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Even though telemedicine seems to be having its day in the sun, with Teladoc's forthcoming IPO and major funding for MDLive, Doctor on Demand, and American Well, one of the oldest, earliest telemedicine companies is shutting down. Bosch has officially closed its US subsidiary Robert Bosch Healthcare, reducing the scope its healthcare operations to a 50-person team based in Germany.

But in recent years, Bosch became most well known for the ferocity with which it defended its intellectual property, energy that, in hindsight, might have been better spent adapting to the changing telehealth world.

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The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy) and (b) compare the effectiveness of the Health Buddy with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

The primary outcome for this analysis was time to all-cause mortality over 3 years after being offered HBP enrollment. Secondary outcomes were changes in quarterly measures of healthcare resource utilization from baseline to the end of the study period including all-cause inpatient admissions, all-cause hospital days (conditional on hospitalization), and all-cause emergency department (ED) visits. As described previously, data from quarters immediately preceding and following HBP initiation were excluded to account for uncertainty regarding exact start date, and the quarter of a patient's death was excluded due to increased resource utilization immediately prior to death.11,12

The HBP demonstration project was designed to improve coordination of care and could potentially impact multiple types of outcomes. Accordingly, we matched on the propensity of being offered the HBP to enable evaluation of multiple outcomes including hospitalization, hospital days, and ED visits. Propensity matching helped identify control patients most similar to HBP patients prior to the intervention as described previously.11,12 The propensity of being offered the HBP was estimated using logistic regression. Baseline characteristics potentially associated with being offered HBP enrollment were considered, including demographics, comorbid conditions, overall health indicators (e.g., Medicare Hierarchical Condition Category score, Elixhauser comorbidity index, and high-risk comorbidities), total healthcare costs, all-cause resource utilization (e.g., hospitalizations, outpatient visits, ED visits, and healthcare provider visits), and HF-related healthcare utilization (e.g., hospitalizations and ED visits with a diagnosis of HF). A high-risk comorbidity was defined as any condition that could impede use of the Health Buddy device (see Supplementary Data; available online at www.liebertpub.com/tmj).

The chatbot is now available for national authorities and public health institutions for tailored use in countries, including in local languages. It uses artificial intelligence to answer questions about COVID-19, and provides local information such as COVID-19 hotlines available in European and central Asian countries.

Comprehensive Health Education is required instruction per Florida Statute 1003.42. The curriculum includes 14 components of health that are age and developmentally appropriate. Human growth and development, including puberty and sexual health education, are an integral part of these components.

Nobody, especially older adults, should try to navigate the system alone. Everyone should have a health buddy, someone who serves as an extra pair of eyes, ears and, perhaps, hands, taking notes about the visit.

If you are a long-distance caregiver and can't serve as the health buddy advocate for your loved one, try to find a relative or good friend to step in for you. Anyone without family or close friends nearby should look for a volunteer health buddy through local support groups or religious organizations.

I dream of starting a volunteer health buddy service for older adults. Many retired adults would be willing to help an older adult prepare for an office visit and go with them into the exam room. Imagine the peace of mind you would have as a long-distance caregiver, knowing there was someone trusted and trained who could go with your loved one to each office visit. They could relay important information back to you as well, keeping you in the loop.

An office visit can be for an older adult can be challenging. An older adult may have more health problems and concerns that require discussion and action. They may take more medications prescribed by various health care professional. And they may have hearing or cognitive difficulties.

They found something else interesting. If the patient initiated the topic, the physician spent almost 20 percent more time on it. What better reminder: You or your health buddy needs to speak up to get your questions answered.

When discussing their findings, the researchers concluded, "We couldn't help but wonder how much is accomplished during such a brief exchange." The truth is, not much. Yet the 15 minutes of face-to-face time you have with your health care professional is where most major health decisions are made and prescriptions are generated.

Today the total time spent in an office visit may be a few minutes more than years past, but the eye-to-eye contact is less thanks to the computer and the typing demands of the electronic health record. Most of us would rather talk to someone looking at us than someone facing a computer, rapidly taking notes.

You and your health buddy should prepare for your doctor's appointment by writing down important questions and concerns. With so little time available with your health care professional, you need to have clear and concise questions to ask at the start of the visit to set the agenda so it works best for you.

In truth, physicians need to take time during office visits to learn more about what truly matters to their patients. This takes time and isn't typically done during routine appointments. A health buddy can help start these important conversations. Remember:

Before the visit, rehearse with your health buddy. By saying things out loud you can hear how your concerns sound and can get over your fear of voicing your concerns. During the visit, a health buddy can bring up topics the patient may be reluctant or embarrassed to ask about. The health buddy can also take notes on what the health care professional says.

A health buddy is indispensable after leaving the doctor's office, helping follow through on what the health care professional advises. Studies show that the average patient forgets half of what is said as soon as the appointment is over.

I was a health buddy for my sister recently when she had major back surgery. I went with her to doctor appointments and stayed with her in the hospital. My sister hated to speak up and be a squeaky wheel. She trusted that doctors knew best, and she didn't want to take up their valuable time. I spoke up on her behalf, provided important health information about my sister, and quickly spotted medication issues and other problems.

Have you been a health buddy for someone you care about? What has been your experience with a loved one? Do you know of someone who could use your help as a health buddy? Pay it forward, commit to being a health buddy for someone you care about today.

Marie Savard, MD, is a trusted voice on women's health, wellness and patient empowerment. She currently writes a blog called Ask Dr. Marie, where this column first appeared. Her blog focuses on the challenges of medication overload in older adults and what caregivers can do to help. Dr. Savard is a former ABC News Medical Contributor and author of four books including her most recent, Ask Dr Marie: What Women Must Know about Hormones, Libido, and the Medical Problems No One Talks About. She lives in Philadelphia with her physician husband and has three grown sons.

About Neil Buddy Shah

Trained as a physician and development economist, Dr. Neil Buddy Shah is an award-winning social entrepreneur, CEO, and global health funder who is passionate about making global health efforts as impactful as possible.

Buddy holds an AB in economics from Harvard, an MD with special distinction in global health policy from Einstein College of Medicine in New York, and an MPA in International Development from Harvard Kennedy School.

About CHAI | The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low-and middle-income countries. We work with our partners to help strengthen the capabilities of governments and the private sector to create and sustain high-quality health systems. For more information, please visit www.clintonhealthaccess.org.

I learned that there is always more than one way to do the same thing, but it is important to strike the balance between the most effective way and the least time consuming one. Also, I learned how to code basic animations with CSS and JavaScript- I had no idea how to do it at first, so it was rewarding when I saw my dreams for the site take shape. Above all, I learned the value of reflecting on my own emotions (as hacking definitely took me on a rollercoaster ride) and that is the main message of Cubby: your mental health buddy. ff782bc1db