Evaluation of the Effect of a Multifunctional Telemedicine Device on Health Care Use and Costs: A Nonrandomized Pragmatic Trial.

Background: Telemedicine health insurance models are highly prevalent in the Swiss health care system. Nevertheless, the potential of telemedicine is only partly being achieved, since current telemedicine health insurance models are limited to an initial contact by telephone and a gatekeeper role that organizes access to health care providers such as general practitioners, specialists, or hospitals. Against this background, a telemedicine device with diverse visual and auscultatory examination functions was made available to 2,000 telemedicine-insured clients. This device allowed diagnostic information to be sent to a medical care provider and used for telemedical consultation. Objective: To determine whether the additional implementation of a multifunctional telemedicine examination device resulted in fewer physical consultations, reduced service utilization, and lower health care expenditures among telemedicine-insured clients. Methods: Our analysis is based on claims data from 135,636 clients insured in a telemedicine call center model covering the years 2019 and 2020. We compare the use of health care and health care costs of clients who received a telemedicine device with those without such a device, using multivariable regression to adjust for group differences due to self-selection. Results: We found lower total health care expenditures of -229 (Swiss Francs) and lower inpatient costs of -160 (Swiss Francs) on the part of clients with the telemedicine device. However, the implementation of the telemedicine device did not lead to a statistically significant reduction in service utilization. Conclusions: The treatment of telemedicine-insured clients was on average more cost-effective when they received the multifunctional telemedicine device. Accordingly, complementing the existing telemedicine model with telemedicine devices that allow for improved telemedical consultations has the potential to increase the cost-saving potential of the existing telemedicine call center models.

The Consequences of Cannabis Use: A Review of Self-Reported Use and Experiences Among College Students.

BACKGROUND: Healthy People 2020 has introduced a new initiative focused on adolescent health, ages 10-17, and young adults, ages 18-25, due to health and social problems starting or peaking during these years. The initiative focuses on decreasing such problems including substance use. Cannabis is one of the most popular illegal substances used among young adults for recreation in the United States. Multiple consequences of cannabis use are well documented in the literature including the development of medical problems, developmental delays, and social issues. Furthermore, academic success is linked to overall health outcomes. OBJECTIVE: The aim of this study was to explore cannabis use and knowledge of consequences among college students at a university in southwest Texas. METHOD: Secondary analysis of survey results from students at a small, private university. The Core Alcohol and Drug Survey, a self-report questionnaire, was utilized to measure alcohol and drug usage, attitudes, perceptions, and opinions regarding drug and alcohol usage. The survey was distributed to all 6,537 undergraduate students. The survey results were collected over a 3-month period and provided to the authors for interpretation. RESULTS: Eighty-two survey responses were received. Analysis indicated that 24.7% of the students used marijuana in the past year, and 16% had used cannabis within 30 days of the survey. Of the respondents surveyed, 13.3% reported they used cannabis occasionally and 38.7% reported they used cannabis regularly. Furthermore, survey results indicated that 12.7% of respondents reported some of the consequences from cannabis use experienced within the past year included public misconduct, such as fighting, arguing, and vandalism. In addition, 13.9% reported having experienced serious personal problems due to cannabis use at least once during the past year including injuries, suicidal thoughts, and sexual assault. Reported attitudes and perceptions of cannabis use include 13.3% perceived great risk associated with cannabis use. Moreover, 62.3% of respondents believe that their friends would disapprove of cannabis use. A negative correlation was identified between cannabis use within the previous 30 days and low grades. CONCLUSION: The consequences of cannabis use are well documented in the literature, yet cannabis remains a popularly used illegal substance among college students. Despite experiencing known consequences of cannabis use, much of the sample reported regular use of the substance. IMPLICATIONS FOR PRACTICE: Results of the study may be used to improve education and interventions aimed at reducing cannabis use among college students. In addition, providers may use the information to provide patient education at routine visits.