title: Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?
abstract: The growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity.
  
  
  
  We describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.
  
  
  
  Recommendations to extend the benefit's coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA. john.batsis@gmail.com.|Geisel School of Medicine at Dartmouth, Hanover, NH, USA. john.batsis@gmail.com.|The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. john.batsis@gmail.com.|Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA. john.batsis@gmail.com.|Health Promotion Research Center at Dartmouth, Lebanon, NH, USA. john.batsis@gmail.com.|Dartmouth Weight and Wellness Center, Lebanon, NH, USA. john.batsis@gmail.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Batsis
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.|Centers for Telehealth, Dartmouth-Hitchcock, Lebanon, NH, USA.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Pletcher
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.|Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Stahl
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D020380:Needs Assessment; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Medicare; Obesity; Primary care; Telemedicine; Weight loss