Progressnotes - October/November 2012
- About MUSC Health
Providing access to medical care, especially specialty care, can be challenging in a rural state like South Carolina, especially in such impoverished and traditionally underserved areas as the counties that lie along the I-95 corridor. In those areas, rates of obesity, diabetes and hypertension, which have traditionally been associated with an aging population, are high even among youth of all races, most especially young African Americans.
Recruiting specialty and even primary care physicians to live in these remote areas can be difficult, and rural residents may be reluctant or not have the means to travel to Charleston for care.
The Southeastern Virtual Institute for Health Equity and Wellness (SEVIEW), directed by Sabra C. Slaughter, PhD, Chief of Staff, Office of the President, is a 20-program, applied research, health disparities reduction and prevention collaborative at MUSC, the goal of which is to discover and deliver innovative health care and community capacity– building solutions to primarily marginally served populations. Dr. Slaughter sees SEVIEW, funded as part of a cooperative agreement with the US Department of Defense, as fulfilling part of MUSC’s mission as an academic medical center: “We are carrying on what we think is a very rich tradition for a medical university, being involved in the notion of improving health care and access to care for the citizens of South Carolina, particularly those who are underserved—ethnic minorities, low-income people, folk who are located in rural parts of the state.”
Telemedicine, the provision of health care or education via high- definition video teleconference or other technology, changes the paradigm of specialty care, bringing the care to the patient instead of the patient to the care. It allows health care to be delivered where need is greatest, whether that be a local physician’s office, a school, a nursing home, a crisis center or even the patient’s own home.
Of SEVIEW’s 20 programs, seven are telemedicine based, providing either specialty care for patients with chronic or degenerative disease or education and lifestyle interventions to prevent the development of such diseases.
Tele-Critical Care Program to Reduce Rural Health Disparities—Dee Ford, M.D.
Dr. Ford’s program will provide telemedicine-based access for emergency departments in rural regions to multidisciplinary adult critical care specialists at MUSC. Eight medical intensive care unit faculty at MUSC will provide consultations and coverage for a 24/7 call schedule. Dr. Ford believes that this program will allow the local providers to continue to offer superlative patient care while also providing access to the specialty services offered by MUSC: “When you are at a community hospital, even an excellent community hospital, it’s harder to stay right on the edge of whatever is the most recent thing. So partnering with MUSC helps them to stay on the edge.” Dr. Ford applauds MUSC’s dedication to telemedicine because she believes it is the future of specialty care: “We have exceeded our bricks and mortar capabilities. There has to be a better organized way to get our expertise to where the patients are and not always try to bring the patients to where we are....Telemedicine is a way to do that.”
Stroke and Stroke Risk Reduction Initiative (SSRI)—Robert Adams, MD, and Daniel Lackland, DrPH
The incidence of stroke and the morbidity and mortality associated with it are very high in SEVIEW regions. This program enhances the REACH (Remote Evaluation of Acute Ischemic Stroke) telemedicine system to attain earlier identification and management of young and rural patients with hypertension and is designed to extend access to expert stroke care to traditionally underserved areas.
Telemedicine in the Evaluation of Alzheimer’s Disease in a Rural, African American Population—Jacobo Mintzer, M.D.
African Americans have a higher prevalence of Alzheimer’s disease than non-Hispanic whites in South Carolina but very few in rural areas are diagnosed and treated, in part because this elderly, often economically disadvantaged population does not have the means to travel to urban treatment centers. Under SEVIEW, MUSC Alzheimer’s Research & Clinical Programs will partner with rural clinical practices to diagnose elderly African Americans with Alzheimer’s disease via high-definition video teleconference, allowing for earlier detection and treatment.
Technology-Assisted Case Management in Low-Income Adults with Type 2 Diabetes (TACM-DM)—Leonard E. Egede, M.D.
The goal of TACM-DM is to improve glycemic and blood pressure control in rural patients with uncontrolled type 2 diabetes treated at a federally qualified health center. Real-time hemoglobin A1c and blood pressure measurements are transmitted to a computer in the office of the nurse case manager, who can adjust dosages or follow up with patients to improve adherence to the medication regimen. Such telemonitoring of glycemic levels and blood pressure should result in better control of diabetes in this population.
Providing access to specialty care for those who are already sick is only part of the solution. Real change will require engagement by rural residents in their own health and a willingness to adapt lifestyles to prevent the development of chronic disease in the first place. For Dr. Slaughter, telemedicine has an important role to play in fostering such patient engagement: “Telemedicine gets folks involved and encourages them to become real advocates for their own health…. We can’t just provide the access; we have to have folks who are taking advantage of the access and becoming involved in their own health, eating differently, exercising, drinking water and adhering to their medications.”
Two SEVIEW programs focused on preventive efforts are centered in Williamsburg County, one of the poorest and most medically underserved counties in South Carolina: Healthy People in Healthy Communities, directed by Brent Egan, M.D., and Providing a Medical Home for Underser ved Children in Williamsburg County via Telemedicine, directed by James T. McElligott, M.D.
Dr. Egan’s project works to engage community organizations such as schools and churches in encouraging county residents to take a more proactive role in their own health. It promotes awareness of risk factors for chronic disease, teaches healthy behaviors and provides access to health care and medication in order to promote lifelong health and prevent disease.
“Telemedicine gets folks involved and encourages them to become real advocates for their own health.” Sabra C. Slaughter, PhD
In Williamsburg County, too many children wind up in the emergency department unnecessarily with conditions that could have been detected earlier and treated had access to primary care been available. Barriers to primary care include a shortage of providers and the reluctance of cash-strapped parents to take time off work for physicians’ appointments. In creating a school-based program, Dr. McElligott has bypassed these barriers by bringing telemedicine care to the place where children spend much of their time. Dr. McElligott is involving local primary care physicians in the provision of this telemedicine care because he believes that it is important to preserve a patient-centered medical home for these patients. When necessary, the primary care physicians can consult a specialist via telemedicine but the primary accountability for the patient remains with the local provider.
For Dr. Slaughter, the Williamsburg projects provide a model of a new, more accessible health care that is forged between dedicated specialists using innovative technology and engaged community members: “I’m quite excited by this. Some of what we are doing with telemedicine—the partnerships, the synergy of the faculty and their true engagement with community players—means something very different than someone coming in and giving you a pill and leaving or waiting for a doctor or nurse to tell you what you need to do. Instead, you get involved.”