Digital health could solve primary care shortage, Frost analyst says

15 04 2013

If digital health technologies take hold the way many believe they will, the U.S. may no longer have to worry about a pressing shortage of primary care physicians, projected by the Association of American Medical Colleges to reach 65,800 doctors by 2025.

“There are a lot of ways to deliver primary care,” explains Greg Caressi, senior vice president for healthcare and life sciences at market analysis firm Frost & Sullivan. A key function of primary care is to screen to determine if a patient needs to see a specialist. Remote technology and midlevel providers are more than adequate for triage and testing, he says.

Caressi noted that Vinod Khosla, co-founder of Sun Microsystems, predicted last year that technology eventually could replace 80 percent of physicians. Accountable care organizations and other payment reforms – as well as changing consumer preferences – are going to force healthcare organizations to reevaluate how they deliver care in the next dozen years or so, according to Caressi.

Caressi shared these ideas at Frost & Sullivan’s 18th annual executive exchange on medical devices last month and spoke to MobiHealthNews this week.

“Some of the business aspects really need to change radically,” Caressi says. “If hospitals are going to survive, they’re going to have to leverage telehealth.”

And makers of medical devices are going to have to pay attention, he added. Quite a few device companies are only contemplating incremental changes in care delivery, says Caressi.

“The world has changed and the way people get information has changed,” he continues. There is a strong opportunity here for healthcare providers to reach young adults and others in generally good health who might not care about seeing a particular physician as long as they can get care when they need it.

This is like the Kaiser Permanente model, where patients are tied to a clinic rather than a single primary care doctor, Caressi notes.

This notion may seem to conflict with the patient-centered medical home, which stresses care coordination by making sure patients have a “home” for all their healthcare needs, in the form of a primary care physician. “This is almost at odds with that,” Caressi says, but he asks an important question: “Is the primary care physician the hub or is primary care the hub?”

In his vision, primary care, not the physician, is the focus, and the most important individual in the entire equation is the patient.

Though he did not say this in his talk last month, Caressi tells MobiHealthNews that electronic health records and interoperability of health data underlie this whole concept because clinicians need accurate information to make informed decisions. Having a complete patient history, medical record, data from remote monitoring devices and clinical decision support makes it easier and safer to care for patients, he explains.

Caressi says clinicians of all levels need to practice to the fullest extent of their licenses, saving physicians for the most difficult tasks. He says hospitals have given lip service to this idea, “but they could do more.” This includes beefing up telehealth services and relying more on call centers staffed by nurses to expand access to care and manage larger panels of patients.

“If you want higher touch at lower cost, you need to leverage technology,” Caressi says.

 

mobihealthnews.com [en línea] Mebane, NC (USA): mobihealthnews.com, 15 de abril de 2013 [ref. 04 de abril de 2013] Disponible en Internet: http://mobihealthnews.com/21454/digital-health-could-solve-primary-care-shortage-frost-analyst-says/



Dr GENÉ: Urge una reforma del modelo sanitario

7 03 2011

Dr. Joan Gené Badia

Editor del Fòrum Clínic

Doctor en Medicina y Especialista en Medicina de Familia y Comunitaria


El sentimiento de que el actual modelo sanitario no da respuesta a las nuevas necesidades de los ciudadanos es hoy mayoritario. La Organización Mundial de la salud1 señala que la atención primaria es hoy más necesaria que nunca. No la entiende como el ámbito asistencial en el que practican los médicos de familia, sino que considera que es la política de salud que ha de inspirar las reformas sanitarias. Es la única capaz de frenar la creciente medicalización y sub-especialización que promueve la industria de la salud tanto en su vertiente farmacéutica como de provisión de servicios. El actual esquema basado en la venta de los productos y servicios que el mismo sistema va creando es insostenible, incluso para el sistema sanitario estadounidense. Esta constatación ha sido uno de los motores de la reforma sanitaria propuesta por el presidente Obama.

Las enfermedades crónicas se han convertido en la verdadera epidemia del siglo XXI. En especial en países como Cataluña que junto a Japón o Italia se convertirán en breve en los más envejecidos del mundo. La cronicidad explica el 80% del gasto sanitario. Una pequeña proporción de la población, que acumula varias enfermedades crónicas, utiliza la mayor parte de los recursos sanitarios. Un paciente que presente cinco enfermedades crónicas consume quince veces más que una persona del mismo grupo de edad que no tenga niguna2. Esta comorbilidad, que se concentra en la población más envejecida, también se acompaña de dependencia. Una vez más comprobamos la artificialidad de separar la atención sanitaria y la social. Nos enfrentamos ante el reto de ofrecer una verdadera atención integral a la persona que cubra todas sus necesidades sociales y sanitarias.

Los sistemas hospitalarios fragmentados deben reformarse y el ámbito de atención primaria de salud ha de velar para que el sistema ofrezca esta atención integral centrada en la persona. Profesionales y pacientes debemos liderar este cambio al que se resisten una parte importante de los políticos y de la industria sanitaria.

Bibliografía

  1. Organización Mundial de la Salud.  Informe sobre la salud en el mundo 2008: la Atención Primaria de Salud más necesaria que nunca. Organización Mundial de la Salud. Ginebra 2008
  2. Bodenheimer T, Berry-Millet R. Follow the money: controlling expendiitures by improving care for patients needing costly services. New Engl J Med 2009: 361(16):1521-3