Publications

Journal of Radiology Nursing · Sep 6, 2022

Facing Healthcare Access Challenges With Specialty Care Clinics in Central Appalachia

Access to specialty care and diagnostic services in rural healthcare settings are required to achieve quality healthcare outcomes. St. Mary’s Health Wagon network of free clinics, established in 1980, serves a region with an array of health disparities and poor social determinants of health. In 2018, the administration envisioned implementation of an interprofessional team to deliver diagnostic services targeting healthcare access challenges in southwest Virginia, which is historically unprecedented. The cost of diagnostic services in the area was not equitable for the poor, uninsured, and underinsured. Many patients had to use the emergency department for radiologic exams, incurring more debt that cannot be afforded or paid or simply forgoing needed diagnostic services. The leadership team applied for and secured a United Health Foundation Grant that fulfilled their vision, employing ultrasound, diagnostic x-ray, mammogram, telecystoscopy, telecolposcopy, and dental visits into the network of clinics. To date, St. Mary’s Health Wagon has performed 3,587 exams (342 ultrasounds, 282 x-rays, 273 mammograms, 21 telecystoscopies, 16 telecolposcopies, and 2,669 dental visits) free of cost for the patients. While there were some challenges with the implementation of these services, the benefits yielded quick diagnosis and treatment, leading to optimal patient outcomes.

Aug 26, 2020

From the Front Lines of the Appalachian Addiction Crisis: Healthcare Providers Discuss Opioids, Meth and Recovery

Stories from doctors, nurses, and therapists dealing on a daily basis with the opioid crisis in Appalachia should be heartbreaking. Yet those told here also inspire with practical advice on how to assist those in addiction, from a grass-roots to a policy level. Readers looking for ways to combat the crisis will find suggestions alongside laughter, tears, and sometimes rage. Each author brings the passion of their profession and the personal losses they have experienced from addiction, and posits solutions and harm reduction with positivity, grace, and even humor. Authors representing seven states from northern, Coalfields, and southern Appalachia relate personal encounters with patients or providers who changed them forever. This is a history document, showing how we got here; an evidenced indictment of current policies failing those who need them most; an affirmation that Appalachia solves its own problems; and a collection of suggestions for best practice moving forward.

Journal of Appalachia Health · Jul 19, 2020

The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia.

Journal of Urology by the American Urological Association · Apr 20, 2020

Blinded Comparison of Clarity, Proficiency and Diagnostic Capability of Tele-Cystoscopy Compared to Traditional Cystoscopy: A Pilot Study

Purpose: In order to expand the availability of cystoscopy to underserved areas we have proposed using advanced practice providers to perform cystoscopy with real-time interpretation by the urologist on a telemedicine platform, termed “tele-cystoscopy.” The purpose of this study is to have blinded external reviewers retrospectively compare multisite, prospectively collected video data from tele-cystoscopy with the video of traditional cystoscopy in terms of video clarity, practitioner proficiency and diagnostic capability.

Materials and methods: Each patient underwent tele-cystoscopy by a trained advanced practice provider and traditional cystoscopy with an onsite urologist. Prospectively collected tele-cystoscopy transmitted video, tele-cystoscopy onsite video and traditional cystoscopy video were de-identified and blinded to external reviewers. Each video was evaluated and rated twice by independent reviewers and diagnostic agreement was quantified.

Results: Six tele-cystoscopy encounters were reviewed for a total of 36 assessments. Video clarity, defined by speed of transmission and image resolution, was better for onsite compared to transmitted tele-cystoscopy. Practitioner proficiency for thoroughness of inspection was rated at 92% for tele-cystoscopy and 100% for traditional cystoscopy. Confidence in identification of an abnormality was equivalent. Four of 6 videos had 100% agreement between reviewers for next action taken, indicating high diagnostic agreement. Additionally, provider performing cystoscopy and location did not statistically influence the ability to make a diagnosis or action taken.

Conclusions: This model has excellent completeness of examination, equivalent ability to identify abnormalities and external validation of action taken. This pilot study demonstrates that tele-cystoscopy may expand access to bladder cancer surveillance.

International Journal of Urological Nursing · Jun 26, 2019

Adapting nurse-led cystoscopy experience to the United States: Tele-cystoscopy a possible compromise?

Urology workforce shortages in rural areas limit access to diagnostic cystoscopy for hematuria or surveillance cystoscopy for patients with bladder cancer. To address this, we developed a tele-cystoscopy model in which urologic advanced practice professionals (APPs) perform cystoscopies that are interpreted in real-time by board-certified urologists at their home institution. This collaborative model allows the cystoscopic interpretation to be performed by a board-certified urologist. This model may both improve access for patients in remote locations and may lead to greater acceptance of nurse-led cystoscopy in the medical legal environment found in the United States.

Journal of Nursing Education and Practice · Feb 18, 2015

An academic and free clinic partnership to develop a sustainable rural training and clinical practice site for the education of undergraduate and advanced practice nurses

The purpose of this project was: 1) to expand clinical training experiences for undergraduate, graduate and advanced practice nursing students at a rural free clinic, 2) to test the feasibility of developing a model training and practice internship for undergraduate, graduate and advanced-practice nurses as part of a Health Resources and Service Administration (HRSA)-funded academic-community partnership to encourage nurses to consider future employment in rural Appalachia and 3) to determine the successes and challenges of this endeavor. This paper reports the successes and challenges of this partnership. Data were collected from nursing students attending the University of Virginia through self-reported student information forms. A total of 145 students (56 advanced practice, 19 graduate and 70 undergraduate nursing students) successfully received scheduled clinical training experiences at three rural clinic sites operated by the Health Wagon (HW), a free clinic in rural Southwest Virginia. It is feasible to develop and implement a long distance academic and community-based partnership to provide real life experiences for undergraduate, graduate and advance practice nurses, including nurse practitioners, in rural settings. Success depends on the commitment of both the academic and free clinic staff to the program, excellent on-site clinical supervision of students, and a source of revenue to cover both on-site and travel related expenses for students and preceptors.

Rural Remote Health · Mar 20, 2012

Delivering free healthcare to rural Central Appalachia population: the case of the Health Wagon

Central Appalachia residents present unique healthcare challenges. This vulnerable population faces poor health status and low access to health care. ‘The Health Wagon’ was established to innovatively enhance access to health care for the poor and marginalized rural population of Central Appalachia. This article describes the operations of the Health Wagon, a full mobile medical clinic, in delivering free health care to those in rural Southwest Virginia in Central Appalachia. The Health Wagon provides a wide range of comprehensive healthcare services, such as acute and chronic disease management, laboratory and diagnostic services, medication assistance, dental and eye care and specialty clinics for marginalized, poor and disenfranchised patients living in the mountains of that region. In 2009, a total of 157 clinics were provided and 2900 patients were seen (3165 patient encounters) in addition to 268 telemedicine specialty consultations at no cost to the patients. The work of the Health Wagon has broken down a financial barrier to healthcare access and offers unique and profound opportunities to improve health and expand health care in rural Central Appalachia.