Bringing Specialty Care to Rural Communities

May 8, 2014

A key part of the College of Community Health Sciences’s mission statement is to improve the health of individuals and communities in rural Alabama. Often, these rural areas aren’t able to attract the needed physicians and specialists to their communities—plus limited resources can make it challenging for residents to travel to the nearest physician available.

So the College, through the use of telemedicine, provides telepsychiatry and diabetes education services to a number of rural communities across the state, with plans to expand to even more.

The College’s telemedicine efforts began in 2007 when it partnered with the Alabama Department of Mental Health, the West Alabama Mental Health Center in Demopolis and others on a $1.2 million grant awarded by the Bristol-Meyers Squibb Foundation with the goal of improving mental health care in the state’s rural and impoverished Black Belt region. With the grant, the College provides telepsychiatry in five rural West Alabama counties: Choctaw, Green, Hale, Marengo and Sumter.

Then, the College’s Institute for Rural Health Research was awarded a nearly $100,000 grant in 2009 from the U.S. Department of Agriculture’s Distance Learning and Telemedicine Grant Program. The funding allowed the College to purchase video conferencing equipment, including cameras and monitors, for the rural Alabama clinics with which the Institute had partnered on the grant.

And in 2012, a nearly $20,000 gift from the Verizon Foundation enabled the College to expand its already established program in Tuscaloosa that teaches diabetic patients how to better manage their disease.

The College’s Diabetes Self-Management Education Program is now offered via telemedicine at the Sumter County Health Center in York, Pickens County Medical Center in Carrollton, Family Medical Center in Thomasville and efforts are underway to expand the program to Lamar and Walker counties. Efforts are also underway to also provide asthma education through the College’s telemedicine program. A Life Changed by Education

When Barbara Fulghum was diagnosed with type 2 diabetes in 2011, she was devastated. After taking care of her mother and her grandmother, who also had the disease, she feared the complications she saw them experience. But now she says both her outlook and her lifestyle have changed thanks to the Diabetes Self-Management Education Program offered by the College in her area through telemedicine.

“It’s really a healthy lifestyle,” she says. “And I can adapt.”

When first diagnosed, Fulghum says she received a prescription after an emergency room visit, but she didn’t know how to manage her diabetes. “I knew I needed education,” she says.

So she reached out to her doctor’s office and was eventually referred to a class offered in her rural hometown ofYork, Ala. Fulghum, along with 24 other patients, make up the Diabetes Self-Management Education Program at the Sumter County Health Center, which had its first class in January 2013. It was the location where the College first started offering diabetes education services through telemedicine after receiving a gift from the Verizon Foundation that enabled the expansion ofits Tuscaloosa program. Classes began at Pickens County Medical Center in Carrollton, Ala., in August 2013 and Family Medical Center in Thomasville, Ala., in November 2013.

Patients in York, Carrollton and Thomasville were recruited into the program, taught from Tuscaloosa by Angela Hammond, CRNP, CDE, a nurse practitioner at University Medical Center, which is operated by the College, through referrals from area physicians who care for Medicaid patients. The program is currently only open to Medicaid recipients. Frank Dozier, MD, the chairman of the Board of Visitors for the College as well as a family medicine physician at the Thomasville location, requested that the program be brought to his practice.

“Every physician needs it,” Dozier says about the program. “It works. This is the future. The College is involved in it. We’re in the right place.”

Diabetes is the sixth leading cause of death for Alabamians, according to the American Diabetes Association. Diabetes-related deaths in rural Alabama are as much as 18 percent higher than in the state’s urban areas, and are as much as 44 percent higher than diabetes-related deaths in the United States, according to the ADA.

Since Fulghum has been attending the classes, she says she has lost 25 pounds with the knowledge she has gained and healthy eating tips she has learned. She says she hopes more people who are able to participate in the program decide to join.

“A lot of people in our community suffer from diabetes,” she says. “I think not only can they benefit from this class but also people who are their caregivers.”

She also says she does not worry the way she used to about suffering from complications she saw her mother and grandmother face.

“I feel like I now know enough to avoid them,” she says. “My whole lifestyle has changed.”

Changes for the Better in Mental Health Three and a half years ago, two residents of DeKalb County in Alabama saw a dire need in their community.

Angela Wilson, a local mental health care activist, and Thomas Whitten, MSW, a licensed clinical social worker and director of DeKalb County Youth Services, found that children and adolescents in their community, particularly youth offenders, needed a psychiatrist who could provide assessments, recommend prescriptions, if necessary, and follow up consistently. The closest psychiatrist in the area was in Fort Payne and often booked months in advance. The best answer for them was telemedicine.

So Wilson reached out to the College and connected with Thad Ulzen, MD, chair of the Department of Psychiatry and Behavioral Medicine at the College and associate dean for Academic Affairs. He recognized Wilson’s goal and connected her with Amelia de los Reyes, RN, the telemedicine coordinator for the College. Now, twice a month, young patients are assessed through telepsychiatry by Lloyda Williamson, MD, child and adolescent psychiatrist and associate professor in the College’s Department of Psychiatry and Behavioral Medicine. Patients communicate with Williamson from the DeKalb County Technical Center through teleconferencing equipment after Wilson. Ulzen also assesses patients twice a month and Marisa Giggie, MD, an assistant professor in the department who specializes in forensic psychiatry, has assessed patients, too.

Three years after its implementation, more than 200 evaluations have been provided, according to a recent report from Whitten to the Appalachian Regional Commission, which provided grant money to expand services. All cases have been linked with a community provider for follow-up treatment, the report said. Whitten’s report attributes the success to a few factors: the donation otelemedicine equipment by the College, the approval of grant funding through the Appalachian Regional Commission, the frequent communication between the College and the site, and quality improvement efforts, including satisfaction surveys oparents.

“The overall project has been successful from the provider aspect, the community aspect and most importantly the patient aspect,” Whitten said in the report. “These are children and youth who would not have been served otherwise.”

In addition to DeKalb County, telepsychiatry services are provided through the West Alabama Mental Health Center with sites in Marengo, Choctaw, Greene, Sumter and Hale counties. In 2013, about 240 patients were seen at these sites (between January and October). This is an increase from about 160 patients in 2012. Faculty from the College’s Department of Psychiatry and Behavioral Medicine also provided, using telemedicine equipment, training for the West Alabama Mental Health Center’s social workers, psychologists and mental health workers at all oits sites. 

DIABETES SELF-MANAGEMENT EDUCATION PROGRAM: Sumter County Health Center (York): 24 patients Pickens County Medical Center (Carrollton): 10 patients Family Medical Center (Thomasville): 11 patients TOTAL: 45 patients (Efforts underway to expand the program to Lamar and Walker Counties)

TELEPSYCHIATRY DeKalb County Youth Services (Rainsville): 200 plus patients West Alabama Mental Health Care Center with sites in counties of: