Telemedicine is an essential service for all patients. Both synchronous and asynchronous telemedicine technologies open up significant new opportunities to expand access to care, reduce disparities, supplement the knowledge base of community clinicians, and improve experiences for patients and their caregivers. These benefits are particularly important for underserved communities, such as those in the rugged and rural Midwest and Western states. With community clinics and academic health systems few and far between, residents of far-flung areas often struggle to access basic primary care, let alone mental and behavioral health care services that are in such high demand. Virtual care is the solution for these challenges. By connecting high-quality care providers to residents of hard-to-reach rural regions, including those living in designated health professional shortage areas (HPSA), telehealth can expand options, close care gaps, and ensure all communities have the resources they need to live their lives to the fullest. Leveraging virtual care for underserved communities HPSAs cover the majority of territory in South Dakota, North Dakota, Montana, and Wyoming, leaving millions without easy access to primary care, acute care, specialty services, and behavioral health resources. Native American communities are among those most affected by these dire shortages. Telemedicine is a proven way to augment the resources of provider organizations including the Indian Health Service (IHS), which NRHA Partner Avel eCare has worked with to provide remote care services to more than 200,000 Native American individuals. Over the past five years, this partnership has resulted in more than 31,000 specialty clinic appointments scheduled and more than 6,400 emergency patients seen across 24 implementation sites. Avel eCare also quickly responded to the IHS request for a rapid COVID-19 response by offering temporary critical care support for any requesting IHS hospital across the 12 areas and delivering care directly to patients’ homes. This strong collaborative partnership may provide a valuable model for similar initiatives across a number of key areas, including:

  • Virtual emergency support: With a wall-mounted HD camera, originating sites can access eCare Emergency’s board-certified physicians and critical care nurses for peer-to-peer support 24 hours a day. Virtual care clinicians can aid in the diagnosis and treatment of stroke, heart attack, trauma, and other critical conditions.
  • Virtual specialty and hospitalist services: Non-urgent specialty visits can be scheduled in advance, while hospitalists support local provider and nursing staff with real-time access for overnight/urgent needs on a 24/7/365 basis. Telemedicine peripherals such as stethoscopes, otoscopes, and examination cameras can be added to the video unit to facilitate the examination.
  • Virtual sexual assault nurse examiner: Certified sexual assault nurse examiners offer culturally appropriate advocacy and medical forensic evidentiary examination support. Staff assist with documentation and evidence collection in accordance with nationally recognized protocols, policies, and procedures.
  • Virtual respiratory therapy support: Telemedicine providers assist in all respiratory needs to increase confidence in delivery and enhance patient safety, including setup and management for mechanical ventilators, non-invasive treatment, troubleshooting, inhaled medications management, focused rounding, and education.
  • Virtual critical care: Avel eCare is collaborating with U.S. Army health officials and the Telemedicine and Advanced Technology Research Center on a federal initiative known as the National Emergency Tele-Critical Care Network. This initiative provides telemedicine services to hospitals and communities managing COVID-19 surges, natural disasters, and health care crises.  Avel has been able to help find a solution with remote support staff delivering critical care consulting to clinicians on-site, avoiding the need to transfer local patients and relieving pressure on staff members stretched to their limits.

Expanding access to behavioral health care with telemedicine The opioid crisis is still raging, with more than 100,000 overdose deaths annually. Meanwhile, the COVID-19 pandemic has compounded the socioeconomic challenges of many individuals, leading to a precipitous rise in anxiety, depression, and self-harm ideation.  Unfortunately, this surge in demand comes at the same time as a growing provider shortage, meaning behavioral health providers are harder to find than ever. There is a clear and immediate need for telebehavioral health to close the gaps. Telebehavioral health can provide 24/7 access to behavioral health nurses and/or psychiatrists for behavioral health assessments, medication management, treatment recommendations, and emergency placement assistance. Remote behavioral health clinicians may be particularly effective when used in situations that involve law enforcement. Estimates show that up to 20 percent of police calls involve a mental health or substance use crisis. These encounters result in a high number of involuntary committals that consume an extraordinary amount of time, people-power, and money. Equipping law enforcement teams with iPads connected to remote behavioral health clinicians can dramatically decrease the use of resources associated with transferring patients to mental health care facilities.  During a South Dakota pilot program conducted in partnership with Avel eCare and a private donor, law enforcement officers could request a video safety assessment from a qualified clinician. Out of 181 encounters during the pilot predicted to result in an involuntary committal, just 19 ended up with a person needing immediate inpatient care. More than half of the 181 calls involved suicidal ideation and 15 percent involved aggressive behavior. These encouraging results indicate that telebehavioral health can successfully deescalate crisis situations while ensuring distressed individuals get speedy, accurate recommendations about the right level of care. Looking to the future of remote care for communities in need It’s clear that telemedicine has a wide variety of applications across the care continuum, from primary care to acute care services to behavioral health.  To create an environment where providers and patients both have access to the resources and support they need, we must invest in remote care strategies and the technical infrastructure required to enable engagement in all communities. Over the next several years, we must continue to address disparities in broadband internet access, train providers in how to remotely collaborate with peers, and empower patients with education about the value of virtual care. By creating a comprehensive ecosystem of virtual care that works in concert with the real-world health care system, we can offer immediate support to on-the-ground providers while ensuring patients have access to convenient, cost-effective, high-quality services whenever and wherever they are needed. NRHA adapted the above piece from Avel eCare, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.Brian Erickson is VP and general manager of behavioral health and specialty clinic at Avel eCare.

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