Chronic obstructive pulmonary disease (COPD) is a respiratory disease affecting over 14 million Americans. In recent years, the American Lung Association has stated that there are likely many more cases of COPD that go unreported in the United States, given the vast prevalence of patients with symptoms consistent with Progression of COPD. Before the Covid-19 pandemic, over 25 million Americans already suffer from impaired lung function in the form of asthma, and patients in rural areas are at particularly high risk.
The latest data shows that people in rural areas have relatively less access to care. Pulmonologists are in high demand as an aging physician population leads to an increase in “care deserts”: geographic areas where patients do not have access to a specialty care provider. Fortunately, modern medical technology—including solutions that integrate the power of machine learning and AI—can help bridge the gaps and ensure that rural patients get access to the care they need.
For COPD, in particular, the patient-physician interaction is critical to providing quality care and improving outcomes. Rural patients with COPD, asthma or other respiratory conditions should take proactive steps to ensure they have access to a specialist care provider, whether using traditional or digital services.
The rise of pulmonology ‘desolate care’
Research shows that people in villages often do not have access to pulmonologists. Just in the last decade 34.5% of people in villages had access to a pulmonologist within 10 miles and that 92% of pulmonologists are located in urban areas, forcing COPD patients with limited access to depend on care provided by primary care physicians. Data released by the Department of Health and Human Services shows that shortages may be particularly acute in the south and less severe in the northeast, with the west falling in between.
There are several factors that contribute to the prevalence of these “care deserts.” The main factor is the demographics of the doctors. By 2025, it is estimated that the country will have a deficit of 1,400 pulmonologists, making the specialist care they provide invaluable – and for many patients, out of reach. Today, a little more 70% of pulmonologists are over 55 years old. Many will retire within the decade. Given the number and age of pulmonologists today, there is simply too much ground to cover and too few specialists to cover it.
Economic realities further compound this problem. Many rural hospitals are unable to offer vacation or weekend care, resulting in difficulty recruiting and retaining critical care specialists. This is particularly limiting when about half of pulmonologists are reported to experience burnout, p 37% of them assess their burnout as severe or severe and 6% are considering leaving the medical profession altogether. The high burnout rate is not surprising. Pulmonologists working in a hospital setting have been at the forefront of the Covid-19 pandemic, which has forced doctors to deal with acute, high-pressure scenarios with patients’ lives at risk.
The pandemic has also created new, steep barriers to patient care that have further reduced patient-physician interactions at an already uncertain time. Efforts to contain the pandemic are making significant progress burden for people with COPD, whose condition puts them at risk if they contract Covid-19. To avoid the risk of exposure, many patients must avoid visiting their doctor in person.
These challenges create an urgent problem for people living in rural communities – many of whom will need access to specialist COPD treatment, which is increasingly difficult to find. As the situation worsens, more patients will progress to the advanced stages of COPD, which makes breathing difficult, significantly reduces quality of life and is associated with 78% and 72% 5-year survival in men and women, respectively.
Modern technology can offer an oasis
Advanced telemonitoring and telehealth systems can offer pulmonologists and patients a way to bridge gaps in care and create a proverbial oasis in the expanding deserts of care. Remote monitoring solutions, such as wearable devices that capture a patient’s biometric data, have made significant progress in recent years, allowing patients to communicate important health data to their care provider regardless of physical distance. Coupled with the development of increasingly sophisticated and user-friendly telehealth platforms, patients now benefit from new ways to access quality consultations from anywhere with an internet connection.
In pulmonology, this can be leveraged through “virtual respiratory practices” that use passive remote monitoring, artificial intelligence, and a curated telehealth system to enhance digitally delivered pulmonology care. A passive, non-contact remote monitoring system can capture respiratory biomarkers while the patient sleeps. The software can then use machine learning to identify irregular patterns, flag them as significant and send them to remote care teams for routine or proactive interventions using the integrated telehealth system.
Although artificial intelligence and machine learning are still in the early stages of integration into medical devices, this model can offer significant reducing rescue inhaler use and emergency room visits and hospitalizations. This means that the burden on patients, carers and hospital systems can be significantly reduced.
A race against time
Changing demographics within pulmonology, the inability of rural hospitals to match the incentives of urban hospitals, and the recently justified reluctance of respiratory patients to increase in-person visits have contributed to the continued growth of pulmonology care deserts in the United States. Accordingly, it is imperative that rural healthcare organizations take steps now to ensure they provide specialist access through traditional or digital solutions to meet the critical needs of these patients.
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