Primary-care delivery for sickle cell patients in rural Georgia using telemedicine

Background: Advances in newborn screening and pediatric management of sickl e cell disease have resulted in patients living well into adulthood. For ad ults, preventive care and medication monitoring are crucial for optimal hea lth maintenance. The Medical College of Georgia (MCG) in Augusta provides c onsultative services and comprehensive medical care to about 1200 sickle ce ll patients residing in middle and southern Georgia. An increase in the dem and for clinical services in this patient population has resulted in expans ion of sickle cell outreach efforts throughout the state. Objective: A telemedicine clinic for adult sickle cell patients was establi shed in order to meet the growing clinical demands. Methods: An on-site outreach clinic was introduced in the target area. Afte r 10 months of operation, a monthly telemedicine clinic was offered to pati ents as an option for routine medical follow-up. A clinic model was used, w ith scheduled appointments and a public health nurse assisting at the remot e site. Phlebotomy and laboratory services enhanced the telemedicine encoun ter. Results: Over a 12-month period, 52 encounters for 28 patients from 17 medi cally underserved counties were completed. All patients were African-Americ an, and 89.3% had Medic-aid or Medicare insurance coverage or both. The cli nic encounter time was 24 +/- 7.9 minutes (mean +/- SD), comparable to that for all telemedicine clinic encounters during the same period. Conclusions: The adult sickle cell population in rural Georgia accepts inno vative health care delivery using telemedicine. Thus, the telemedicine sick le cell clinic has increased access to care for rural patients in underserv ed areas. For providers, it has allowed greater clinical productivity and d iminished travel time to outreach clinics.