O2170: Advantages of Telemedicine for Quality, Access and Cultural Humility

Background: Families in rural Montana face many challenges in obtaining pediatric healthcare including long wait times, limited local options, and long distances to specialty care. Providers in these rural locations work in isolation with limited opportunities for peer-collaboration.

The average life expectancy for a person on the Fort Peck Indian Reservation is 20 years lower than for a non-native Montanan living off the reservation. Quality, culturally-informed programs that support children and families are vital to closing the gap in this stark inequality.

Montana Pediatrics is a technology-enabled collaborative of Montana's pediatric providers who work for a common goal to increase access to healthcare and health equity for Montana’s children. The Fort Peck Indian Reservation, located in one of the most rural and isolated areas of Montana, is one of the communities with which we have partnered.

Project Description: In collaboration with a Tribal Health program, we provide:
daily pediatric telemedicine through school-based health clinics
monthly in-person visits
subspecialist care in pediatric cardiology, pulmonology, neurology, and psychiatry
and collaboration across health systems to promote continuity of care

In the last year:
2000+ hours of pediatric care where there was none before
over 600 unique children have been served
420,000+ miles that would have been driven to receive comparable care

In the coming year:
We are in the early phases of an integrated mental and behavioral health program for a growing community of remote mental health specialists paired with pediatricians.

Discussion: The collaborative nature of Montana Pediatrics via which Montana-based providers work together to serve remote and unserved children has benefits for providers and the communities they serve. While telemedicine necessitates prolonged and deliberate relationship building, the remote collective also created the opportunity for providers to leverage their social and relational privilege in service to a Tribal Health program in ways that would not be possible working in isolation. Persistent shortages and high turnover of providers in rural communities are uniquely mitigated by a long-term, devoted telemedicine programs.

Conclusion: Telemedicine, while convenient and accessible, is not typically attributed with being culturally relevant, continuous with primary care, or more therapeutic when compared to in-person models. However, not being physically located in the highly interconnected community of Fort Peck has proven to be a strength when it comes to providing some aspects of highly confidential care. We will also explore how speaking to a compassionate “outsider” may have therapeutic benefits, particularly in the realm of mental health support. We will also discuss how learning from community and the constraints of telemedicine may counterintuitively improve the cultural relevance of care, increase continuity, and elevate quality. The collaborative remote model developed with guidance from the local healthcare systems fills gaps in access and the scope of care available to children.