A feasibility study of telemedicine for paediatric sickle cell patients living in a rural medically underserved area

Introduction Sickle cell disease (SCD) is the most common inherited haematological disease, with potentially devastating complications. Improvements in therapies have increased the life span of patients with SCD, but this is contingent on receiving timely evidence-based medical care, including regular evaluations with haematologists, disease-specific education and psychosocial care. Our objective was to evaluate the feasibility of utilizing telemedicine for the provision of subspecialty paediatric SCD care in a rural medically underserved area. Methods This was a cross-sectional, observational, feasibility study. All patients 0–21 years old with SCD seen at Riley Hospital for Children Comprehensive Pediatric Sickle Cell Clinic who lived within 30 miles of the spoke telemedicine facility were eligible for recruitment. The Telehealth Satisfaction Scale (TeSS) was adapted for the SCD population and administered at each visit. Results Ten SCD patients, ranging in age from 10 months to 18 years old, initiated telemedicine visits during this timeframe. Some 60% were lost to follow-up or did not attend >50% of scheduled visits prior to beginning telemedicine visits. Following initiation of telemedicine, all Hb SS patients were started and/or maintained on hydroxyurea. Nine out of 10 patients who participated during this timeframe had a 100% follow-up rate. All who participated rated the comfort and ease of using the telehealth system as good or excellent and would do a telemedicine visit again. Discussion This study provides critical information to determine the feasibility and acceptability of a telemedicine intervention to aid in SCD care. To our knowledge, this is the first study to examine the effectiveness of telemedicine to deliver comprehensive paediatric SCD care. Future research with a larger sample size is needed to confirm findings of our study, including expansion of telemedicine sites to include more urban areas.

Abstract WP271: Door to Page Time to Initiate a Telemedicine Consult Varies Among Spoke Hospitals for Acute Stroke

Introduction: Although telemedicine (TM) has increased tPA use for acute ischemic stroke (AIS), there are delays between when an AIS patient enters the ED and when the TM consultant is paged. We identified predictors of delayed door-to-page time (DTP) for AIS patients evaluated on TM. Hypothesis: We investigated spoke characteristics associated with the time between patient arrival and the TM code stroke page. Methods: We identified suspected AIS patients in our telestroke registry who were evaluated by video consultation at one of 15 spoke hospitals within six hours of symptom onset (9/2015-3/2016). We compared DTP among spokes and identified factors associated with prolonged DTP. Results: Median DTP was 22 minutes (12-38, Q1-Q3). Of 382 cases 44.0% had DTP ≤20 minutes and 13.5% >60 minutes (Figure). There was no significant difference in DTP among patients of different age, gender, race/ethnicity, and stroke severity (Table). Hospitals with fewer beds, no pre-notification protocols, location in a medically underserved area (MUA), and less in-house neurology availability had delayed DTP. Conclusions: Bed capacity, pre-notification, location in a MUA, and in-house neurology availability are associated with prolonged DTP. While retrospective in nature, our study confirms the utility of pre-notification for spoke hospitals. Further investigation is needed to understand why smaller hospitals and spokes in a MUA have longer DTP, and how in-house neurology coverage affects DTP. In addition, standardized acute stroke metrics over TM are needed.

Unmet Primary Care Needs in Diabetic Patients with Multimorbidity in a Medically Underserved Area

Background: Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA). Community Context: A suburb of Memphis—Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)—majority African American (96.6%) with 30.5% below the poverty level. Methods: Community case study using multiple data sources including diabetes registry, individual interviews, focus groups, and a survey of 30 ED patients with diabetes and multimorbidity. Results: Diabetes registry data indicated that 95.5% of 5723 diabetic patients had multimorbidity. Over 91.5% were uncontrolled at some point in 2014 to 2015. Only 83% of patients with diabetes and multimorbidity reported having a primary care provider (PCP) and those without a PCP were more likely to report delays in needed care. Patients expressed strong interest in health coaching (88%) and receiving text messages from the doctor’s office (73%). Individual patient interviews (n = 9) and focus groups (n = 11) revealed common primary care and self-care experiences and needs including diabetes education, improved patient–provider communication, health-care access and coverage, and strengthened primary care and community. Conclusion: This study demonstrates that almost 1 in 5 ED complex diabetic patients in an MUA do not have a PCP, and that difficulty accessing primary care often results in patients forgoing needed care. Qualitative findings support these conclusions. These results suggest that primary care capacity and infrastructure to support diabetes self-care need strengthening in MUAs.