Sickle Cell Outreach Clinic Expands Service With Telemedicine
by Toni Baker
When the monthly sickle cell clinic at the Macon-Bibb County Health Department got too busy, the logical choice was to start a second clinic.
But when that clinic became packed with patients too, creating a third clinic didn’t seem doable.
No matter how much she wanted to, Dr. Kristy Woods, internist and director of education at the Medical College of Georgia Comprehensive Sickle Cell Center in Augusta, just couldn’t spend another day of the week on the road to Macon.
"We soon found ourselves needing to do the same thing in Albany," said Dr. Abdullah Kutlar, director of MCG’s Comprehensive Sickle Cell Center. "We couldn’t meet the demand by going once a month."
And when he looked at the geography of Georgia, he saw yet another need, this time for a new clinic in Waycross to serve southeastern Georgia. His idea was to have the majority of citizens within a 100-mile radius of one of the regional clinics.
The Georgia Statewide Telemedicine Program has been a great enabler of this regional approach to providing consultative care to people with the chronic problem of sickle cell anemia.
"Telemedicine works well as a supplementary tool to an existing clinic," Dr. Kutlar said. "In other words, you establish a presence, such as an outreach clinic, then you increase your services and your availability with telemedicine."
Dr. Kutlar emphasizes that there is no way the sickle cell specialists in Augusta can provide total care for all patients in the three regions. "These are only consultative clinics," he said. By serving these other cities in person or via telemedicine, MCG can help the communities’ physicians take care of the special needs of these patients, he said.
"I like the comprehensive effort of two facilities," said Jo Ann Sams-Sinclair, coordinator of the sickle cell program at the Macon-Bibb County Health Department, who works as a liaison between physicians in Macon and Augusta. The patients generally like telemedicine too, she said.
The advent of hydroxyurea, approved by the Food and Drug Administration in 1995, has increased the number of patients healthy enough to be seen in such a clinic. The drug boosts percentages of fetal hemoglobin and prevents sickling. The result is that many patients are living better, Dr. Kutlar said.
"The best patients to be seen via telemedicine, in my experience, are those treated with hydroxyurea," he said. These patients tend to do well generally, but need regular follow-up to check for complications and other concerns. The drug mildly suppresses the bone marrow, so monthly blood studies are important. The blood is drawn at the satellite clinics then shipped to MCG for analysis. Via telemedicine, Dr. Kutlar also can check for signs of trouble by looking for jaundice in the patient’s eyes, for swelling in the throat and listening to the heart and lungs. "If they have a leg ulcer, we can focus the camera on the ulcer," he said. As is routine in any clinic, the nurse already has checked the weight, blood pressure, pulse and temperature before the physician’s exam begins. "I have a fairly good assessment of the patient overall," Dr. Kutlar said. If he finds a patient isn’t doing well, he recommends an in-person visit.
The patients generally feel comfortable with telemedicine and appreciate not having to regularly travel or wait to see the doctor, said Kelly Sheffield, sickle cell nurse at the Ware County Health Department in Waycross. MCG sickle cell specialists actually see patients more via telemedicine than in person in Waycross; doctors travel to Waycross once every three months and see patients via telemedicine in the intervening months.
In Albany, where a monthly telemedicine sickle cell clinic augments the monthly satellite clinic, telemedicine technology has been largely welcomed, particularly by the young patients of the district health department’s sickle cell program, said Lori Eubanks, manager of critical care transport and telemedicine for Phoebe Putney Memorial Hospital. The hospital makes its hub room available for the telemedicine sickle cell clinic. The success of that clinic led to the establishment of a pediatric pulmonology clinic via telemedicine as well, Mrs. Eubanks said.
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Medical College of Georgia Telemedicine Center