FEBRUARY 2024 ISSUE

FEATURE

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GRHIC Offers Free ECHO Training Sessions

by Samantha Johnson, Community Resource and Assessment Specialist

The Georgia Rural Health Innovation Center (GRHIC) has been a Project ECHO Hub since 2020. Rural communities face unique challenges when it comes to health and health care, such as having a higher prevalence of chronic diseases compared to some urban areas and a shortage of health care resources and personnel. To support rural practitioners and other professionals, GRHIC hosts a Rural Health Care Ethics ECHO and supports partners around the state that are launching rural-focused ECHO programs. The goal of the Rural Health Care Ethics ECHO is to create space for difficult ethical topics to be discussed in an interprofessional and supportive way. Topics that are discussed explore ethical implications of end-of-life care, proxy decision making, scarcity of resources, pediatrics, and difficult discharge.

The 2023-2024 Rural Health Care Ethics ECHO is divided into three sessions that are focused on pediatrics, mental health of health care providers, and organ donation and transplantation. Within the rural health care setting, sessions are designed for hospital and clinical educators, chaplains, social workers, registered nurses, nurse practitioners, doctors, psychiatrists, and hospital executive members.

Project ECHO, Extension for Community Healthcare Outcomes, was launched in 2003 by Sanjeev Arora, MD, a liver disease specialist at the University of New Mexico Health Sciences Center. Dr. Arora was frustrated because he could only serve a small portion of hepatitis C patients in the state due to barriers, such as lack of transportation and limited availability to travel. This sparked the creation of Project ECHO, which built a community of practice where physicians could share knowledges and experiences with each other on specialty treatments and uncommon conditions. The use of a web-based platform allows connection and collaboration with peers across the state, country, and world. ECHO is not a lecture or webinar. It is an interactive, collaborative learning experience facilitated by subject-matter experts but led by participants.

The united principle of ECHO is “all teach, all learn," which emphasizes the value of every member’s experience and knowledge. ECHO sessions are designed around case-based learning and gives providers the opportunity to gain skills and confidence from their peers. When this principle is applied, participants experience guided practice, on-going mentorship, and peer-to-peer collaboration. As participants learn from each other, their knowledge is tested through a local lens, creating a continuous cycle of learning and having a long-lasting community impact.

Today, ECHO expands around the globe and is used in a variety of fields and topics including education, maternal and child health, gender equity, emergency preparedness, COVID-19, HIV/AIDS, and rural health.

Ed Honeycutt, senior telehealth project manager, leads a telehealth simulation with first-year Mercer University School of Medicine students Cody Waterman and Roman Fortin (on screen) and Dr. David Kay, of Mercer Medicine Harris County (far right).

Telehealth as a Tool for Health Care Access in Rural Communities

The Georgia Rural Health Innovation Center sponsored the installation of telehealth equipment at Mercer Medicine Harris County in Hamilton, Georgia, as part of a pilot project to expand health care access in rural communities. Telehealth not only gives an opportunity for people to reach a primary care provider, but it also increases access to subspecialists without the patient having to travel away from their home county.

David Kay, MD, is a primary care practitioner at Mercer Medicine Harris County. Recently, one of his patients was experiencing psychiatric issues. Through a telehealth appointment at Dr. Kay’s office, the patient communicated with Jacob Hanna, MD, a psychiatrist with Mercer Medicine Macon. “I knew Dr. Hanna had the skills to connect with and win over this patient.”

Telehealth is more than just a phone call. It allows patients to see the physician on the other end and build trust and confidence. Roman Fortin, a first-year Mercer University School of Medicine (MUSM) student on the Columbus campus, said, “One of the benefits of doing telehealth in this way, especially for mental health, is the psychiatrist and the patient were able to get that non-verbal communication, which they would not be able to get over a phone call.”

Telehealth visits through a high quality, secure system is more effective than virtual consultations through other means. Dr. Kay said that by doing the visit in the office, the patient and physician were in a safety bubble, and they were able to gain the greatest possible benefit out of the one-hour interview.

When patients already have an established rapport with the primary care physician in the office — Dr. Kay in this case — it only adds to the strength of the care team. Dr. Kay enters the room with the patient to make the formal introductions. He can also perform physical exams, as necessary, with peripheral equipment on the telehealth cart, which allows the physician on the other end to visualize and review results in real time.

The Importance of Primary Care and Well-Visits at Any Age

It’s the season of flu and cold viruses. This might be the time of year when people experiencing a wintertime illness will seek medical advice. Terrell Jenrette, MD, is a 2020 graduate of Mercer University School of Medicine and a primary care physician with Atrium Health Floyd Primary Care in Rockmart, Georgia. Dr. Jenrette explains why a primary care physician is essential in keeping people healthy throughout all stages of life, and not just during flu season and times of illness.

“The primary care physician is the one doctor who knows your baseline. They know you when you are not sick. Having someone that you can go to and say ‘I’m not feeling well’ — they’ve seen you for months and years and can say something is definitely off and that is incredibly important,” said Dr. Jenrette.

Primary care physicians are the ones to complete screenings. “Whether a patient is a newborn or geriatric age, there are always some screenings that need to happen.” Making sure patients are well — and stay well — is essential. Things like hypertension and diabetes, which may not produce symptoms, can be caught early through regular visits.

What does a typical well-visit look like?

The basis of a well-visit is the same for most ages, including labs and vitals, with some age- or gender-appropriate adjustments through the years. For Dr. Jenrette, the mental well-being of each patient is as much a priority as their physical well-being. Patients complete a Patient Health Questionnaire (PHQ-9) and a General Anxiety Disorder(GAD) screening at each visit to check for depression and anxiety.

Read on for details about what to expect at well-visits for each life stage.

Dr. Jenrette's Top 5 Tips for Staying Healthy:

Eat less than 2,000 calories per day and make sure your plate has a good variety of healthy foods. Vegetables should make up half of your plate. Choosing proteins that are not fried and less fatty are preferred. Be selective of the breads and pastas that you eat, especially if you are diabetic.
Exercise is important for mental and physical health, and 150 minutes per week is recommended for heart health. For weight loss, an hour each day for 4 to 7 days a week, plus a healthy diet, is key.
Quit smoking and limit alcohol intake as these can cause health issues.
Adults should see their primary care physician at least once per year. However, while insurance typically covers well visits every 12 months at any age, Dr. Jenrette recommends seeing a primary care physician twice per year when patients reach their forties.
One of the leading causes of death for men is accidents. Taking precautions when pursuing activities or risky behaviors is important.

Mental Health Focus: Winter Blues

Physicians agree that mental health is just as important as physical health. The Georgia Rural Health Innovation Center has specialized programs to address mental health access and issues in rural communities, such as school-based mental health initiatives that include telehealth and mental health training for citizens.

The holidays and the general gloominess of the winter season can contribute to depression and anxiety for many people.

What are the winter blues?

According to Brian Wright, MD, Mercer University School of Medicine graduate and psychiatrist with Mercer Medicine in Macon, said, “Winter blues is a slang term for an actual medical condition called Seasonal Affective Disorder.” According to Dr. Wright, up to 20% of people say their mood is worse in winter, and 85% of people who suffer from depression say their symptoms worsen during this time.

“What most people call the winter blues are just ‘I feel a little bit blah.’ Most people feel like they have a little less energy, they feel some extra fatigue,” he said. People may not want to go outside as much, crave carbohydrate-rich foods, and do not sleep well. For most, symptoms are mild and can resolve within a couple of months.

While these symptoms are most associated with wintertime, Seasonal Affective Disorder (SAD) can occur during any season. “There are people who in the spring and summer have the opposite reaction. For people who have bipolar disorder, the spring and summer can elicit manic episodes,” said Dr. Wright. “People who live in areas that have 24 hours of daylight or long periods of daylight in the summer are especially prone to triggering mood symptoms or even psychosis, occasionally.”

The “blues” may make people think symptoms are only mild, when in actuality, symptoms can be severe. “Suicide rates go up in the winter. And especially at the end of winter when the first sign of spring comes back, suicide rates go up,” said Dr. Wright.

Dr. Wright recommends people seek medical attention when symptoms interfere with the things they need to do in their daily life. “If you can’t get up and go to work, you stop taking care of yourself, you are not cleaning your house and doing laundry, it’s a trigger that it’s gone beyond the general 'blah.'” He explained that those with serious depression stay in bed for long periods of time and socially isolate themselves. “Anytime it gets to the point where people are thinking about hurting themselves, they don’t feel safe, or they start having intrusive thoughts, not wanting to be here anymore, it’s time to get some help.”

Beating Winter Blues

For general blues, Dr. Wright said exercising more, getting outside when sunlight is available, making a special effort to socialize, and planning things throughout the day can help relieve symptoms. If symptoms cannot be managed, the first stop should be a primary care physician for evaluation. For more serious cases of SAD, people should seek a mental health professional.

“We have a lot less light during the winter. One of the treatments for people who have mild Seasonal Affective Disorder is light therapy,” said Dr. Wright. Special lights are used to help shut off melatonin and increase serotonin, which is the main medication that is used in anti-depressants.

Seeing a therapist more often or a physician adjusting medications during winter can be beneficial.

“Your mental health is the same as your physical health. Doing the things that keep your body healthy also keep your mind healthy,” he said. Eating a healthy diet, exercising, and socializing with others in positive ways are things to help get through the cold months.

If you or someone you know is in crisis, call 988, the Suicide & Crisis Lifeline that is available 24 hours a day, 7 days a week.

Rural Pediatric Health Alliance is Now Kids Alliance for Better Care

New Name, Same Mission

Children's Healthcare of Atlanta (Children's), Mercer University School of Medicine (MUSM), and the Georgia Rural Health Innovation Center (GRHIC) share a common goal of increasing health care access and health education to rural communities. Together in 2023, they established the Rural Pediatric Health Alliance, now the Kids Alliance for Better Care (KidsABC), with a mission to provide rural children timely, quality health care close to home. The work of the alliance is funded by a dedicated and long-term sustainable fund of $200 million from Children's.

KidsABC expands cutting edge health care for children in rural communities. The alliance brings together a network of rural hospital emergency departments, pediatric offices, regional and state pediatric tertiary care hospitals, and school systems to address the challenge of health care access, which many rural families face. KidsABC participants are equipped with the necessary tools, protocols, training, and research, so families have access to subspecialty care, mental health care, and emergency medical care in their hometowns.

Healthy hometowns start with healthy kids!

Rural Hospital Emergency Department Collaborative

The KidsABC Rural Hospital Emergency Department Collaborative has worked to complete equipment installation at the eight hospitals in Cohort 1. Additionally, planning for year two and Cohort 2 has been a focus. Initial meetings with the five hospitals in Cohort 2 have begun. Additionally, planning for the quarterly collaborative meeting and new hospital orientation is underway, with the event scheduled for March 7-8.

Rural Pediatrician Support Collaborative

The PASS seminars and pediatric education offerings from 2023 are available online with private access for educational review. The 2024 PASS sessions kicked off January 31, with the first session topic on neonatal jaundice. The free, in-person Pediatric Continuing Education Conference will be held at Mercer University in Macon on May 17 (register here). Pediatric offices support recently entailed the scheduling and completion of telehealth pathways demos at several pediatric offices, following the technical challenges being addressed in Pathways and pediatric office internet sources. Advancements have been made in the areas of instruction of KidsABC branding use for Telehealth Champions; announcement of 2024 Cohort of pediatric care offices and scheduling of introductory visits; and detailed planning for the Children’s Scholars Summer Program.

Rural Pediatric Mental Health Collaborative

Communications plans were developed with each school contact to help promote the upcoming screenings in Jefferson County Schools, Washington County Schools, and Brentwood School. Mental health and wellness screenings will take place mid-February.

Training and News for Rural Pediatric Health Care Providers

Rural Pediatric News is published bimonthly and highlights training and continuing medical education options, recommended reading, physician spotlights, seasonal health and wellness information to share with patients, and more.

The Pediatric Advanced Speakers Series is a free monthly training series for providers to earn CME credits, offered by Mercer University School of Medicine, through one-hour virtual training sessions with subject matter experts in a variety of topics. PASS includes peer-led rural pediatric patient case studies and an in-person continuing education conference.

If you are a rural pediatric provider, please click to register for trainings and subscribe to Rural Pediatric News.

2024 Ongoing Center Initiatives

Maternal Health Improvement

All Rural Counties

Kedrick Williams

Maternal Health Observership

All Rural Counties

Kedrick Williams

Maternal Health Symposium

All Rural Counties

Joan Anderson

Community Health Reporter

All Rural Counties

Kedrick Williams, Harvey Moody

Clinical Ethics ECHO

All Rural Counties

Chris Scoggins

Opioid Misuse Prevention Project

Rural Hospitals

Joan Anderson, Chris Scoggins

ASIST Suicide Training

All Rural Counties

Travis Crafter

Community Resiliency

Model (CRM)

All Rural Counties

Joan Anderson, Travis Crafter

Mental Health First Aid

All Rural Counties

Kedrick Williams,

Glenda Grant

Pediatric Mental Health Initiative

Ben Hill, Jefferson, Washington

Joan Anderson

Barber/Beauty Shop Project

Randolph County

Harvey Moody

Rural Medicine Pathways Events

All Rural Counties

Glenda Grant

QPR (Question, Persuade, Refer) Gatekeeper Training for Suicide Prevention

All Rural Counties

Joan Anderson

Faith in Rural Health

Berrien, Putnam, Toombs/Montgomery

Paul Byrd

Health Fairs

Rural Partners

Amanda Livingston

Georgia Agricultural Wellness Alliance

All Counties

John McElveen

Continuing Medical Education and Continuing Nursing Education Training

Harvey Moody

ECHO is a collaborative learning community model used throughout health care to build skills and communities of practice. The Georgia Rural Health Innovation Center is hosting the Rural Health Care Ethics Echo Series October 2023 through April 2024.

Coming Up:

Organ Donation ECHO:

March 6, 2024; March 20, 2024; April 3, 2024; April 17, 2024

Facilitators:

Caroline Anglim, Ph.D. HEC-C, Assistant Professor of Bioethics and Professionalism, Mercer University School of Medicine; Donald E. Carter, MBA, M.Div., DBe, Assistant Professor of Bioethics and Professionalism, Mercer University School of Medicine; Brian Childs, M.Div. Ph.D. HEC-C, Professor of Bioethics and Medical Humanities, Mercer University School of Medicine

Sessions are noon to 1 p.m. via Zoom. Credits: 1 CME credit per hour provided by Mercer University School of Medicine. Registrants will receive Zoom event information for each session.

The Georgia Rural Health Innovation Center works with rural partners to enhance health education through health fairs.

We encourage these community members to join us:

Washington County | March 9 | 10 a.m.–1 p.m.

Co-Hosts: Representative Mack Jackson, Washington County Regional Medical Center, Washington EMC

Harris County | July 13 | 9 a.m.–Noon

Co-Host: Harris County School District

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ABOUT THE CENTER

In 2018, Georgia lawmakers dedicated special funds to establish a new Rural Health Innovation Center tasked with confronting the complex health care challenges and wellness disparities facing rural communities. Mercer University School of Medicine (MUSM) was awarded the grant funds in 2019 and formally established the Georgia Rural Health Innovation Center on its Macon campus. MUSM boasts a longstanding commitment to serving rural Georgia’s health needs, with a mission to educate physicians dedicated to tackling the health challenges in rural Georgia. The Rural Health Innovation Center serves as a critical resource to rural communities to improve access and effectiveness of health care by offering research, collaboration, and training opportunities.

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