Q: My 85-year-old aunt cannot get to her doctor’s appointments unless we drive around 50 miles to take her, and that isn’t always possible. I wish doctors made house calls these days! Is there any way to arrange that? -- Emma S., Dayton, Ohio
A: House-call programs are springing up all over the country, and they’re saving Medicare and insurance companies a lot of money! For example, there’s the Medicare and Medicaid program called Independence at Home. It started in 2014 and will be re-evaluated by Congress in 2017.
Dr. Mike’s Cleveland Clinic runs one of those innovative programs (there are 16 more), called Medical Care at Home. The Visiting Physician’s Association also is administering several of these programs, and at last count, they operate in 15 states. You can get in touch with them by calling 877-HOUSECALL or going to www.visitingphysicians.com. Besides bringing medical care to people who have a difficult time getting to the doctor’s office or hospital, they’re saving Medicare around $25 million a year.
The advantages for elderly and house-bound patients are enormous. As Dr. William Zafirau, the medical director for Cleveland Clinic’s house-call program, points out, when doctors and nurses come into a home, they can spot things like malnutrition, improper medicine storage, safety risks and cognitive issues. This can allow them to initiate programs like Meals on Wheels or call in social services. That prevents further medical problems for the patient and ballooning expenses for public health-care providers.
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Let’s hope, for everyone’s sake, that these programs continue to be funded and supported by local, state and federal agencies (write your representatives!) and that you can access them in your aunt’s area.
P.S.: For the computer-savvy, telemedicine is also increasingly available, so a patient can be monitored and talk to a doctor many miles away. Medicare even pays for it.
Q: I just turned 50, and I’m dreading getting a colonoscopy and the prep. Do I really have to go through all that? -- John W., Lexington, Kentucky
A: You may remember when Dr. Oz had his procedure televised, and his doc found polyps. What you might not remember is that he had to do it twice, because the first time he didn’t prep right. Prepping really is the toughest part, but once it’s done correctly, colon cancer screening is incredibly effective. In fact, colon cancer is highly preventable if the screen IDs intestinal polyps, which can take five to 10 years to become malignant, and your doctor removes them.
A brand-new United States Preventive Services Task Force report states that screening “substantially reduces deaths” from colon cancer, and they recommend screening start at 50 and continue as needed up to age 75 (older is case by case). Unfortunately, they found that 33 percent of eligible adults have NEVER been screened, which may be why colon cancer is the second leading cause of cancer death in the U.S.
In the report, the task force also reviewed evidence on the effectiveness and risks of various screens, including colonoscopy (a full-colon screen), flexible sigmoidoscopy (that looks at less than half the colon), computerized tomography (CT) colonography (uses X-rays and is noninvasive), the guaiac-based fecal occult blood test (a stool sample is examined to see if there’s blood present, which can indicate if you need a colonoscopy), the fecal immunochemical test, or FIT (which also checks for blood in the stool), and the multi-targeted stool DNA test that detects biomarkers associated with both precancerous lesions and cancer (not covered by most insurance plans). They reported that the tests “have varying levels of evidence supporting their effectiveness, as well as different strengths and limitations.”
We say, go for the gold standard -- a colonoscopy. (If you pick another test, do it regularly; that’s essential.) And adopt a gut-healthy diet: Eat plenty of high-fiber foods, 100 percent whole grains and produce; and banish red and processed meats from your plate.
Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at firstname.lastname@example.org.