1 DISTANCE LEARNING ISSUES for Rural disadvantaged minorities and their health care providers A DISCUSSION ROUNDTABLE

2 Distance Learning Approaches for Physicians and Disadvantaged Minority Populations in Rural Pennsylvania: Effective and Inexpensive Telemedicine? ABSTRACT # Larry L. Schenken, PhD, ROCOG Disparities CDRP Grant, Room 344 Shaw Building, UPMC McKeesport Hospital, McKeesport, PA , , Julian W. Proctor, PhD, MD, Radiation Oncology, UPMC-Jameson Cancer Center, 2602 Wilmington Road, Suite 104, New Castle, PA 16105, Dwight E. Heron, MD, Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Fifth Floor, Pittsburgh, PA 15232, and Susan M. Rakfal, MD, Department of Radiation Oncology, UPMC McKeesport Hospital, th Avenue, McKeesport, PA

3 Establishing a network for MEDICAL communication/ professional education and COMMUNITY distance learning SOME GENERAL APPROACHES AND POINTS FOR DISCUSSIO9N

4 Why may establishing a biomedicine communication network be appropriate? First of all, many of the rural regions of the United States are socio-economically disadvantaged regions with significant sub populations of low income, lower educational levels, with poor access to health care facilities and information sources. Secondly, many of these rural regions are underserved by healthcare facilities and staff. Finally, distance and lack of Quality communication systems impair adequate and appropriate communication and education between medical professionals and their service area communities or patients.

5 What might be general goals for such a network? Using this network, provide distance consults, distance learning, and CME/CE credits for rural health care professionals, PCP’s and Specialists! Assist PCP’s in providing their communities with outreach and community/patient education for varying health care issues. Expand rural capabilities to enable patients to access programs providing support, assistance, and guidance in understanding and traversing the sometimes complex healthcare system.

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7 Part I: Understanding your target What are the rural regional characteristics within Western Pennsylvania? Discussion: are they really much different in other US regions?

8 What are common Rural Regional Characteristics? Geographic considerations (long or difficult travel times) Population density (generally low) Health care facility density (maybe 1/county) Population economic levels (low income levels) Education levels (many counties very low) Cancer death rates (Many areas high) Cardiovascular death rates (many also high)

9 Looking at basic geography! Your region may differ, but target areas may be determined rather easily! A B

10 What are the characteristics of your target populations?!?! Your people? Employment levels Education levels Income Insurance coverage % in poverty Single parent families Home ownership School lunch program participation Alcohol, tobacco, drug abuse Other health care behavioral issues Dietary patterns

11 How do they live and socialize? In Rural PA, churches, union halls, rod and gun clubs (sportsman’s clubs), volunteer fire companies, and ethnocentric clubs or organizations and bars are key centers of community in many regions. There are usually few issue-centered support mechanisms, i.e., cancer or diabetes support groups.

12 Get to know their hearts and souls! Consider racial, cultural/ethnic barriers Be aware of both openings for conversation and communication/language barriers Use local resource people to help you learn If at all possible, access the target population needs by group discussions GIVE THEM OWNERSHIP

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14 Part II:Determine your goals! How could one organize a communications enhancement effort to help minimize Health Disparities?-- Then Form a Program Plan of Attack

15 First order of business Understand the present state of existing home and community communications in each of your target areas Internet capability, T1, DSL, Cable, dial-up? Print matter, community newsletters, papers? Are any centers/schools/churches/healthcare clinics or other community resources wired? ( or used for meetings and could be easily wired?)

16 Second order of business Understand community perceived needs. (listen to what they say about issues and priorities) Talk with leaders and enablers Understand your own perception of needs (Sometimes groups do not really understand what might be needed to solve problems) You may then have to listen to your own thoughts and bounce them back to the group AGAIN, promote partnering and ownership at all times!

17 Third order of business Your goals must reflect needs!!! Carefully plan what you want to accomplish Determine HOW you might move forward Think outside the box when considering methods Be efficient and use money effectively!

18 Fourth order of business: As you start your plans, consider a program for you to objectively evaluate both your processes and your outcomes! You should document the how and why of each component’s evolution. Quantfy both your short and long term outcomes Finally evaluate satisfaction levels in target populations and your staff

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20 Part III:Devise Implementation Strategies Print matter - handouts, brochures Streaming audio or tapes Phone conferences Streaming video to share talks (often in combination with 2-way phone conference) Mobile video options for 2-way (now you can “move the mountain” with V.O.I.P.) Link, Link, Link with local groups and programs! Evaluate, modify, improve as needed.

21 Our most $ effective strategies: Video streaming (cheap, effective one way) See example mobile.html mobile.html Make your equipment mobile so it can be shared See example reaming.html reaming.html PowerPoints with Audio conference calls Printed material

22 SELECT ISSUES CAREFULLY Target area and population selection criteria: 1.) The “degree of rural” is reflected in school system or geographic entity scores. 2.) Other important selection criteria for your rural target populations include these that are all easily searched: Remember: EDUCATIONAL LEVELS---PERSONS IN POVERTY—FAMILIES IN POVERTY--PER CAPITA INCOME LEVELS--- PROPORTIONS OF SCHOOL STUDENTS WITH LUNCH PROGRAM ASSISTANCE---EMPLOYMENT LEVELS---POPULATION AGE DISTRIBUTION---LIFESTYLE ISSUES (tobacco-alcohol-drugs, etc) --- EMPLOYMENT RATES.

23 Use Information sources: Quick facts US census information may be found at ml This source then can hone down to state, county and local level statistics ml tions_by_per_capita_income will give you valuable info concerning comparative income levels tions_by_per_capita_income USDA fact sheets may be found at

24 Information sources: Federal Communication Commission Ed.Gov: ersites/associations.html ersites/associations.html Also see: dex.html?src=ln dex.html?src=ln

25 Now, Don’t forget to measure your outcomes!!! Were your processes efficient and orderly? Did you reach your expected outcomes? Were there any ways you could improve? Were results satisfactory for your target audience? And (parenthetically) was it worth the effort?

26 What do You as a Regional Medical Facility get out of this? Provide all your cadre of attending physicians with a network linkage for CME, CE and community education. Enhance patient and community outreach for those in your service areas. Strengthen your service and business opportunities. your Provide a backbone for your community research opportunities. Enhance inter and intra institutional/community collaboration in education and clinically based research efforts for all rural populations

27 Remember Rural Outreach Network! Medical (Doc to Doc, etc.) links for CME/CE as Primary Effort AND Community links for public education as Primary Effort

28 Roundtable discussion issues-- Remember there is only one rule— ”All ideas are great!!” And there are few cautions---in particular the two following thoughts come to mind

29 Are they going to drink?

30 Do you have a critical mass necessary for something to happen?!?