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Using telemedicine to extend the reach of dermatology into the Mississippi Delta

Community Leadership Category - Community Vote Award

Mississippi Delta
  • Lead Dermatologist: Dr. Robert T. Brodell
  • Project team members: Kim Ward, Julie Wyatt, Nancye McCowan, Stephen E. Helms, Jeremy D. Jackson, William Black, Jasmine Hollinger, Ashley Emerson, Leslie Partridge, Angela Jackson
  • Affiliation: Department of Dermatology, University of Mississippi Medical Center, USA

Teledermatology initiative to work through primary care physicians and close the 60-mile gap in dermatology care across the Mississippi Delta, the poorest region of the US.

Executive Summary
The Mississippi Delta is the poorest region in the US with no dermatologists within 60 miles. Faculty of the Department of Dermatology of "Ole Miss" have established volunteer clinics twice per month in the Delta to serve the needs of this population. A teledermatology program has been initiated to work through primary care physician offices in the Delta. We anticipate managing 90% telederm/10% in live clinics. The problem: educating and motivating primary care physicians to engage. A medical student and computer technician will be sent to the Delta next summer to promote dermatology access through this multi-pronged system.

The Challenge
Mississippi's population is the sickest and most obese in the nation, while also having the second-highest rate of diabetes, lowest education level and shortest life expectancy. A quarter of the nearly three million residents live at or below the poverty line, and about 17 percent of residents lack health insurance. Mississippi did not participate in the Affordable Care Act. The state also has the least per capita dermatologists of any state, with only 48 physicians for the above-mentioned three million citizens, and 20 of these dermatologists are over the age of 65. The Mississippi Delta is the poorest part of Mississippi and with no dermatologists.
The economic impact of untreated and under-treated skin disease in a Southern State, with skin disease potentiated by heat and UV light, is very great and can be measured in increased mortality from melanoma, lost work and decreased productivity rooted in poor quality of life because of itching, cutaneous infections and cutaneous malignancies.

Project Details
In 2015, Galderma supplied a "start up" grant to help supply dermatologic equipment and supplies to the Jackson Free Clinic. The Ole Miss Dermatology faculty subsequently started two additional clinics in the Mississippi Delta. One is housed in a high school and the other in an urgent care facility 16 miles away. These two clinics see about 50 patients per month.

Target Audience
40 Primary Care Physicians and Nurse Practitioners in the Mississippi Delta.

Collaboration 
Center for Telehealth at the University of Mississippi Medical Center (UMMC)

Structural benefits

  • 1. Third party teledermatology insurance coverage is mandated by law to match payment for “in person” visits in the State of Mississippi.
  • 2. UMMC receives Federal and State Government funding for a telehealth infrastructure to support efforts to improve access to care.
  • 3. An EPIC compatible “store-and-forward” system has been working flawlessly over the past year.
  • 4. The 10 faculty and 4 nurse practitioners involved have time to devote to teledermatology and are compensated for this work on an incentive plan.

All of this should help make this approach to increasing access to health care in the Delta sustainable.


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