美国国家公共电台 NPR With Rural Health Care Stretched Thin, More Patients Turn To Telehealth

 

LULU GARCIA-NAVARRO, HOST:

For people living in rural communities, accessing health care can be a challenge. Hospitals have closed. Doctors are in short supply. Advances in technology may help solve some of these problems. Polling by NPR finds that many rural Americans are using and liking¹ technologies that can provide diagnosis² and treatment, even when the health-care provider is not in the room with the patient. NPR's Patti Neighmond reports on the findings of the poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

PATTI NEIGHMOND, BYLINE³: Beautiful but isolated⁴ is how Jill Hill describes where she lives. Grass Valley's an old mining town in the Sierra Nevada foothills of Northern California. Jill gives me a tour of her garden, framed by a fence handmade from pieces of old wooden slats and gnarly tree branches.

JILL HILL: We've got kale, lettuce⁵, parsley. We'll have tomatoes going. And we grow pumpkins⁶ and cantaloupe.

NEIGHMOND: Hill's grown to love it here. But at 63, she never thought her life would be like this.

HILL: We were living in Arizona. My husband was in construction.

NEIGHMOND: A project manager for a multi-million-dollar homebuilding company.

HILL: We had health insurance. We had life insurance. We had the American dream.

NEIGHMOND: Then the housing crisis hit in 2008. Her husband lost his job and his health insurance. He got sick and ended up on dialysis. They decided⁷ to move back to California and rebuild their lives, but her husband passed away a few years later.

HILL: I was grief-stricken. And my self-esteem was down. I didn't care about myself. I didn't brush my hair. I isolated. I just kind of locked myself in the bedroom.

NEIGHMOND: She knew she needed therapy, but the nearby community health center in this rural area had only two therapists. She could see one once a month. She knew she needed more.

HILL: So then Brandy called me and said, hey. We've got this telehealth program, where they bring the therapist in on a computer screen, like Skype. And do you want to try it?

NEIGHMOND: Brandy Hartsgrove coordinates⁸ telehealth for the Chapa-de Indian Health Clinic. Telehealth sounded a bit impersonal⁹ to Hill, but she says she was desperate and willing to try it.

HILL: This is my chair.

NEIGHMOND: For almost a year now, Hill's been sitting in this chair in front of a large computer screen. Twice a week for 30 minutes, she speaks with a clinical psychologist hundreds of miles away in San Diego. Her latest assignment in therapy; write down her positive characteristics.

HILL: And I had three.

NEIGHMOND: What were they?

HILL: Oh, loyalty¹⁰, compassion¹¹ and resilience. She said, only three? She wanted 10. And I said, well, I'm just getting started. Well, then she and I started talking. And now I've got, like, probably 15 at least. And I'm - keep adding to the list. But once I started, like, writing things down, I started really seeing I have a lot of strengths.

NEIGHMOND: Hill says she's lucky. The Chapa-de clinic offers telehealth. Many clinics don't, which means people have to rely on their own resources. And in many rural areas, that's nearly impossible, according to Harvard professor Robert Blendon, who co-directed our poll about life and health among rural Americans.

ROBERT BLENDON: The majority - essentially¹², 8 in 10 people living in rural America - have access to high-speed Internet. But 1 in 5 really have a problem having access to it. And that means they don't have the ability to get critical information in today's world.

NEIGHMOND: This includes information such as diagnosing a problem, providing treatment or getting medical advice.

BLENDON: They lose the ability to contact their physicians, to fill prescriptions¹³ and to get follow-up information without having to go see a health professional.

NEIGHMOND: In our poll, a vast majority of those who were able to use telehealth reported being satisfied with the diagnosis or treatment they received. An important note here - telehealth comes in many forms. It can be a patient speaking directly with a health care provider via text, email or on-screen like Jill Hill. It can also be doctor-to-doctor like it is for critical-care pediatrician James Morrison with the UC Davis Children's Hospital, where patients often face long, costly¹⁴ trips just to get needed specialty¹⁵ care.

JAMES MARCIN: We have patients that drive to our Sacramento offices that have to drive the night before, spend the night in a hotel because it's a five-hour trip each way. And if you're talking about taking time off of work or school, the costs of getting what should be otherwise routine care are significant barriers for those living in rural communities.

NEIGHMOND: Telehealth can remove those barriers, says Marcin, by bringing UC Davis specialists to the patient's bedside hundreds of miles away.

MARCIN: In the emergency department, they're able to put the telemedicine cart at the patient's bedside. And within minutes, our physicians are able to see the child and talk with the family members and help assist in the care that way.

NEIGHMOND: It's not just emergency care. It can also be cardiology, gastroenterology, dermatology - any number of specialty services. Attorney Mei Kwong with the Center for Connected Health Policy agrees telehealth holds great potential to reduce disparities. But she says payment policies for telehealth services lag way behind the technology.

MEI KWONG: A lot of the policies that are out there are probably about 15 to 10 years behind, unlike what the technology can do now. So stuff that they have on the books regarding telehealth maybe made sense about 10 or 15 years ago because the technology wasn't at a place where it is today and what it can do and what it can safely do.

NEIGHMOND: For example, services like high-resolution photos, retinal screenings for diabetic patients or consultations¹⁶ between a specialist and primary care doctor may not be paid for by Medicaid, Medicare or private insurance. Today change is happening, says Kwong, but it's slow-going.

Patti Neighmond, NPR News.

(SOUNDBITE OF LAKEY INSPIRED'S "5 MIN CALL")

1 liking   

n.爱好；嗜好；喜欢

参考例句：

• The word palate also means taste or liking.Palate这个词也有“口味”或“嗜好”的意思。
• I must admit I have no liking for exaggeration.我必须承认我不喜欢夸大其词。

2 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 isolated   

adj.与世隔绝的

参考例句：

• His bad behaviour was just an isolated incident. 他的不良行为只是个别事件。
• Patients with the disease should be isolated. 这种病的患者应予以隔离。

5 lettuce   

n.莴苣；生菜

参考例句：

• Get some lettuce and tomatoes so I can make a salad.买些莴苣和西红柿，我好做色拉。
• The lettuce is crisp and cold.莴苣松脆爽口。

6 pumpkins   

n.南瓜( pumpkin的名词复数 )；南瓜的果肉，南瓜囊

参考例句：

• I like white gourds, but not pumpkins. 我喜欢吃冬瓜，但不喜欢吃南瓜。 来自《简明英汉词典》
• Then they cut faces in the pumpkins and put lights inside. 然后在南瓜上刻出一张脸，并把瓜挖空。 来自英语晨读30分（高三）

7 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

8 coordinates   

n.相配之衣物；坐标( coordinate的名词复数 )；（颜色协调的）配套服装；[复数]女套服；同等重要的人（或物）v.使协调，使调和( coordinate的第三人称单数 )；协调；协同；成为同等

参考例句：

• The town coordinates on this map are 695037. 该镇在这幅地图上的坐标是695037。 来自《简明英汉词典》
• The UN Office for the Coordination of Humanitarian Affairs, headed by the Emergency Relief Coordinator, coordinates all UN emergency relief. 联合国人道主义事务协调厅在紧急救济协调员领导下，负责协调联合国的所有紧急救济工作。 来自《简明英汉词典》

9 impersonal   

adj.无个人感情的，与个人无关的，非人称的

参考例句：

• Even his children found him strangely distant and impersonal.他的孩子们也认为他跟其他人很疏远，没有人情味。
• His manner seemed rather stiff and impersonal.他的态度似乎很生硬冷淡。

10 loyalty   

n.忠诚，忠心

参考例句：

• She told him the truth from a sense of loyalty.她告诉他真相是出于忠诚。
• His loyalty to his friends was never in doubt.他对朋友的一片忠心从来没受到怀疑。

11 compassion   

n.同情，怜悯

参考例句：

• He could not help having compassion for the poor creature.他情不自禁地怜悯起那个可怜的人来。
• Her heart was filled with compassion for the motherless children.她对于没有母亲的孩子们充满了怜悯心。

12 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

13 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

14 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

15 specialty   

n.(speciality)特性，特质；专业，专长

参考例句：

• Shell carvings are a specialty of the town.贝雕是该城的特产。
• His specialty is English literature.他的专业是英国文学。

16 consultations   

n.磋商（会议）( consultation的名词复数 )；商讨会；协商会；查找

参考例句：

• Consultations can be arranged at other times by appointment. 磋商可以通过预约安排在其他时间。 来自《现代汉英综合大词典》
• Consultations are under way. 正在进行磋商。 来自《现代汉英综合大词典》