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

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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 liking technologies that can provide diagnosis 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, BYLINE: Beautiful but isolated 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, lettuce, parsley. We'll have tomatoes going. And we grow pumpkins 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 decided 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 coordinates telehealth for the Chapa-de Indian Health Clinic. Telehealth sounded a bit impersonal 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, loyalty, compassion 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 - essentially, 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 prescriptions 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, costly trips just to get needed specialty 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 consultations 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.

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