本次网络研讨会于2023年1月27日星期五录制
科技与哮喘的发展同步了吗?有没有办法用数字工具来监测我们的哮喘?加入我们一起探讨这个话题
演讲者
- 帕耶尔·古普塔博士
由美国过敏，哮喘和免疫学学院赞助
记录:虽然这份文字记录被认为是准确的，但有时也会出现错误。您仍有责任评估本成绩单中信息的准确性和完整性。本记录不能代替专业的医疗建议。
安德里亚:大家好。感谢大家今天的光临。我是安德里亚·詹森。过敏和哮喘教育网络的主任。所有与会者将在网络研讨会上静音。我们将录制网络研讨会，因此它将被张贴在我们的网站上。你可以再听一遍，也可以和同事分享。你可以访问我们的网站:过敏网址:allergyasthma.org。网络研讨会将持续一小时，包括远程时间。我们会在最后回答这些问题，但你可以随时把它们放在问题里。 We have someone monitoring the chat if you need — have questions or need help. We are using a different platform which means we also have a new way of giving you a certificate of attendance. The day after the webinar, you will receive an email with resources about Digital Health, a link to download your certificate, and information about how to obtain CE use. Digital Health and technology have changed drastically since the pandemic began in 2020. Telehealth can improve patient health and reduce costs for patient health and providers. It makes costs more equitable and accessible for patients in medically underserved communities in rural areas. It is important for allergists to understand how Digital Health can be realized in the practice and how it is being utilized in direct consumer models. Today’s webinar helps with needless death and suffering due to allergies, asthma, and related conditions due to outreach, education conditions, and research. It is my pleasure to introduce our speaker, Dr. Payel Gupta. A clinical professor at Mount Sinai Medical Center in New York. She is a triple certified and holds certifications from the American Board of allergy and immunology, the American Board of internal medicine, and the American Board of pediatrics. She is the medical director of allergy, asthma, immunology, and ENT at lifeMD.com. She is cofounder of life.com. She trained both adult and pediatric patients with asthma, environmental allergies, skin conditions, and food allergies. She is also a member of the Telemedicine Task Force for American College of allergy, asthma, and immunology. She is the immediate past president of the –. She is cohost of the itch podcast. Dedicated to helping patients understand their allergic conditions. With all of those, I am surprised you have time to sleep. Thank you for being with us today. We look forward to hearing about how you can use Digital Health to really help your patients.
古普塔博士:非常感谢你们邀请我。我真的很期待谈论这个话题。我披露的信息是，我是ALK的发言人，也是赛诺菲(Sanofi)、blueprint和强生(Johnson & Johnson)的顾问委员会成员。每个人都应该知道我们要录制今天的网络研讨会。这个信息已经讨论过了。今天，我要概述一下远程医疗的目标是什么然后总结一下目标是什么我们达到目标了吗?我要用讲故事的方式来讲。我认为2019年的每个人都有点怀疑。然后COVID来了，我们变得不怀疑，然后转变。人们经常问的问题是什么? There are many pitfalls of telemedicine. How can you connect with patients via virtual care? It will not like it. The technology needs to work for patients and physicians and will be too hard to come up with that technology and make sure it works for everyone. You need a license for multiple states. And you cannot examine a patient through the Internet so how is this going to work? How does telemedicine work? The definitions are confusing. There is Digital Health which means electronic and telecommunications technologies and services used provide care and services at a distance. Whereas digital medicine is what we are really talking about which is the practice of medicine using technology to deliver care at a distance. For the physician is in one place and uses telecommunications. There are various ones and we’ll talk about that. In order to deliver care at a distant site at their home, office, or car. Digital therapeutics are evidence-based, clinically evaluated software and devices that can be used to treat an array of this aces — of diseases. And there is secretiveness which are scheduled, real-time interaction by phone, video or in person. Those are the ones we are most familiar with. But then there are also asynchronous consults which happen on their own time and do not need scheduling. Communication is done by text, email, or hippo validated — a HIPAA-validated Insecure portal. You can simply pictures and other things are stored and evaluated at another time. Dr. Portnoy is one of the people in telemedicine and he put together this info graphic that I love which shows you the different ways you can have a visit with a patient. There are in person visits that we are used too.
然后是存储和转发，你从病人那里得到数据，比如肺活量测定数据。它被存储在云中，然后发送给远程的供应商。还有远程病人监测和远程治疗监测。这就是你使用可穿戴设备的地方，比如数字吸入器和类似的东西，把信息输入到一个设置中，并将其传输给供应商进行远程查看。还有电话会面，我们也会使用。还有一种是直接面向消费者的医疗保健。这在COVID期间也出现了好转。我个人是直接面向消费者的远程医疗的重要组成部分，这是我生活的重要组成部分。这是另一种方式，消费者只是去一个网站，决定他们想要一个特定的药物或有一个特定的问题。然后，他们可以直接从他们的电脑到一个遥远的供应商，沟通，以获得咨询。 Then there are facilitated and integrated visits were a patient in a remote area might travel to a facilitator location where there is a nurse or other provider that can help do different exams, different diagnostics, and send that information to a physician at another location. Those are the definitions. And the big picture. All of the things that everyone is thinking about in 2019 and before 2020 hit. What does it even mean? It will never even come to fruition. But in March of 2020, when COVID hit, everyone began to think differently. We started to see empty waiting rooms and all, from less than 1% of visits being telemedicine, as high as 80%. I think almost 100%. For me, during the pandemic. That is a 63-fold increase between 2019 and 2020. The college actually did a survey during this time. There was some shifts. April of 2020 to August of 2020, we saw a 30% in person visit to 66% visit. There is a shift going back toward seeing patients in person after the big peak of the pandemic hit. But, you can see that it is still higher than the 1% that we saw before April 2020. In that survey, they also asked, do physicians, allergists, plan to continue to use telemedicine in their practice? 90% liked it. Out of the 250 eight responses, which is a lot of practitioners, they liked it and plan to continue to use it.
我简要地提到了临床远程医疗和直接面向消费者的远程医疗。我的意思是，在诊所环境中，我们会考虑咨询和我们在COVID期间习惯的那种瓶子。但还有另一种模式。直接面向消费者的远程医疗，允许患者在填写医疗摄入表格时获得简化的访问。这些信息被发送给医生，然后病人得到处方药物，这些药物被送到他们的家里。因此，从技术上讲，他们从来没有亲自见到过医生，甚至可能没有通过视频咨询见到过医生。大多数情况下，直接面向消费者的远程医疗是以异步方式完成的。很多人都见过Hims and Hers和其他公司，他们开始治疗让病人尴尬的疾病，比如直接治疗这种功能或脱发。病人们正在寻找一种不同的方式来获得药物，这样他们就不必去看任何人来获得他们认为需要的药物。我们确实看到越来越多的公司直接向消费者提供过敏护理，我就是其中的一员。 It is an interesting concept. From having lived it, it is much needed. A lot of the patients are those that do not have insurance for various reasons or are between insurance plans and are just looking for alternative, more cost effective ways of getting their. — there health care. Then I became a convert. I think that telemedicine — there was a report put out that telemedicine addresses the shortage of allergy specialists especially in rural and underserved communities and facilitate station access to allergy services. I truly believe that. There is so much data available to us that there are ways that we can provide care to patients that is government to providing patient care. There was a another survey done in conjunction with the ACAAI and the American Medical Association.
这些是填写调查问卷的医生。61%在郊区，29%在城市，10%在农村。大多是在单一专业医生办公室的医生。有些在教学医院单独执业。这是一个很好的组合，我们的专家大多在哪里。92%的患者表示他们目前使用远程医疗。它还在继续被使用。无论如何，大多数实践都是结合而不仅仅是远程医疗。他们正在进行远程医疗和亲自就诊的结合。该学院对过敏症专家进行了一项调查关于他们在实践中如何使用远程医疗。 You can see that most of the visits are for follow-up patients. For follow-up asthma, it is 80% versus new of 28%. Follow-up food allergy is 91% versus 51% new. All of these, the follow-up visits are more than the new patient. Physicians feel more comfortable seeing their follow-up patients through telemedicine then they do seeing patients. What are the benefits of telemedicine? For the physician, there are multiple benefits and for the patient, there are multiple benefits. For the physician, it frees up office’s to see more complicated patient for testing and procedures. Expands office hours without increasing office overhead. Allows reimbursement for follow-ups. There are fewer no-shows. In my small practice I have in Brooklyn, I just use the office space hours that I have for testing. Patients that just you follow-ups like legwork — bloodwork or to see how their asthma has been doing or refills can all be handled through telemedicine. But for a new patient or a patient who needs testing, that needs to be seen in person. The great thing is that through telemedicine, one of the benefits of COVID is we have started to see more reimbursement for this. But now we have a way of actually getting paid for the bloodwork review visits. Whereas before, we were doing the phone calls and having visits without getting paid. There is a lot of physician benefit that I think of telemedicine. For the patient, there is a lot of benefit too. No need to travel, no childcare issues, no need to miss work or school. Quicker access to appointments, lower cost reduction for visits. Meaning you are not taking a day off, not driving, not spending money to get to the appointment through subway or bus or whatever it is. And you are gaining time. Because the average time that you are saving from having a telemedicine visit versus an in person visit can be as high as four hours versus 30 minutes. For the patient, this makes a loss of sense. Obviously it has to be for the right visit and the right conditions, but for any allergic patient, telemedicine can be used in many different ways. We will review that now. One of the pitfalls we discussed early that people were concerned about is how can you connect to a patient via virtual care. They will not like it. The data does not show that. The data shows there is better outcomes, increase compliance, a decrease in no-show rates, and similar outcomes.
慢性病患者在专科医生的帮助下会有更好的治疗效果。有更好的途径意味着更好的护理，病人会喜欢的。然后，增加远程医疗就诊后哮喘患者的依从性。这意味着他们对自己的状况有了更好的了解，因为他们可以在两次访问之间与医生进行检查，并回顾他们可能不了解的事情。他们可以和医生谈谈他们是怎么做的，并得到澄清。所以我们确实看到患者的依从性增加了。然后，减少缺勤率。不需要去旅行，不需要照顾孩子，或者不需要做这些事情，让病人更容易被看到。他们喜欢这样。然后，在虚拟访问中也看到了类似的结果。 We’ll talk more about that too. Again, one study I wanted to highlight was this telemedicine use for pediatric asthma care done at UC Davis between March 2020 and September 2020. There were 502 patients in the study. They looked at electronic health record analysis and a qualitative focus group analysis area their findings showed that alternating telemedicine with in person visits for asthma care may result in improved access to care and reduced burdens on patients and families. Again, just highlighting that patients felt like they had more access to the provider and improved access to care. Now I am just going to put out a patient case that our normal, allergic patient and a patient I think can easily be managed mostly through telemedicine, and partly through in person. A 30-year-old man with a history of PTSD, asthma, chronic lower back pain, allergic conjunctivitis, nasal polyps and has had two surgeries and eczema. Has had frequent sinus infection for which he has had antibiotics. Smokes 1-2 packs of cigarettes per day. Has had asthma since childhood and recently noted increased symptoms with his allergies. He has been going in and out of urgent care for his asthma. This is a patient we are worried about and do not see often enough. Sometimes they are in the cycle and never get in to see us because of multiple reasons. For this occasion, he has a full-time job at a fulfillment center and never has the ability to take time off to come see a physician. He has been prescribed oral steroids early — oral steroids over and over. He recently saw an article about telemedicine and decided to could get more help without missing work. One thing I want to point out is obviously every state has different rules for new patient visit. In some states, you cannot establish a doctor-patient relationship via telemedicine and to see them in person. It depends on the state you are in and we are not going to go into these roles because they vary state to state. That is something you need to understand for wherever you practice.
你能用科技做什么?您可以嵌入医疗摄入表单。我想我们已经做过了。你让他们用电子方式填写他们所有的历史数据并在预约前访问这些数据。你也可以用摄入表格做筛选问卷这样你就有了所有这些数据。然后是体检。你能做什么?像Tonya Elliott医生这样的医生，多年来一直在为过敏患者做远程医疗，有很多视频，她谈到了她能找到的所有身体检查结果。你可以观察他们是如何呼吸和说话的，这可以给你很多信息。你可以让他们张开嘴，甚至检查他们的喉咙。 There are also devices available that can be used to listen to patients in their home. Wheezing can also be monitored via patient remote devices. So that you cannot examine a patient through the Internet is not true. There are many tools available for how you can examine a patient through the Internet. Then there are out home — are at-home diagnostics and wearables. These are things that if we had the right tech and the right support, you can really utilize a law of information and help our patients in a more effective way. So there are electronic diaries where we can have patients record their systems — symptoms and medication use. Often times I find this for myself to wear patients just do not have time or cannot move their recollection of their symptoms or medication use and it is often flawed. There is research to show that. Everyone is so busy that it is hard to remember what happened yesterday and what happened in the last month or two months or three months is even more overwhelming. Having a way for patients to be able to write down their symptoms, medication use, and get the electronic diary into a system where then it is already there for you to review during your visit and just kind of quickly produced. We are not asking physicians to look through pages and pages of data because that is not feasible. But if it is done in the right way, we can get a lot of information. There is wearable technology to monitor activity and vital signs. And things that can also help us. Dr. MOSIne who I am going to mention later has done a lot of work on how can we find that patient that is not doing well before they are even not doing well? What are the signs in their vitals and their activity that can help us determine what — that something is not going right? Then we have remote patient monitoring. Things like environmental exposures, medication adherence. Those things can also be incorporated into the data that we bring into the visit. Then there are digital therapeutics. Again, the definition is evidence-based, clinically evaluate software and devices that can be used to treat an array of diseases and disorders. For the allergic patient, the main tool and asset we have right now are a number of different digital inhalers.
有数字吸入器，可连接到吸入器上的传感器已经可用，然后将两种不同的应用程序和设备连接起来，我们可以使用这些应用程序和设备来获取数据，并帮助我们了解患者在我们不在身边时的情况。此外，这也可以帮助我们了解他们使用吸入器的情况，以及他们是否从他们的药物中获得了最大的好处?这实际上是医生和其他人一起写的一篇文章是关于数字设备和数字疗法以及它们如何用于应用的。这篇文章就是“数字吸入器与哮喘患者远程监测”。如果你想深入了解，这篇文章可以帮你。它非常全面，涵盖了你想知道的一切。我会把重点放在我认为重要的事情上。对于文章中强调的内容。我刚才展示的数字吸入器系统不仅可以作为诊断工具和治疗干预手段。有治疗干预和药物，但它们也可以帮助我们诊断病人是否有不良的依从性或报告吸入器技术。 It can help us understand, is this patient truly uncontrolled or are they just not using their medication? Are they not using their medication well? It can really help change the plan for the patient. What they found is this may specifically benefit newly diagnosed patients to establish good adherence and inhaler technique. For that new patient, before they get into habits that are harder to break, it may be beneficial to start them on a digital therapeutic early on so that you can really help them understand the importance of adherence and the importance of good inhaler technique. Then, also, they found that it may help patients with difficult to control asthma to improve adherence and technique, to avoid treatment with high side effects like oral corticosteroids for costly Biologics. So we can find those patients that we think may be very severe and not to manage under current treatment. When they come in and tell us they are using their medication correctly and all the time, when you have a tool to actually say, it looks like you are not using it all the time or you are not using it as effectively as you thought you were. We get it because you are busy and life is busy but now we have extra data to help you understand that the way you are using the medication is likely part of the reasons were asthma is not controlled. In that, we can avoid patients getting on oral corticosteroids or Biologics. In this article, they also talk about when choosing a digital inhaler system for a patient with asthma, it is important to take into consideration the preferences for either a built in versus an add on sensor. Is the patient just really used to be inhaler they are using into not want to change the inhaler or device or medication because then there is also that psychological component we always have to think about where the patient knows that inhaler works for them and they do not want to switch? Does an add on Senator McMorris once — add on sensor make more sense than getting a new digital inhalers system? I also want to look at whether the system is able to detect inhalation quality.
卫生保健提供者还需要了解他们的吸入器，以及如何教授吸入器技术和他们给病人的装置。那么，这台设备有关联的应用吗?你怎么用移动哮喘应用来发头发?在病人的手机上。你的办公室里有人负责这方面的工作吗?谁来负责教学方面的工作?我接下来会讲到这一点，但实际上你可以使用计费代码当你为他们的数字护理进行持续登机时。然后，如果你正在实施这些远程病人监测或远程治疗监测设备，在大型医疗保健系统中，或者在小型实践中，你可能想要考虑作为一个试点项目，在你打印出这个非常昂贵的程序之前测试技术的可行性。为了了解财务影响如何，患者满意度如何?你是否也会让病人相信你所在的地区和你所服务的病人? There is some data to show that patients where English is not their predominantly, a lot of these patients aren’t as likely to use telemedicine or devices. Why is that? They think there is more and more data that will come out to how can we help all our patients feel comfortable using telemedicine and devices? What are the barriers that we need to overcome in order to make sure every patient is served? All of these things need to be thought about. Of course, it is important to have policies in place to manage liability risks. If you are getting a lot of data back from these devices and these therapeutics, it is very important to know how are you managing that data? Who is looking at the data on a regular basis to tell you that this patient is not using their medication? Should you have intervened earlier if you have them? If you know this data. If you did not and there is a bad outcome, you just want to know. Could you be liable for that? The ultimate message was digital inhaler systems, remote patient monitoring, and remote therapeutic monitoring can power — empower patients and remote care providers to improve ICS adherence and inhaler technique. To ultimately improve asthma outcomes and reduce costs for asthma patients. Now, for the hot topic, which I am not an expert, but there are other physicians that have also done a loss of on this topic. One of them is Ridge Walla . Dr. Bridge Walla has a lot of videos online through the college that go into coding and billing. For remote patient monitoring and remote therapeutic monitoring.
有些医生在他们的办公室里使用这些技术并与我们分享这些信息。事实上，学院发表了一篇文章，让远程病人监控和远程治疗监控在你的实践中发挥作用。这篇文章很好地介绍了医生使用这些技术的几个临床场景以及他们是如何实施这些技术的?他们要考虑什么呢?如果你想在你的实践中实现这些，你必须考虑什么?如果您感兴趣，我强烈建议您查看king和其他提供商提供的数据。从本质上讲，患者监测和CPT代码允许医生提供生理数据并获得报酬。这些指标包括心率、呼吸频率、血压、体重和心率。肺量测定法。这可以转化为医生办公室或第三方提供商，为你管理数据。 These services can be provided — should be provided under general physician supervision which means a physician’s clinical staff or an outside company that can provide the services without the physician being in the office or on site. You could either train or have a dedicated clinical staff member or you could even hire a remote staff member. Personally, I have had great experience using remote nursing services out of the Philippines where you can have staff there look at data for and you manage those kinds of things in addition to a lot of other things I knew your practice to help make sure you are looking into the data and someone is managing it. All of this can be paid for through these RPM and CPT codes. In the article I was talking about, they have a nice chart that goes into the different codes you can use. I am not an expert on this but there are many people who have written nice articles and then nice videos on this that you can refer to. You can get paid for the setup of the remote patient monitoring. Patient education and use of the equipment. That is billable once. Or supply of the device. Then, treatment management. For the first 20 minutes and every third dust every 30 minutes. For a lot of clinicians, it seems to work for their practice. Once it is in place, you can make profit form it. The remote therapeutic monitoring because I got from Dr. Mosnaim’s article. There are different codes for that with an initial set of codes and supply of the device. All of those things — the RPM and RTM codes, lots of things you can learn and lots of important information that you can gather from all of these articles and people that are — have been doing it themselves. Patient communication and data collection. You can see patients, more frequently, to touch pays — base with them through technology. It is not always just the telemedicine synchronous visit. A phone call, text, or email can also be considered telemedicine because you are asynchronously getting information from the patient and using the patient to help provide care. All of that is important to remember that now we can get paid for it and we can more frequently touch base with our patients and help make sure they are feeling better and doing well with their condition. Going back to our patient, I think now it is hopefully the picture — now, hopefully the picture is set for what can we do? How can we help him manage his condition? It may look like he comes in for a visit at some point when he has time.
但在此期间，当他不能如果你所在的州你可以建立医生病人委员会而不需要见他，他就可以开始治疗哮喘。你可以和他交谈，在视频中看到他的身体，看看他在访问期间的呼吸情况。看他是否每隔一句话就咳嗽一次。你可以询问他的全部经历，了解他的全部情况。我们治疗病人的90%都是基于病史。我认为和我交谈过的大多数医生，历史是关键。你需要知道发生了什么以及病人出现了什么症状。检查只是我们做出临床决定的一小部分。大部分都是基于历史。对于这个病人，我们可以让他们服用更好的控制药物，这样他们就不会去急诊室接受紧急护理，也不会因为无法控制的哮喘而寻求治疗。 We can start their evaluation process for the uncontrolled asthma. If they do start on controller medication but continue to do poorly, we can to bloodwork to see if they high — have a high — count. You can send a patient for bloodwork without seeing them in the office as long as you write a requisition for bloodwork to go to places like Orlando or — quest or llabcore. You can also send them for a full pulmonary function testing or send them a spirometry device to teach them how to do that at home via video. You can also have a nurse go into the induced barometer reading — go to the home of a patient and do spirometry. We can definitely start him on treatment for his asthma and sent him for IGE testing. If you truly cannot, I need to see, what are his allergic triggers? Can we make changes in the home? But I love about telemedicine visits is the patient can go into their medicine cabinet and show you their medications. It is thought an I do not know what I am taking. It is get up and go to your bathroom and show me what you are taking. Show me what your previous doctor prescribed her wet urgent care — prescribed or wet urgent care has given you.
看看药房开了什么药。对于我们所知道的过敏性结膜炎，我们可以说你有五种鼻腔喷雾剂都有相同的成分当他们打开药柜时你可以看到。这是我喜欢和我的病人在一起的事情，当他们感觉不能告诉我发生了什么，或者他们在做什么，或者我知道他们的药柜里有一百万种药物。我让他们去那里，打开他们的橱柜，展示他们正在使用的东西。对于戒烟，你也可以提供咨询和经常随访。因为对那些感兴趣的病人，他们真的需要频繁的随访。远程医疗就是一个很好的机会。最终，我们可以为病人的论文做很多事情，即使没有在办公室见到他们。我希望这节课能让大家对我们能为这个病人做的所有事情有一个大致的了解。以及我们能帮多少忙。 The key takeaways for me are that telemedicine is here to stay. I think hybrid care is essential in 2023 and beyond. In-home services and monitoring offer benefits to both patients and physicians. Direct to consumer care is also changing the landscape of medicine. From my experience over the last three years, I really, truly believe it is something we need in this country, given the high cost of health care. The adoption of telemedicine is truly driven by patient preference. Because patients just need something different. It is not for every patient. Some patients like the physical connection and do need to be in the office. With our busy lifestyles and everything else, there are a large proportion of patients that really do you love telemedicine and the convenience it provides. That is my son, Phoenix J. He has changed a lot. But he was a big part of my journey. I can say, for me, I chose to leave practice and leave the normal clinic practice because I was pregnant during COVID. I had him in July 2020. I had to think for the first time as a health care provider because a lot us think about others before we think about ourselves. For the first time, I had to think about myself and my baby and how I was going to keep us healthy during the pandemic. I think that, as much as patient benefits, we also benefited from feeling safer telemedicine — safer with telemedicine. I made that huge ships because of him. One day when he is old enough to understand, I will let him know that he is a big reason why in this wonderful change in my life to doing more telemedicine and providing care in that way. I think the fundamental aim of telemedicine is to improve access to care. I think times have changed and things rapidly changed. This is video of my son scooting away. We really have to run to keep up with changing times. I am really excited about all the research that people are doing in the telemedicine space is all the information that we are starting to slowly get about how can we help our patients, what does this mean? How can we do this in the most effective way? Thank you. I see there is a lot of chats. I don’t know if those are questions.
安德里亚:谢谢你！这是一次美妙的谈话。我非常喜欢你对如何过渡到远程医疗的概述，因为这真的可以帮助你和其他医生在工作，生活，度假和其他事情之间取得平衡。这可能是一种防止过度疲劳的方法。我不知道有任何医生在COVID之前就知道如何预防倦怠。我们确实有一些问题，我会读给你们听。我们的第一个问题是，我们的数字设备是否有国家和私人保险?如果是这样，那么共同支付的选择呢?有些人告诉我，他们经验丰富——价格昂贵，因此优惠券降低人们使用设备?这是一个复杂的话题。我不是这方面的专家。 I think it will vary based on insurance the patient has. Where you’re located, all of that stuff as to how well, these therapeutic devices are covered. I think that as we have more data on how helpful they can be and how they can reduce or potentially reduce costs and reduce generally cost, that is the ultimate thing that guides things. Not only to mention patient improvement but if we can show that, more and more, the digital therapeutics are going to get covered by insurance and the cost will be lowered eventually. I think that is already happening and going to continue to happen more and more. Of course, cost is a very important part of determining whether or not you want to do something like this for your patient. That is definitely a shared decision-making element to all of this. It does not make sense to do a digital therapeutic if interest — insurance is not covering it. It is not feasible.
安德里亚:关于使用电子设备，你说得很好，因为我们都知道有些病人一生都患有哮喘。我们看看他们的吸入器技术，这是不正确的，但他们一直在这样做。为了纠正他们的吸入器技术可以是一个数字设备。我们的另一个问题是，梯瓦已经停产了Pro air，但是Pro air的数字吸入器还在用吗?
古普塔博士:我想是的。安德里亚，我们有一个来自学校护士的问题，他问他的学校护士如何从这篇文章中获得一些帮助学生理解他们是否正确使用了他们的东西?
古普塔博士:作为一名学校护士，我假设你是作为二级医疗服务提供者来管理病情，而病人实际上是由他们的主治医生来管理他们的哮喘。例如，可能是过敏症专科医生，肺科医生或儿科医生。如果你认为这对病人有帮助，把它带到他们的医生那里，看看是否有帮助。我认为很明显，在儿科患者中，设备的使用一直是一个问题。所以有适当的吸入器技术和那些早期的双胞胎是很重要的但很明显，早期的工具是很重要的但显然取决于病人以及他们如何在他们的游戏计划中使用数字疗法。我确实认为，作为一名学校护士，如果你认为这是你感兴趣的事情，我会和你病人的一些医疗服务提供者谈谈，看看他们是否愿意考虑这个问题。
安德里亚:好的答案。这很有道理。我们的另一个问题是你是否发现远程医疗可以解决病人的心理需求?它可以是面对面的，也可以是数字化的。
古普塔博士:当然可以。情况不同了。但对我来说，最重要的是2023年。我们现在所处的时代，即使是我和我最好的朋友，我的家人，每个人的交流，大部分都是异步的。通过短信。我们通过短信联系，但我仍然感到被关心。通过一条短信想到的。这只是一个例子。我认为与家人、同事通话的Zoom和Facetime等显然是新的，你想与家人见面等，但我认为这只是一个很好的例子，说明我们都是如何使用这种类型的沟通的。我想确实有但是我没有查过相关研究但是我被动地从精神病学和心理学家，心理治疗领域的人那里得到了这个信息。 They are finding that there is definitely where access if we do it through telemedicine. For most practitioners, when you want your patient to get in and be seen by a psychologist or psychiatrist, it can be months. If we can reduce that time, because there is not the check in process and this process and that process, and physicians are able to see people through a more streamlined way through telemedicine, then we can provide more effective therapy. I absolutely do not think that we are missing the element with telemedicine. I think it is — obviously, it depends on the person but in this time of our existence, we are communicating with everyone in a different way.
安德里亚:这说得通。这是另一层。只有家人，朋友和同事，我们的医生也使用同样的平台。另一个问题是我可以看到数字NDI如何检测转换和传输分割它是如何检测的?你能解释一下这是怎么回事吗?
古普塔博士:我不是专家，但有些设备确实可以监测吸入。我相信。这样就能给你关于设备的信息，关于设备的正确使用。我很抱歉。我不得不把这个问题推迟一点但我确实认为一些传感器和东西可以监测吸入以及它是如何完成的以便提供信息。
安德里亚:太好了。我喜欢你今天讲的一些事情让病人的治疗变得容易多了。在这些庄园中，很多都是相当大的，有一个可爱的农村地区，去看专家需要三到四个小时的车程。你说他们可以去附近的诊所，你可以在你那边联系，这对那些没有意识到这是一个选择的人很有帮助。即使您居住在角色区域，您仍然可以访问。我认为这是你今天谈到的最重要的部分之一。我喜欢的另一点是你谈到没有保险的人。我知道有些人的家庭保险计划中有7000美元的免赔额。所以他们必须支付所有的费用直到他们的7000美元水平所以我认为这是一个很好的选择。
古普塔博士:它可以是。有些病人会补充这种东西。您可以使用您的HSA/FSA帐户直接面向消费者的远程医疗选项。你可以用它来治疗药物，也可以用它来使用直接面向消费者的远程医疗。
安德里亚:完美的。我注意到的另一件事是，当你谈到有很多人可能第一次亲自去看医生时，但我们有一些人开了两三个小时的车去看医生。但在那之后转而做远程医疗的人的比例是一个很好的想法，这将为每个人节省大量的时间和精力去找保姆和其他有趣的事情。你觉得一开始和他们见面真的很有帮助吗?或者你的一些同事，然后让他们转而跟进远程医疗?这是一个很好的成功吗?
古普塔博士:是的。我认为混合护理是非常成功的，我认为这是大多数医生正在做的。我不认为有很多人只做远程医疗，但我喜欢。你可以和某人有那种身体上的联系并建立这种关系，测试他们的过敏原，做任何你认为他们需要的诊断测试，然后跟进血液检查和他们的治疗，再补充，以及所有这些事情，或者他们有什么问题。对医生来说，很多东西都是不可用的，但对我和我的实践来说，我可以毫不犹豫地告诉给我发邮件的病人，顺便说一下，现在也有电子邮件交流的代码。或者它们已经存在了，人们正在寻找更多。但是我也不介意告诉一个来回发邮件太多的病人，让我们把这个改成远程医疗就诊，这样我就能了解发生了什么，我们可以得出结论，并通过远程医疗为你制定更好的治疗计划。我认为，这对病人来说是一个很好的选择对医生来说也是一个很好的选择因为我们所做的工作没有得到报销。
安德里亚:这是有道理的，这有助于你能够个性化每个病人的需求。有些人可能需要更多的帮助——帮助和帮助。人们对一些在家里使用的设备很好奇，这些设备可以发送给家里的病人。你能否提供这方面的信息?
古普塔博士:再说一次，我可能应该多调查一下。我不太了解这方面的情况，但是有很多公司提供这些服务，你可以做不同的事情。他们会把这个装置像听诊器一样送出去，病人可以把这个装置放在他们的胸口，你告诉他们放在哪里，然后这个装置就会在你这边捡起来。这些设备是存在的。在这些农村地区，同样的事情也存在于农村诊所的从业人员身上。他们可以把听诊器和医生的系统或者专科医生的系统连接起来，这样他们就可以和你一起听病人的肺或者心脏。这些设备是存在的。我很抱歉，我没有一个完整的或不能给你完整的细节。我想这就是我的总体情况。安德里亚:这很有帮助。我们就要做完了。我们还有最后一个问题，我将读一下最后的Ed评分有人问你如何帮助那些没有参加远程医疗的人?这可能是个人和远程医疗的问题，但这将是我们最后一次休息。
古普塔博士:我认为提醒很重要。不管你用什么系统让你的病人知道他们的预约，你只需要-我使用的系统，因为病人有一个日历邀请，所以它在他们的日历中。所有的事情都在他们的日历上。有了这个，甚至可能有一个系统，你可以给他们发短信，这是你可以通过你的员工做的事情，有在线的东西，比如谷歌语音。这是一项免费的服务，当我注册它的时候。有一些免费的计划，你可以通过谷歌语音给病人发短信，并给他们发送提醒。你可以让你的助理或工作人员在预约前一天，甚至是早上，甚至是预约前10分钟给你所有的病人发信息来提醒他们。我再次发现，使用我创办的远程医疗公司，人们回复和查看短信的频率确实比查看电子邮件的频率要高。甚至比他们愿意接电话的次数还要多。短信是给病人发送提醒的好方法。
安德里亚:我同意。来这里之前，我协调了一个过敏和哮喘网络，我协调了一个过敏项目。我们发现人们会回复短信。裸体的人在会议上看到他们——他们可以在会议上看到他们，所以我们也做了同样的事情。谢谢你！
古普塔博士:。我真的很感谢你分享你所有的信息。请再往前看一张幻灯片。下周你可以在这里找到这个。这是我们的主页的样子。你将滚动到底部，这就是它的样子。它后面有黄色，你可以找到webinar。请加入我们的下一个网络研讨会。如果可以的话，再看一张幻灯片。还有一个，抱歉。 And one more. Then, we should be there. Our next webinar . What you should know about COPD, February 9, 4:00 p.m. Eastern time. You can register at allergyasthma.org. You can find all the links there. We had a lot of questions about certificates in the chat so keep an eye out the next couple days. We will have all the information you need about Digital Health and other links to resources for you and how to get your certificate of attendance as well as continuing education credits. Thank you for joining us. This is Andrea Jensen for the staff at Allergy & Asthma Network. Rightness as we work every day to help people breathe better and have a better quality of life. Thank you everyone.
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