should have it’s own DSM-IV category, that is, it's own diagnostic category.

I worry that to give it a category of its own would just continue to bloat health care expenditures that just treat symptoms and not underlying causes. I have seen alcoholics quit alcohol and then become ‘addicted’ to another thing, like cigarettes, religion, work or sex to name a few because the underlying issue was never treated. There is a lot of money to be made by creating boutique facilities, retreat centers with tunnel-visioned counselors (who may not have any real credentials at all) that may be effective at relieving the currently-presenting compulsive online behavior, but in the end, unless the root of the problem is addressed, another compulsion may arise. In some people there may be a lifelong need to evaluate and monitor their compulsive tendencies.

Treating Internet Addiction by itself is like treating CHF with Lasix and then sending the patient home when the shortness of breath is relieved after the fluid overload is resolved. Eventually the fluid overload will return, and you’ll be treating the symptoms again. The improvements in the quality of life are short-lived.

The symptoms, (obsession with and compulsive use of the Internet) are only a manifestation of one of the many obsessive and or compulsive behaviors found in alcoholism, sex addiction, workaholism, drug addiction (really, any substance addiction or abuse)

Briefly, I think a better way to state the diagnosis of Internet Addiction would be as a sub category of an obsessive-compulsive disorder, with the specific symptoms and characteristics of each different thing a person can be ‘addicted’ to being part of the symptom and treatment portion. (e.g. “Obsessive compulsive disorder as manifested by compulsive pornography surfing, chat room voyeurism and online gaming”), Such a ‘label’ I hope would not only encourage treating the symptoms, but also encourage getting to the root of the problem, which may involve long-term or lifetime maintenance therapy and or meds. The Goal of my idea is to improve the overall feeling of well-being for the patient for life. Solving the symptoms of one addiction provides temporary relief, but does little to treat or resolve the underlying issue.

My proposal does not exclude, for example, the patient attending a 12 step program to relate with peers with similar symptoms instead of lumping them all together, but allows for a multi-faceted treatment program aimed at the underlying problem, with the goal of life long wellness.

References and Additional Reading:

Widyanto L and McMurran M. (07Aug2004). The psychometric properties of the internet addiction test. Retrieved 18Sep2009 from the World Wide Web: http://www.ncbi.nlm.nih.gov/pubmed/15331031

Internet Addiction Disorder. Retrieved 18Sep2009 from the World Wide Web:
http://en.wikipedia.org/wiki/Internet_addiction

GERANIOS, NICHOLAS K. (15Sep2009). Internet addiction center opens. Retrieved 18Sep2009 from the World Wide Web:
http://www.miamiherald.com/business/technology/story/1234240.html

TimesOnline(18Sep2009) Heavensfield centre opens its doors to America’s internet addicts.Retrieved 18Sep2009 from the World Wide Web: http://technology.timesonline.co.uk/tol/news/tech_and_web/gadgets_and_gaming/article6839222.ece

TimesOnline(26Aug2009) Internet addiction among China’s teenagers spawns brutal boot camps.Retrieved 18Sep2009 from the World Wide Web: http://technology.timesonline.co.uk/tol/news/tech_and_web/the_web/article6809831.ece

Center for Internet Addiction Recovery. Internet Addiction Test (IAT) Retrieved 18Sep2009 from the World Wide Web:
http://www.netaddiction.com/resources/internet_addiction_test.htm

King, S. A. (1996). Is the Internet Addictive, or Are Addicts Using the Internet? Retrieved 18Sep2009 from the World Wide Web:
http://webpages.charter.net/stormking/iad.html