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The Arizona Telemedicine Program Blog

Every summer the five regional Arizona Area Health Education Centers (AzAHEC) join forces to put together a program to expose high school students to the vast array of health careers. Called Future Health Leaders (FHL), the initiative typically selects 40 high school students from across the state to reside at one of the state’s Universities for a week-long experience discovering health professions.

The COVID-19 pandemic has completely transformed our world in a matter of a few months. Issues that have prevailed for years like healthcare access disparity, have become exacerbated even though agencies have put forth their best efforts to mitigate the effects.

Carol Lewis, a manager for community health education (CHE), has experienced the effects of this inequality firsthand in Yavapai County. Yavapai county is a county in central Arizona with approximately 235,100 inhabitants of which about 46,000 live in its largest city of Prescott Valley. It’s population is spread over 8,128 square miles leading to a population density of about 26 people per square mile.

By now, I think we have all heard about the surge of temporary waivers, relaxations of Medicare coverage restrictions, regulatory changes and flexibilities, and governors’ orders allowing for the expansion of telehealth during the COVID-19 Public Health Emergency (PHE).

This is all great news for telehealth – for now. Medicare telehealth services increased by 11,718 percent between March and April, and other payers are reporting similar increases. But what happens when the PHE is over? And when will the PHE be over?

So far, the Health & Human Services (HHS) Secretary has renewed the PHE once, in April, for 90 days. HHS has announced its intent to renew it again this month, meaning the PHE would then expire October 21, unless renewed again or declared over before that date.

The Arizona Telemedicine Program’s T-Health Institute (Institute for Advanced Telemedicine and Telehealth) is charged with developing innovative medical science curriculum throughout the education continuum in Arizona and throughout the Unites States.  Since its creation in 2004 by the Arizona State Legislature, and initially supported by targeted funding in the federal budget, the T-Health Institute has facilitated over 100 webinars and helped publish over 200 blogs articles.  It has supported innovative education research for STEM training, K-12 medical science education, early college curriculum development, and interprofessional education.  T-Health is currently engaged in developing telemedicine curriculum for medical students.

There is a glaring shortage of healthcare providers across the world as is, and with the novel coronavirus epidemic taking over the world, hospitals are stretched too thin. It is envisaged by Inside Higher Ed that there will be a shortage of almost 120,000 doctors in the United States alone by the year 2030. The extremely lopsided doctor to patient ratio in some clinical specialties and geographic locations highlights the difficulty healthcare providers have in providing care to patients in a satisfactory manner. At present, there are around 40 doctors for 100,000 patients in the rural areas and around 53 doctors for 100,000 patients in the urban areas, as stated by Rural Health Web. This stark gap is one of the key driving forces for the adoption of digital applications and mechanisms by healthcare institutions.

Since July of 2019, a unique collaborative team approach has been employed to optimize HIV and general infectious diseases telemedicine services delivered to correctional facilities throughout Arizona. The program builds on a program to provide telemedicine services to the Arizona Correctional system since 1998, with infectious diseases services being provided since 2009.
 
This team in the University of Arizona (UA) Petersen HIV clinics (PHC) includes an infectious diseases physician and a clinical pharmacist along with administrative, scheduling, and technological support.  This model was adapted from a process already in place at PHC in Banner University Medical Center (Tucson, AZ) in which a physician, pharmacist, and clinical coordinator all see the patient simultaneously.  This model was implemented in direct response to the numerous issues and barriers faced by individuals living with HIV, not only in affording costly antiretroviral HIV medications but in addressing social barriers that are just as likely to contribute to treatment failure.  By the conclusion of the brief visits, all issues have been addressed relating to HIV care, including medication usage and acquisition as well as insurance coverage and follow-up plans.

Imagine delivering a baby at 24 weeks gestation, or three months early. You deliver at the hospital closest to your house or the one that your OB/GYN recommends.  Exploring the quality of care outcomes in that facility are not at the forefront of your mind. Wanting a healthy baby, or even a baby that simply survives, free of life-altering complications, becomes your goal. Quickly after this baby is born, he is whisked away to the neonatal intensive care unit (NICU), and it may be hours or sometimes even days before you see him again. The clinicians in that unit are trying their very best and they are providing excellent care: or are they? How do you know? Without questioning the intent or skill of clinicians, the data show that the quality of NICU care varies from unit to unit, and one complication in particular can vary widely: necrotizing enterocolitis (NEC). For this condition, there is a core of evidence-based prevention interventions that are essential to reduce the risk of contracting NEC. Perhaps most importantly among these tactics is giving baby the mom’s own milk, using a feeding protocol, limiting antibiotic and antacid exposure, and considering strategies for timely recognition. NEC-Zero is a prevention bundle for NEC and our team has made a concerted effort to share it freely so any unit in any location can deliver excellent care to any baby. However, improving quality is a difficult task, and it requires a committed team to implement the best evidence in the NICU.

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