June 2016

High-Tech Help for Sick Kids Without Leaving the Community

Author: Special to CH2

For a lot of kids, trips to the school nurse aren’t what they used to be. Through secure videoconferencing, kids can be examined by a pediatric expert without leaving school. School-based health centers have been shown to increase health access for rural children, decrease emergency room visits, decrease absenteeism, improve chronic disease management and improve academic performance.

Recently, an MUSC nurse practitioner who works with those schools described how it helped a boy she called J.T. (not his real name). Kelli Garber’s story first appeared in the American Academy of Pediatrics’ spring 2016 newsletter.

J.T. is a seven-year-old boy who has asthma. He lives with his grandmother, along with five other children. His mother comes and goes and his father is not involved.

His grandmother does her best to care for her grandchildren, but with so many young ones at home, she often directs J.T. to take his own medications with little or no supervision. He often coughs with exertion, which limits his activity, especially at recess. He also coughs at night, while sleeping on the floor with the other children in the only heated room in his house.

Illness typically triggers significant wheezing and trips to the emergency department. But rarely does he see his primary care provider. Transportation, childcare and financial barriers often get in the way.

On a recent Tuesday, J.T. went to the nurse at his elementary school with significant wheezing. With no medications on hand to treat him, she would typically have to send him to the emergency room. But thanks to the School-Based Telehealth program at MUSC, she had access to pediatric health care right in her office.

J.T.’s grandmother had completed consent forms at the beginning of the school year, so the nurse was able to confirm consent by phone and refer him to be seen via telemedicine. Through the use of secure video conferencing technology, an electronic stethoscope and digital otoscope exam camera to check his ears, he was able to be evaluated in real time by a pediatric nurse practitioner at MUSC.

J.T. was diagnosed with an upper respiratory infection, pneumonia and an exacerbation of his asthma and was given albuterol nebulizer treatments in the office, as well as oral prednisolone. After a period of observation, he returned to class. Prescriptions for albuterol, an antibiotic and prednisolone were called to his local pharmacy, and his grandmother was informed by phone.

Here’s another case. James Simmons is a pediatrician at All Children’s Pediatrics in Port Royal. Dr. Simmons sees an increasing need for mental health services, particularly given bullying and anxiety he’s seeing teens experience from the influence of technology and social media in their lives. Simmons loves knowing that, when he has a child struggling perhaps with developmental or mental health issues, he can get MUSC psychiatrist M. Frampton Gwynette on the phone for a telehealth conference. He likes the continuity in care that Dr. Gwynette provides, because his patients can have a consult without having to leave their hometown, and Simmons is involved in developing the treatment plan in tandem.

He did this recently with a child who was struggling in school. Simmons thought he should have a telehealth psychiatry consult, and the mother was willing to give it a try, especially since their therapist had left town and they hadn’t been able to find another.

The consult was set, and Gwynette met with the child, who has attention deficit disorder, and then with Simmons. Simmons and the mom both got a surprise when Gwynette told them the child was having suicidal thoughts. The two doctors worked in tandem to set up a treatment plan. The mother said he’s doing much better, and she’s so relieved she was open to trying it.

The rapid development of telehealth nationally is being patient- and-family-driven. That doesn’t mean that there’s no reason for in-person visits. It just means local physicians will need to weigh what services to provide in which way. In many ways, telehealth offers substantial savings without sacrificing quality. And parents don’t have to miss work or bear unnecessary travel expense to ensure quality care for their children.

Excerpted from stories originally published on the Medical University of South Carolina News Center. For full text of the stories, please visit academicdepartments.musc.edu/pr/newscenter/2016/school-telehealth-through-musc.html#.VzN9wmPFrLJ and http://academicdepartments.musc.edu/pr/newscenter/2015/telehealth-psychiatry.html#.VzORGWPFrLJ .

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