technology and population with special health needs

who are they??

Individuals with special healthcare needs are those who have or are at increased
risk for a disease, defect or medical condition that may hinder the achievement of
normal physical growth and development and who also require health and related
services of a type or amount beyond that required by individuals generally.
But… The U.S healthcare system categorized those into three groups:
-population with predisposing characteristics refer to those inherent in a person,
some which are permanent, and some which are not.  Examples include
racial/ethnic characteristics, gender, age, and geographic location. Many of these
are not easy to change.

- population with enabling characteristics are time-dependent also, but reflect

characteristics of how a person is living that are easier to change than
predisposing characteristics.  Examples include insurance status & homelessness.

- population with need characteristics, also time-dependent, reflect the specific

health needs of the person, & these can be directly affected by the health care
system. Examples include mental health, chronic illness & disability, and HIV/AIDS.

population with enabling characteristics:-

-uninsured population: Uninsured people
People without insurance coverage have worse access to care than people who are
insured. Over a quarter of uninsured adults in 2014 (27%) went without needed
medical care due to cost. Studies repeatedly demonstrate that the uninsured are
less likely than those with insurance to receive preventive care and services for
major health conditions and chronic diseases.

48% of uninsured adults said the main reason they were uninsured was because
the cost was too high. Many people do not have access to coverage through a job,
and some people, particularly poor adults in states that did not expand Medicaid,
remain ineligible for public coverage. In addition, undocumented immigrants are
ineligible for Medicaid or Marketplace coverage.

-Homeless:
1% of U.S. is homeless each year, in a study established in the U.S among homeless
population Seventy-three percent of the respondents reported at least one unmet
health need, including an inability to obtain needed medical or surgical care
(32%), prescription medications (36%), mental health care (21%), eyeglasses
(41%), and dental care (41%), other study shows that the risk of death among
younger homeless women is 5–30 times higher than the risk among their housed
counterparts. One important resone fot this is that 70% of homeless population do
not have health insurance as estimated by The National Health Care for the
Homeless Council (2008), and so the expansion of health insurance may improve
health care access for homeless adults .
-Population with need characteristics:

• Mental illness (MI(

Ranked 2nd as a nationwide burden on health and productivity. 26.2 of U.S. adults
have at least one MI\year and only 41% of those with an MI get any treatment. In
2009, 36.2 million people received 57.5$ billions of mental health services, at
average $1,591\person.

One of the biggest factors is that it’s really confusing for people. A lot of times,
patients don’t get screened, so they struggle with their emotional problems for a
while before realizing that what they are experiencing is actually linked to a
mental health issue. And they can often end up struggling for a long time.

How can technology help patients get access to the behavioral healthcare they
need?

A.The internet has been pretty awesome. Before the internet, where would patients
start to get help? Now we have things like MHA Screening, where people can get
free, confidential, and anonymous online screening for mental health problems.
You have tools, like SAMHSA’s treatment locator, where you can enter your zip
code in and find help in your area. And there are websites allowing people to
search for providers, and find someone that they feel is a good fit. It’s a lot like
finding a friend. It’s more person-centered, gives patient more access and control,
and gives them a good sense of a provider’s personality and specialties.

B.Also, mobile solutions, mental health apps and telehealth processes have all been
a huge help. Some providers offer 24 hour care where you can call a provider and
they call you back either for a phone or video chat.

C.Technologists have been striving to share patient records electronically and link
providers up with one another. From a policy standpoint, we have wanted to
streamline the sharing of both behavioral health and physical health records with
one another for a while. This will only help ensure people can get the care that they
need.

•Chronic illness\disability

Almost half of all Americans have at least one chronic condition.Chronic disease
deaths are largely attributed to preventable illnesses

How does technology help those groups? let's take Thalassemic and diabetic
patients as an example :
-Diabetic patient: Users of insulin pumps are at 29% lower risk of death compared
with patients on insulin injections

An insulin pump is an external, battery-powered device that continuously delivers

insulin in small doses to the body. An insulin pump is a device about the size of a
cell phone that contains a cartridge of rapid-acting insulin. A pump has a screen
and buttons for programming the pump's internal computer, and a precise motor
that pushes the insulin from the cartridge into your body through a thin plastic
tube called an infusion set.

Improved glycemic control can reduce the microvascular and macrovascular

complications associated with type 1 diabetes mellitus,1-3 and diabetes
practitioners are continuously challenged to optimize glucose control while
minimizing severe hypoglycemia and weight gain. Insulin pumps and systems for
continuous glucose monitoring represent technologies designed to assist patients
with type 1 diabetes in safely reaching glycemic goals. Among adults, the use of an
insulin pump has been shown to reduce glycated hemoglobin levels without an
increased risk of hypoglycemia, as compared with a regimen of multiple daily
insulin injections, but results in children have been inconsistent.4 Recent studies
have suggested that patients who used sensor-augmented pump therapy with
adherence to continuous glucose monitoring had improved glycated hemoglobin
levels without an increased rate of hypoglycemia.5-7 Similarly, in a multicenter
trial of continuous glucose monitoring in patients with type 1 diabetes, sponsored
by the Juvenile Diabetes Research Foundation (JDRF) (ClinicalTrials.gov number,
NCT00406133), the use of a continuous glucose-monitoring device was effective in
reducing glycated hemoglobin levels among patients who were 25 years of age or
older but not among patients under the age of 25 years

In both adults and children with inadequately controlled type 1 diabetes, sensor-
augmented pump therapy resulted in significant improvement in glycated
hemoglobin levels, as compared with injection therapy. A significantly greater
proportion of both adults and children in the pump-therapy group than in the
injection-therapy group reached the target glycated hemoglobin level

Its cost:

 IN USA insulin pumps cost between $4,500 and $6,500 for individuals
without insurance ; Patients will also need to pay for the insulin delivered
via the device while it’s not available in Palestine yet.

-Thalassemic patients :
In 1938 published the first recorded case of thalassemia on east side of Suez
was published,
In 1990, an important study on the care of thalassaemic patients in Mumbai
highlighted the significant, unavoidable and increasing demand on the
public health services by patients with β-thalassaemia major the situation
was also characterized by evasion of the problem, failure of planning, no
provisions for prevention, and inadequate treatment leading to premature
death among the affected children. Another study group reported that most
thalassemics were not satisfied with their body image. The adolescents were
anxious about their future health and education. Majority of the subjects
 (80%) did not discuss their disease and its related problems with their
friends. They mainly depended on their parents for monetary and emotional
support.
The first way of management was blood transfusion, in the initial years the
major problem was to obtain blood for transfusions, in India 2 million units
of packed red cells are required for transfusion to thalassaemic patients.
In the early years most of the blood donations were obtained from the
relatives or professional donors. Therefore, ensuring safety was difficult,
and some cases of transmission of HIV through blood donations were
described, In 1987 the Government of India set up the National AIDS
Control Organization, One of its main mandates was ensuring safe blood for
transfusion by proper screening of blood and blood products throughout
the country. Now, all the blood banks supply blood that has been tested for
malaria, syphilis, hepatitis B, HIV and hepatitis C, therefore the
transmission of infections through blood is now negligible.
repeated blood transfusions result in excess iron in the body, to remove it
chelation was used and in the early years desferal (deferoxamine, DFO) was
the only chelator available. However, its use has a number of problems - it
has to be given intravenously for many hours using a pump, and it is
expensive. Therefore, compliance is poor. In 1994, George J. Kontoghiorghes
discovered an oral iron chelator deferiprone (L1) ,thousands of patients are
now treated with L1 worldwide, not only for transfusional iron overload but
also for non-iron loading conditions. L1 is set to assume a role of universal
antioxidant pharmaceutical and a therapeutic for more than 100 diseases.

-Population with predisposing characteristic :

 The predisposing characteristic of race and ethnicity

36.4 million persons, approximately 12.9% of the U.S. population, identified
themselves as Black or African American; 35.4 million of these persons
identified themselves as non-Hispanic . For many health conditions, non-
Hispanic blacks bear a disproportionate burden of disease, injury, death,
and disability. Although the top three causes and seven of the 10 leading
causes of death are the same for non-Hispanic blacks and non-Hispanic
whites, the risk factors and incidence, morbidity, and mortality rates for
these diseases and injuries often are greater among blacks than whites. In
addition, three of the 10 leading causes of death for non-Hispanic blacks are
not among the leading causes of death for non-Hispanic whites: homicide ,
human immunodeficiency virus (HIV) disease, and septicemia .
Disparities in:

1-health outcomes in blacks versus whites include life expectancy;

In 2009, the average life expectancy of black men and women in the United States
was just 75 life expectancy gap was actually at an all-time low of 4 years

2-Enabling characteristics :

-Literacy:
54% of African Americans graduate from high school, compared to more than
three quarters of whiteand Asian students.

-access to health care :

Few disparities in quality of care related to race, ethnicity, or income showed
significant improvement although the number of disparities that were getting
smaller exceeded the number of disparities that were getting larger.
Despite improvements, differences persist in health care quality among racial and
ethnic minority groups. People in low-income families also experience poorer
quality care.

 The predisposing characteristic of geographic location:

-rural vs urban:
Rural Americans face a unique combination of factors that create disparities in
health care not found in urban areas. Economic factors, cultural and social
differences, educational shortcomings, lack of recognition by legislators and the
sheer isolation of living in remote rural areas all conspire to impede rural
Americans in their struggle to lead a normal, healthy life. Some of these factors,
and their effects, are listed below.
1-Only about ten percent of physicians practice in rural America despite the fact
that nearly one-fourth of the population lives in these areas. **
2-Rural residents are less likely to have employer-provided health care coverage or
prescription drug coverage, and the rural poor are less likely to be covered by
Medicaid benefits than their urban counterparts.
3-Although only one-third of all motor vehicle accidents occur in rural areas, two-
thirds of the deaths attributed to these accidents occur on rural roads.**
4-Rural residents are nearly twice as likely to die from unintentional injuries other
than motor vehical accidents than are urban residents. Rural residents are also at
a significantly higher risk of death by gunshot than urban residents.
5-Rural residents tend to be poorer. On the average, per capita income is $7,417
lower than in urban areas, and rural Americans are more likely to live below the
poverty level. The disparity in incomes is even greater for minorities living in rural
areas. Nearly 24% of rural children live in poverty.
6-People who live in rural America rely more heavily on the federal Food Stamp
Program, according to The Carsey Institute at the University of New Hampshire.
The Institute's analysis found that while 22 percent of Americans lived in rural
areas in 2001, a full 31 percent of the nation's food stamp beneficiaries lived there.
In all, 4.6 million rural residents received food stamp benefits in 2001, the analysis
found.
7-There are 2,157 Health Professional Shortage Areas (HPSA’s) in rural and
frontier areas of all states and US territories compared to 910 in urban areas.**
8-Abuse of alcohol and use of smokeless tobacco is a significant problem among
rural youth. The rate of DUI arrests is significantly greater in non-urban counties.
Forty percent of rural 12th graders reported using alcohol while driving compared
to 25% of their urban counterparts. Rural eighth graders are twice as likely to
smoke cigarettes (26.1% versus 12.7% in large metro areas.) **
9-Anywhere from 57 to 90 percent of first responders in rural areas are volunteers.
**
10-There are 60 dentists per 100,000 population in urban areas versus 40 per
100,000 in rural areas**
11-Cerebrovascular disease was reportedly 1.45 higher in non-Metropolitan
Statistical Areas (MSAs) than in MSAs.**
12-Hypertension was also higher in rural than urban areas (101.3 per 1,000
individuals in MSAs and 128.8 per 1,000 individuals in non-MSAs.)**
13-Twenty percent of nonmetropolitan counties lack mental health services versus
five percent of metropolitan counties. In 1999, 87 percent of the 1,669 Mental
Health Professional Shortage Areas in theUnited States were in non-metropolitan
counties and home to over 30 million people **
14-The suicide rate among rural men is significantly higher than in urban
areas,particularly among adult men and children. The suicide rate among rural
women is escalating rapidly and is approaching that of men.**
15-Medicare payments to rural hospitals and physicians are dramatically less than
those to their urban counterparts for equivalent services. This correlates closely
with the fact that more than 470 rural hospitals have closed in the past 25 years.
16-Medicare patients with acute myocardial infarction (AMI) who were treated in
rural hospitals were less likely than those treated in urban hospitals to receive
recommended treatments and had significantly higher adjusted 30-day post AMI
death rates from all causes than those in urban hospitals. ***
17-Rural residents have greater transportation difficulties reaching health care
providers, often travelling great distances to reach a doctor or hospital.
18-Death and serious injury accidents account for 60 percent of total rural
accidents versus only 48 percent of urban. One reason for this increased rate of
morbidity and mortality is that in rural areas, prolonged delays can occur between
a crash, the call for EMS, and the arrival of an EMS provider. Many of these delays
are related to increased travel distances in rural areas and personnel distribution
across the response area. National average response times from motor vehicle
accident to EMS arrival in rural areas was 18 minutes, or eight minutes greater
than in urban areas.**

A National Rural Health Snapshot Rural Urban

Percentage of USA Population** nearly 25% 75% +

Percentage of USA Physicians** 10% 90%

Num. of Specialists per 100,000

40.1 134.1
population**

Population aged 65 and older 18% 15%

Population below the poverty level 14% 11%

Average per capita income $19K $26K

Population who are non-Hispanic

83% 69%
Whites

Adults who describe health status as

28% 21%
fair/poor

Adolescents (Aged 12-17) who

19% 11%
smoke

Male death rate per 100,000 (Ages

80 60
1-24)

Female death rate per 100,000

40 30
(Ages 1-24)

Population covered by private

64% 69%
insurance

Population who are Medicare

23% 20%
beneficiaries
 Medicare beneficiaries without drug
45% 31%
coverage

Medicare spends per capita

85% 106%
compared to USA average

Medicare hospital payment-to-cost

90% 100%
ratio

Percentage of poor covered by

45% 49%
Medicaid

Statistics used with permission from "Eye on Health" by the Rural

Wisconsin Health Cooperative, from an article entitled "Rural Health
Can Lead the Way," by former NRHA President, Tim Size; Executive
Director of the Rural Wisconsin Health Cooperative

 The predisposing characteristic of women and children

All over the world, women, for a variety of reasons, experience much higher rates of
pain than men. More than 100 million Americans report living with chronic pain,
and the vast majority are women. Also women have a higher mental illness rate
than men, that’s attributed to stress from sexism (e.g. lower pay) and other
environmental sources.

Children are the group who needs the vast majority of medical care in any
population, that’s become more important when they are suffering from new
morbidities; alcohol or drug abuse, obesity and type 2 diabetes, other mental
health and learning disabilities.
So much effort should be done to provide access to mental health services for
women and children. For childhood obesity as well, we should deploy the internet
and mobile apps with medical teaching programs that helps control their obesity
problems.
http://health.mo.gov/living/families/shcn/