Health Newsfeed – Johns Hopkins Medicine Podcasts

Corrie is the name of an app developed by Johns Hopkins and Apple to enable people who’ve had a heart attack become informed, active participants in their own care, and that’s just what the most recent data show. Seth Martin, one of the app’s developers and a cardiologist at Hopkins, explains.

Martin: We’re testing the ability of the app to empower patients to follow everything that we know works. They’ve had a heart attack and the question is what’s next and that’s where Corrie came in. And so what we’ve found first of all that patients using the Corrie app had very high levels of patient activation and what means is a high level of confidence that our patients know what they need to do to be successful, so that’s your medications to lower cholesterol and control your blood pressure, and antiplatelet medicines to prevent stickiness of the blood.  :32

Martin anticipates wider availability of the app and additional positive results of ongoing studies on its use. At Johns Hopkins, I’m Elizabeth Tracey.

Imagine how hard it is for some people to get to a physician’s office, especially those with disabilities such as movement disorders, or children. For them telemedicine has proven very helpful, but is poised to ramp down after special allowances during the pandemic. Brian Hasselfeld, director of telemedicine at Johns Hopkins, comments.

Hasselfeld: Not all care is perfect for telemedicine, but we should allow convenience and access and choice to be a main component of what we do in patient centered design. With many states after a seizure or a stroke you can’t drive for six months. Those patients aren’t getting to make the easy choice about go to the visit or not, they’re making the choice of how am I going to do that? How much easier would it be to do that virtually, I mean how much more patient centered would it be to do that virtually? Many patients are struggling not with oh of course it’s easy to go to that visit, I might not be able to go, period.  :32

Hasselfeld encourages everyone to reach out to lawmakers. At Johns Hopkins, I’m Elizabeth Tracey.

Telemedicine proved its worth during the pandemic, providing medical visits to millions. Now barriers to continue to allow telemedicine services are curtailing them. Brian Hasselfeld, director of telemedicine at Johns Hopkins, says a big one is physician licensure.

Hasselfeld: The rule of the road is I must be licensed where you, the patient, are physically located at the time of the visit. In a world of expanded telemedicine care, you could be anywhere of course. That also means I need to be licensed anywhere potentially, or I can’t see you. And so now we’re stuck with this really difficult situation. You my patient. I know you, you know me, we have a trusted relationship. You happen to travel 45 minutes to the north and you’re in Pennsylvania. I’m not licensed there. I cannot care for you, legally.  :30

Hasselfeld says some states have limited agreements with one another, and these may be helpful in the short term. A longer term solution is needed however, since many specialty care visits simply aren’t practical in person for many people. At Johns Hopkins, I’m Elizabeth Tracey.

During the pandemic, telemedicine has been a boon for many, perhaps most especially older people, who are often much more at risk for severe disease and death when they develop Covid-19 infection, and may be reluctant to visit a health care provider in person. Brian Hasselfeld, director of telemedicine at Johns Hopkins, says now this service may be largely eliminated.

Hasselfeld: Medicare beneficiaries, those insured by Medicare fee for service, when the federal public health emergency ends, Medicare beneficiaries will only have access to telemedicine in very specific circumstances. Mostly you won’t have access to it, so Congress will hopefully act to ensure that Medicare beneficiaries don’t get a new kind of Medicare donut. It used to be about pharmacy and prescription benefits, now it could be about telehealth benefits, not having telehealth benefits as a Medicare beneficiary.  :28

Hasselfeld says people should contact their legislators and express their desire to see telehealth services preserved under Medicare, and to urge Congress to act. At Johns Hopkins, I’m Elizabeth Tracey.

Telemedicine took a quantum leap during the pandemic, with millions of visits across the nation. Now that both state and federal emergency access is expired or about to be, what is the situation now? Brian Hasselfeld, director of telemedicine at Johns Hopkins, explains the barriers in making telemedicine more accessible.

Hasselfeld: A couple different barriers, and we’ll put them in two big buckets. Does my insurance cover it, and can I get it where I’m physically located? And they both have some real regulatory challenges ahead of them. Broadly, most commercial insurers cover telemedicine before the pandemic, and we believe most likely are going to continue to do so after, but Medicare and Medicaid insure a lot of people, and for those two insurers, and the people insured by those programs, that will be the decision of the federal government for Medicare, and state government for Medicaid.  :33

Hasselfeld notes that Medicare’s rulesmaking is often the pattern other insurers follow. At Johns Hopkins, I’m Elizabeth Tracey.

Telehealth, where physician and patient can meet remotely via telephone or video, was utilized by millions when the Covid pandemic was at its height. Now emergency measures to facilitate this are or are about to be expired, and Brian Hasselfeld, director of telemedicine at Johns Hopkins, says perhaps these measures or some like them should be made permanent. 

Hasselfeld: Because of all the reasons we feel telemedicine is good for the patient, convenient, less time to travel, paying for parking, finding mass transit, time away from work, time away from child care. Sometimes, I mean clinically, it’s better seeing a patient in their home environment, can’t forget your medications anymore because they’re right down the hallway. Looking at impairment of activities of daily living instead of just hearing about them. There are many actual benefits in addition to being really patient centered.  :29

Hasselfeld says both federal and state authorities will have to weigh in on regulations to allow easily accessible telemedicine services to continue. At Johns Hopkins, I’m Elizabeth Tracey.

Women are a rarity in the biological world, since they will spend up to a third or more of their lives after the point where they cease reproductive ability, at menopause. Wen Shen, a menopause expert at Johns Hopkins, says that fact alone points to a need for greater awareness.

Shen: We need to educate younger women, starting in their late thirties, about the fact that menopause is coming. For every woman you live long enough, you’re going into menopause. Girls are normally told about having their first period, women who are pregnant get advice from everybody under the sun, but nothing about menopause. There’s plenty of clinical data to show that for women who start hormone therapy early, in their perimenopause, actually get the most benefit.  :34

Shen says all women should ask questions about menopause. At Johns Hopkins, I’m Elizabeth Tracey.

The Women’s Health Initiative was a series of studies looking at interventions to improve the health of women after menopause, and in examining hormone therapy, found an increased risk for breast cancer. Wen Shen, a menopause expert at Johns Hopkins, says that study used oral estrogen and that different forms of hormones are used today.

Shen: The 17-beta estradiol patch and the micronized progesterone capsule based in peanut oil may have lower breast cancer risk than the oral hormones that were used in the WHI. Timing hypothesis is very very important. For women who are more than five or ten years out from their last menstrual period they are not good candidates for hormone therapy.  :32

Shen says research into this field is ongoing and women should ask about what current studies are showing. At Johns Hopkins, I’m Elizabeth Tracey.

Oral estrogen products for women in perimenopause and menopause can be associated with a number of negative side effects. That’s according to Wen Shen, a menopause expert at Johns Hopkins.

Shen: Oral estrogen therapy can increase c-reactive protein, which is an inflammatory marker. It increases inflammation. Inflammation affects so much of autoimmune diseases and also diabetes is a form of inflammation. And estrogen therapy orally does increase the risk of stroke. That’s why estrogen therapy should not be given to women over 65 years.  :32

Shen says that there are other options for women seeking to ameliorate uncomfortable aspects of perimenopause and menopause, so talk with your provider to find out which might work for you. She cautions against self-medication with supplements or products available on the internet. At Johns Hopkins, I’m Elizabeth Tracey.

Hormone therapy helps women in both perimenopause and menopause cope with symptoms like hot flashes and sleep interruption, but choosing whether to take hormones is complicated. Wen Shen, a menopause expert at Johns Hopkins, offers some insight.

Shen: Estrogen therapy depends very strongly on the type of estrogen that you’re prescribed and also the method of administration. The natural ovarian estradiol is 17-beta estradiol. And not all estrogens in hormone therapies are created equal. Oral estrogens do increase a woman’s triglycerides. Oral estrogen therapy also increases a woman’s risk for clotting.  :32

Shen says the oral estrogen products are not likely to be the best solution for most women, and an experienced provider can help you navigate the many choices for hormone replacement that are available. At Johns Hopkins, I’m Elizabeth Tracey.