Rural Telehealth – Part 1 of 2

Linda: 00:00

Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At AgriSafe, we work to protect the people that feed the world by supporting the health and safety professionals, ensuring access to preventative services for farm families and the agriculture community

Linda: 00:22

It can be difficult finding time to take off from the farm, especially when it means travelling a decent amount chunk of time to see a healthcare professional. Thankfully, Telehealth has come a long way in helping increase access to services, and lower that burden of travel and time away from the farm. But it also has changed the scope of these visits, when you aren’t going into an office to have that face-to-face interaction. So today, we are going to talk about telehealth.

Linda: 00:50

Well, hello listeners. It is my pleasure today to introduce you to Mr. Randy McKinney. So, Randy, please introduce yourself and let us know a little bit about your work.

Randy: 00:59

I sure will, Linda. And thank you very much for having me today. I'm grateful for this opportunity. I am Randy McKinney. I have over 25 years of healthcare and management experience. I work currently for the Louisiana Primary Care Association as the Healthcare Technology and Innovations Manager. This is the membership for Louisiana's Community Health Centers, which are also known as federally qualified health centers. Prior to my coming to work for LPCA, I was fortunate to have worked as an administrator in a small rural health clinic, Bienville Family Clinic in Arcadia, Louisiana. Prior to this, I was a practice management consultant in the Louisiana Department of Health, and I've been a licensed nursing home administrator for almost 30 years.

Randy: 01:45

During the time that I was at Bienville Family Clinic, I was fortunate to be able to work in collaboration with the Bienville Parish School Board, where we received the 2019 National Rural Health Association's Outstanding Program Award for our work in providing telemedicine services in Bienville Parish Schools. So if I have a claim to fame, I would guess that that's it. And so of course that was pre-COVID. We didn't know a lot about telehealth, pre-COVID. And so we had work to do in marketing our program from the standpoint of education and having to explain to to the public, to the parents, to the children, to the educators what telehealth was. So that's kind of brought me to where I am today.

Linda: 02:30

Well, what a great, deep, rich history in healthcare. And as well as this new approach that our listeners are wanting to learn more about, I'm wanting to learn more about as a nurse as well. I know there is some new information coming out about how nurses can be involved in telehealth, so I'm excited for our visit today. So we know that telehealth offers an approach to healthcare to redesign and enhance medical care specifically for our rural and frontier communities. So, tell us how you're specifically involved in your role now with Telehealth.

Randy: 03:01

Uh, I now assist Louisiana's federally qualified health centers with telehealth, with setting up telehealth health systems and platforms, with how to run a telehealth visit, for generating ideas, keeping in mind that different clinics workflows may differ and patients differ. And so one of the things that I try to accentuate is the need to meet the patient wherever they're at in the telehealth world and to help them to understand what telehealth is and how it can help them to improve their health outcomes.

Linda: 03:39

That is awesome. I love how we're evolving our healthcare and how we approach and how we deliver care. I think the pandemic definitely brought up real quickly the need for those of us that live rural and everywhere really that the importance of telehealth. So there are some interchangeable terms out there when we talk about telehealth, share some of those terms that folks may hear.

Randy: 03:57

Well, absolutely. You know, we have heard telehealth. We hear telemedicine. Sometimes we hear audio video visits. And those are kind of the same things. Telemedicine, specifically under some definitions, is the practice of medicine remotely using technology where telehealth is a more all-inclusive term that includes remote education, it can include remote patient monitoring and general assistance from day to day that patients may need, absent a clinical visit with a provider.

Linda: 04:32

I see. telemedicine and telehealth. Okay, got that. Tell us how telehealth may increase access and improve safety and quality of care. And is it as effective as a face-to-face health service?

Randy: 04:45

Well, first of all, I'll say this, that we we all know that there are some things we can do on telehealth and some things that we can't do. We know that we cannot, provider cannot provide an open heart surgery through telehealth. So we back away from that and and we go with what we can do and how we can help patients based on one, the patient's level of comfort with a telehealth type of communication, a telemedicine visit, and also the provider's level of comfort with a telemedicine visit. For an example, a patient may have a lower right abdominal quadrant pain and describe that pain in such a way on a telehealth visit where it is a real time audio video visit where the provider may be comfortable enough between what the patient tells the provider and the nonverbal cues that the provider can see, how the patient looks, whether they look healthy or not, how or whether or not they're they're experiencing pain. Sometimes a patient may not say I'm in pain, but a grimace when a patient touches their maybe lower right abdomen might show the doctor that this is more than just maybe a stomach ache. And so at that point, the doctor may not be comfortable with making a decision on a telehealth platform. And with that, he or she may ask the patient to either go to the nearest emergency room or to come into the office so that he can physically or she can physically lay their hands on that patient to provide the care.

Randy: 06:18

So it is about not only patient level of comfort, but provider level of comfort. And we have to respect each other's level of comfort whenever we're dealing with telehealth from the standpoint of safety and security, of course. Many patients may have been injured or they may be suffering from some type of illness, such as gout or arthritis, that may render them unable to be mobile at all times with this. The patient may be at risk just moving from their house to their car, driving to the provider's office, getting out, getting into the provider's office and then into a waiting room and then into an exam room and then out of that and then maybe to the pharmacy and back home. Of course, if the patient is able to have a visit from the comfort of their home, it may be one less painful for them. But as well, it may be much safer for them, particularly if they may be at risk of falling and having another injury, you know, to manifest itself, trying to get to the patient visit for an illness. So we don't want to make things worse. We always want to make things better. And so with that, telehealth may be the appropriate mode of service delivery even more than in person.

Linda: 07:41

No, so what I'm hearing from you is that it's up to the provider and the patient really to discuss what's best. And sometimes telehealth is appropriate and maybe sometimes a face-to-face visit is more appropriate.

Randy: 07:53

Absolutely.

Linda: 07:55

All right. What healthcare services are available within telehealth and are there some certain services you can only get in person? And we touched a little bit about that. But can you expand on what's available for telehealth?

Randy: 08:05

Absolutely. Telehealth can be the service delivery mode for many types of medical and dental services as well as for mental health services. While we all know that medical providers again cannot perform surgeries through telehealth, there are many, many primary care services that can be provided through telehealth. Providers can treat common colds and flu like symptoms and other minor types of illnesses through telehealth. And this can be especially important and critical during times such as flu season, when it's important that we not come in contact with others who we may give the flu to. Or perhaps we don't have the flu. We go into a clinic and it's full of people that do have the flu and they transmit it to us. You know, it's just a part of life that we've all been used to. But there's one way to prevent the spread of disease - a telehealth visit in our homes or even in the nursing home environment or in our schools can prevent the spreading of infectious disease to others who may be present…

Randy: 09:10

Also, telehealth delivery may be applicable for some types of dental visits. Some screenings, of course, can be accomplished through telehealth using a presenter or a hygienist. But initial visits for tooth and gum pain, including circumstances where the gums may be bleeding or there may be tooth sensitivity, could be treated through telehealth, particularly when in-clinic appointments may not be available or after hours. Even dentist could make recommendations for treatments and even prescribe certain pain medications for pain or infection until an in house appointment could be conducted. And also, I feel that telehealth works extremely well with mental health and counseling visits. Just as with all telehealth visits, patients can remain in the quietness of their home in a private location where they can maintain their dignity or even in a quiet office in the workspace that could be private or in any location that that could afford privacy for a patient to have a conversation with a mental or behavioral health provider. Often we associate mental or behavioral health visits with with negative thoughts, but many times there are all of us in one way or another that need mental health services. We need somebody to talk to. And perhaps there are things that we're not comfortable telling our family members and even and and but we would be comfortable telling a counselor, perhaps.

Linda: 10:44

Oh, yeah. And we definitely here at AgriSafe, staff are working hard to talk more about mental health and how it impacts our physical health. The total farmer health, really it's a model that we drive most of our work from. And so I can totally understand where if you were able to talk to a mental health provider in the comforts of your own home where you maybe felt less vulnerable, that those visits could be a little bit more meaningful and as well as improving the access to care. What I'm hearing from you, too, is that there's an easier access, maybe quicker access to care, especially for those of us that may have to drive an hour to a metropolitan area to seek care, so.

Randy: 11:20

Absolutely. And you know, if we're in our own environments, you know, I think there is always an increased level of comfort. We all have concerns and life problems that we have to deal with every day. And for me as an individual, I'd much rather deal with those, if possible, from from the comfort of my home rather than having to go into an office where I might feel at risk, you know, of something I'm saying maybe getting out or somebody hearing it through the walls. And also, I think this this can be a helpful thought to as we tackle sexually transmitted disease concerns, many don't want to go into clinics to talk about this. They don't want to maybe see staff members that they know. Generally to us with rural, there always is a connotation that we know people in the town that we're in because it's a small area. I was raised in a very small town and I would have been very uncomfortable going into my local clinic and telling an individual who I had known most of my life who I knew well and personally, hey, you know, I think I may have a sexually transmitted disease of some sort or I've got something going on, you know, from the standpoint of mental health that I need to talk to about to someone about. And I think if that the home environment just makes us more at ease overall and talking about the things that we need to talk about with our providers that can affect us for the rest of our lives and can improve the quality of the rest of our life.

Linda: 12:53

Well said. So what can folks expect during a telehealth visit with their provider in terms of professional and legal standards of confidentiality? I think about ethics, communication, and then cultural considerations.

Randy: 13:06

Yes, certainly. Certainly with telehealth. Cultural considerations should be taken into account. One of our concerns, of course, are the of the many languages that are spoken in our country. You know, we're we're moving more more toward Hispanic populations and other populations that speak different languages. And and one of the things that we're able to do with telehealth to help that is that we can have interpreters available. Some providers do have language interpreters available that they can bring in onto the telehealth call so that both parties can understand what is being communicated in an effective way to provide for the best potential outcome for the patient and for the treatment plan that the doctor enact for the patient.

Linda: 13:51

That's great. Do you know any barriers to accessing telehealth among rural communities?

Randy: 13:56

Well, sure, there are some barriers, as with anything accessing telehealth and our in our rural communities, especially in what I call a community that's remote, far away from the center of town, let's say, is the issue of connectivity. And many of us have cell phones, but we know that there are some places that even cell phones coverage is poor in our country and our nation. So, you know, there may be times that we have to move around in our house to get a connection. But what we need to know about telehealth is that telehealth does not necessarily take a booming ultrafast internet connection. We can generally conduct a telehealth visit using our smartphone with with 3G, 4G, 5G, whatever it is that we have in our area. Even with dial up. Another barrier might be with us. It might be within ourselves. Our level of comfort in having a telehealth visit. Even with the onset of the pandemic, there still may be many today who have not experienced a telehealth visit because of their level of comfort. But what I would hope that if there are those out there who don't feel comfortable with it, that they would at least consider giving telehealth delivery a good faith. Try at least one time. They may find it easier and more accessible and they may really like it. And also it's easier a lot of times to to get an appointment for a telehealth visit than it is to to have a walk in maybe where you have to wait two hours, where you're walked in on a walk in, or if you, you know, pick up the phone and try to get a call, it may be two days.

Randy: 15:29

But, you may be able to find a provider who can who can answer a telehealth visit within just a few minutes or within within the hour. Again, in our program in Bienville Parish schools, we found that at first a few parents weren't too comfortable with this telehealth thing. So after trying it though, and they realized that one thing, they did not have to leave work to go and pick up their child at school, take them to the doctor, go then. And you know, the wait that goes on with that, go then and get a prescription and then take them home and get back to work in any way you look at it, whether you're in a rural area or whether you're in a metropolitan area, that can be a minimum of a four hour issue. There are many of us who don't have leave if we don't have sick leave or we don't have some type of leave that we can use to take care of our children, then if we have to leave work, we may not receive pay for that four hours or it may be an entire day that we don't receive pay for. And then that that us not being able to receive pay may equate to even other problems that we have our lack of ability to pay for food, our lack of ability to pay for the medical care that we all need. So telehealth visits can help in in many other ways, not just with the logistics, but also economically speaking.

Randy: 16:55

One of the things that we did on our telehealth visits and and everybody, every agricultural worker, every farmer, everyone in America should keep this in mind that if you need somebody, a family member, your your spouse, husband, to be on the telehealth visit with you, even though they're not in the physical room with you or with the provider. Also think it would we wouldn't be doing justice if we didn't mention specialty care. Um, some of our best cancer care is in Houston and in larger metropolitan areas and here in in the area that I live in, which is rural north Louisiana, we're 5 to 6 hours from Houston. But if I could, once my my cancer has been diagnosed, if I could, telehealth up to a provider in Houston, that specialty provider may be able to devise a plan for me to get my treatment maybe within an hour. Of where my home is, rather than within six hours where I might have to get on a plane to fly or drive six hours. None of us with a debilitating illness that is tiring us out need to be tired more because we have to be transported somewhere to get our care. So we have to think at the big picture, not only primary care, but also our specialty care. There are ways that telehealth can help us with that also.

Linda: 18:20

So what I'm really thinking about here is you're explaining all these great nuances of telehealth is that we can have more successful patient outcomes as well as greater patient satisfaction because like you said, the easier access to care and you get to maybe get that initial visit done with the specialist and then be able to receive that ongoing treatment more locally. So then you're more around your people as well as the services that surround that specific treatment. So yeah, really interesting.

Linda: 18:53

It is truly wonderful to see how telehealth can help reduce barriers to accessing healthcare services, along with many other benefits! We’re going to end here for today, but keep your eyes peeled for our next episode, where we continue our discussion with Randy and address how to make the most out of your telehealth visits!

Linda: 19:11

Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. If you’d like to suggest topics, or have a story you’d like to share, contact us by email at INFO AT AGRISAFE DOT ORG, and title your email “T T F H Podcast.” You can also get our attention by using the hashtag "T T F H pod" on Twitter! To see more from AgriSafe, including webinars and our newsletter, visit w w w dot agrisafe dot org.

Linda: 19:45

This episode was created by AgriSafe Network, directed by Laura Siegel, hosted Linda Emanuel, edited by Matt McKenney for ProPodcastingServices.com, with special guest Randy McKinney.