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Update May, 2019

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Health & Wellbeing

Germany mulls fines to boost measles vaccination rates

Measles, mumps and rubella vaccines sit in a cooler. German Health Minister Jens Spahn is proposing fines for parents of school-age children who haven’t been vaccinated for measles. (AP Photo/Seth Wenig, File)

Frank Jordans

Berlin (AP) — Germany’s health minister is proposing fines for parents of school-age children who haven’t been vaccinated for measles amid concern that the highly contagious and potentially deadly disease could make a comeback.

In an interview published Sunday with German weekly Bild am Sonntag, Minister Jens Spahn said parents who can’t prove their children have been vaccinated for measles should have to pay up to 2,500 euros ($2,790).

The minister also proposed that children without measles vaccinations be banned from going to daycare facilities, to protect others who are too young or medically unable to receive a measles immunization.

Compulsory medical procedures, including vaccinations, are a politically sensitive issue in Germany and it’s unclear whether Spahn’s proposal, which has yet to be discussed by Cabinet, will be implemented.

But worries that a disease once thought under control could re-emerge as a major threat has experts calling for vaccinations to be stepped up. The head of the German Medical Association, Frank Ulrich Montgomery, on Sunday welcomed Spahn’s proposal, telling Germany’s RND media group that it was “an important step at the right time.”

Germany had 203 reported cases of measles in the first 10 weeks of 2019, more than twice as many as in the same period last year but fewer than in 2017. Neighboring Switzerland last week reported two adult deaths from measles this year: one in an unvaccinated man of about 30 and another in a man of about 70 whose immune system had been compromised by cancer.

Experts generally say if more than 95% of the population is properly immunized, measles cannot spread easily and is effectively contained. But pockets of unvaccinated children or adults can cause flare-ups, as has recently been the case in the United States, which has over 700 cases this year in an outbreak that has not been halted.

According to the World Health Organization, Europe as a whole had 82,596 cases of measles last year and 72 measles deaths. Most of those infections — 53,218 — were recorded in Ukraine, where an armed conflict with separatists is hurting medical care in its eastern regions.

Popular European tourist destinations such as France and Italy had more than 2,400 measles cases each from March 2018 to February 2019, according to the European Centre for Disease Prevention and Control, an EU agency. Greece had more than 1,400 measles cases and Britain reported over 900 during that time.

Telemedicine, walk-in clinics cloud role of family doctor

In this April 9, 2019 photo, Dr. Megan Mahoney, center, smiles after examining patient Consuelo Castaneda, bottom right, at the Stanford Family Medicine office in Stanford, Calif. At left is Castaneda’s husband, Epitacio, and at right, medical scribe Anu Tirapasur, who documented the visit. “We want to do as much outside the walls of the clinic as we can,” says Mahoney, noting that this push to keep patients healthy and out of the doctor’s office depends on insurers expanding what they will cover. (AP Photo/Jeff Chiu)

Tom Murphy

Lisa Love hasn’t seen her doctor of 25 years since she discovered telemedicine.

Love tried virtual visits last summer for help with a skin irritation and returned for another minor problem. She doesn’t feel a pressing need to seek care the old-fashioned way, especially since she also gets free health screenings at work.

No more waiting for the doctor’s office to open. Convenience rules in health care now, where patients can use technology or growing options like walk-in clinics and urgent care centers to get help whenever they need it.

A survey last year found that about a quarter of U.S. adults don’t have a regular doctor. Some like Love wonder how much they still need one.

“Telemedicine probably can’t do everything ... but for most of the things I might ever have, I’m pretty sure they can take care of it,” the Twin Falls, Idaho, resident said.

Health care experts say the changing, fragmented nature of care is precisely why people still need someone who looks out for their overall health, which is the traditional role of primary care physicians like family doctors and internists.

They know patients’ medical histories, and they’re trained to spot problems that may be developing instead of just addressing symptoms that prompted the patient’s visit. They also can make sure medications don’t conflict with regular prescriptions, and they can help make sense of the information patients dig up with a Google search.

But the nature of primary care is changing as patients branch off to drugstore clinics and urgent care centers. Practices are slowly shifting to more of a team-based approach that focuses on keeping patients healthy and reserves visits with a doctor for the more serious cases.

“The idea that the primary care physician is the one-size-fits-all solution ... that’s going to change pretty dramatically,” said Sam Glick, an executive with the research firm Oliver Wyman.

This evolution began years ago when drugstores started providing flu shots and opening clinics that handle minor issues like ear infections or pink eye. The two largest chains, CVS Health and Walgreens, now run about 1,500 clinics combined.

More recently, employers have started adding worksite clinics, and thousands of urgent care centers have opened around the country to treat emergencies that aren’t life-threatening. Then there’s telemedicine, which patients can use to connect to a doctor in minutes without leaving their home or office.

Love said she’s hooked on virtual visits. They only cost $42, or less than half the price of an office visit under her insurance plan.

“I like technology and I like new things and I like saving money,” Love said. “It was worth it to me to try it.”

About 25% of adults don’t have a regular doctor, the nonprofit Kaiser Family Foundation found last year. That jumps to 45% for those under age 30.

On top of all the competition for patients, the field also is fighting a shortage of doctors as medical school students opt for higher-paying specialties.

Primary care practices have adjusted by adding physician assistants or nurse practitioners to handle annual physicals and other routine care.

They’re also creating teams that help them take a broader look at patient health. Those teams might include mental health specialists who screen for depression and health coaches who can improve diet and exercise.

The idea is to keep patients healthy instead of waiting to treat them after they become sick.

“We want to do as much outside the walls of the clinic as we can,” said Stanford University’s Dr. Megan Mahoney, noting that this push depends on insurers expanding what they will cover.

Doctors also are continuing to focus more on coordinating care for people with complex health needs.

Bryant Campbell’s care team includes a primary care doctor, a pharmacist and specialists to help manage his chronic liver condition and rheumatoid arthritis. The Portland, Oregon, man said his team members talk frequently to avoid problems like duplicate tests, and their approach gives him more confidence.

“I sometimes think as patients we feel isolated in our health care, and this team-based approach helps a patient be as involved as you need or want to be,” he said.

Doctors say the expanded scope of their practices is changing how they interact with patients. Dr. Russell Phillips frequently responds to email or cellphone questions from his patients. He also refers them to clinics for minor issues like urinary tract infections.

The Harvard Medical School professor says primary care is evolving into more of a flowing, virtual relationship where patients have more frequent but briefer contact with their doctor’s office instead of just office visits maybe twice a year.

“Getting medical care is such a complex activity that people really need somebody who can advise, guide and coordinate for them,” Phillips said. “People still really want a relationship with someone who can do that.”


HEADLINES [click on headline to view story]

Germany mulls fines to boost measles vaccination rates

Telemedicine, walk-in clinics cloud role of family doctor