Ruby and I have got it down pat. A bark at the back door tells me one of two things: "I want to go outside" or "I'm ready to come back in."
But a few months ago, when Ruby – my 65-pound standard poodle -- signaled her wish to come in, the next thing I noticed was how she was holding up her left front foot, while giving me her "Do something!" look.
Standing or walking on that foot was obviously painful, but I found no wound or bite to tell me what was wrong.
As a child and adolescent psychiatrist practicing in person for a number of years, and eventually making the shift to telepsychiatry, I have observed the subtle differences and nuances between the two mediums of care.
In my experience, telepsychiatry can be particularly powerful when working with children and teens. I had one experience with a 15-year-old adolescent who was admitted to the hospital for the fourth time with continued severe abdominal pain that could not be attributed to a medical cause. The hospital staff was puzzled, as the diagnostic tests did not show any signs of ailments and there were no physical afflictions present in the child. Interestingly enough, the teen had already been evaluated by another psychiatrist at the hospital, who was unable to get the teen to “open up.”
The care continuum increasingly relies on the skilled nursing facility to extend patient care beyond the acute care facility before the patient is sent home. The hospitals are under pressure to treat only the most acute conditions and then move the patient to facilities with lower costs of care. Accordingly, skilled nursing facilities are accepting patients who are frailer and more complicated. “Between 2005 and 2009, the percentage of Medicare SNF patients with eight or more co-mobidities increased from 74.8 to 86.9 percent..” And, the “proportion of patients in SNFs categorized as having major or extreme severity of illness increased from about 45 percent in 2005 to 53 percent in 2009.”
When endocrinologist Shubh Kaur, MD, was first approached to consider telehealth visits with patients in the Douglas and Safford areas, she was immediately intrigued.
It seemed an appropriate solution for patients whose zip codes made it difficult to get specialty care without a lengthy drive.
But she was also new to the technology. “I had an open mind about what the interaction would be like, but I was very interested in the question of patient experience, and whether it would be effective in building relationships.”
In 2006, 10 years after he received his PharmD from the University of Arizona College of Pharmacy, Kevin Boesen, then a faculty member with the college, decided to follow through on what seemed like a great idea.
Today he is CEO of SinfoniaRx, a medication therapy management company that has outpaced its competitors and has tracked $778 million in healthcare cost savings, while improving medication safety and effectiveness for millions of patients across the country.
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