2003 Traveling Professorship in Rual Areas

87% of Kentucky's 120 counties are rural and considered medically underserved. The rugged Appalachian Mountains in eastern Kentucky and the broad expanse of sparsely populated areas in western Kentucky cause many rural physicians and their patients to be geographically isolated from specialty care. Kentucky faces a severe shortage of Board Certified Infectious Disease specialists, and most of these specialists practice in the two University Medical Centers in Lexington and Louisville. Rural clinicians, geographically isolated from specialists, must be prepared to diagnose and manage the infectious disease conditions found in their communities. Rural clinicians need advanced training in TB, AIDS/HIV, infectious disease emergency management and antibiotic resistance in order to serve the needs of their community. Additionally, the growing threat of bioterrorism requires rural physicians to prepare for potential bioterrorism agents such as smallpox, anthrax and other rare or forgotten diseases. How can a limited number of Board Certified, Infectious Disease specialists, who are already overwhelmed with increased patient loads, take time to deliver educational programming to rural clinicians? This project will provide for five, unique Infectious Disease specialty training courses to be delivered from five different rural Kentucky medical centers. Martin Evans, MD will travel to the "Presenting Site", the facility where the talk is presented. The one hour presentation will be followed by a more informa' "Meet the Professor" session which will allow community physicians to talk more personally with Dr. Evans. Each of these programs will also be transmitted, via the Kentucky TeleHealth Network (KTHN), a highly advanced interactive videoconference system, to an additional 13 rural medical centers to maximize the reach of the program's content, and prepare even more Kentucky physicians to deal with these important clinical issues. KTHN is a network of over 60 videoconference facilities, located in all three of Kentucky's medical schools (University of Kentucky, University of Louisville and Pikeville College School of Osteopathic Medicine), rural hospitals, primary care clinics, public school clinics and Public Health Departments. This network allows the presenter to see and hear participants from each site, and each site can see and hear the presenter, easily interacting with one another as if they are in the same room. Based on interviews with the participating network sites, the estimated number of total participants in all the combined programs is 631, an average of 126 participants per program. As noted in the Sample Day schedule, below, Dr. Evans will also stop at a community Public Health Department, at least 30 miles from the presenting site, to meet with community healthcare professionals that could not attend the presentation. Martin Evans, MD will present each program. He is Professor and Chief, Division of Infectious Disease, Dept of Internal Medicine, and Program Director of the Infectious Disease fellowship. He has published over 50 articles and book chapters, and given more than 145 lectures at the local, state, national and international levels on numerous topics (see attached CV). Dr. Evans has been conducting a telemedicine TB clinic for over 4 years, and has managed over 450 cases. Dr. Evans has given several Grand Rounds talks on the telemedicine network, and in October, 2001, presented a two-hour infectious disease-focused bioterrorism talk for rural clinicians that reached 23 sites and over 400 clinicians, providing vital information to prepare rural Kentucky health professionals with information needed to understand and diagnose potential bioterrorism victims. The Southeast Area Health Education Center (AHEC) has agreed to provide free Continuing Medical Education (CME) credits for all participants in the series, and all the Kentucky AHEC's have agreed to market the program to physicians. The normal cost of processing CME credits is $15/credit hour. Based on the estimated 631 participants, this is an in-kind contribution of $9,465. Access on the KTHN network will be provided free of charge. The network often charges $50/hourlsite, so this will result in an in-kind contribution of $3,500. Each of the five presenting sites has agreed to host Dr. Evans, distribute handouts, serve the meal, collect evaluations and provide any support needed to conduct the program. Kentucky TeleCare staff will work with Dr. Evans to develop the evaluation instrument, collect the data and report the findings. Several other potential partners have been targeted to participate in this project. The Kentucky Department of Public Health will help recruit public health personnel to participate. State Emergency Management personnel have shown an interest in the bioterrorism program and KTHN has already attracted nursing home and home health personnel to TB programs.