Hello, I'm Dr. Steve Kaminsky,
preventive cardiologists at
Mayo Clinic in Rochester, minnesota.
And today I have
the great pleasure of speaking with
my colleague and friend, Dr. Rudolf Olson.
Adelaide also as we know her so fondly.
And we're gonna be talking about
a very interesting and timely subject,
which is the health of rural communities
and how to improve
our delivery of ASCVD
preventive care to rural communities.
So welcome, Dr. Olson.
Thank you, Steven.
Thanks for having me here.
Yes. Well, it will be
a very exciting conversation
because rural communities,
how do you define a rural community?
There are many different definitions
for rural communities.
One of those are communities that have
a one urban core
of less than 50 thousand people.
And so we essentially
are these smaller communities
as we have many here in the Midwest.
Yes, we certainly do.
And then the urban versus rural.
Rural is like 25% of the population,
but 75% of the landmass,
so they're really spread out.
The other part is will
be the secondary prevention.
How do you define secondary prevention?
So that's, that's a great question.
Secondary prevention is when you apply
preventive strategies to avoid
an event to occur.
Again, let's say a person
may have had a heart attack.
And so what should the person to
12 having another heart attack
or avoid having progression of their disease.
Then there are recommendations
from our clinical
practice guidelines that are
also endorsed by the CDC on how
which strategies should work for
patients who have
atherosclerotic cardiovascular disease.
Then the other question would be,
what are the adverse cardiovascular diseases?
And those include the heart attacks,
stroke, and peripheral arterial disease.
The third blockages to
the blood vessels of the legs.
So all the recommendations
to essentially there are
four main recommendations
with these patients.
Ah, that are, let's
say they should have good control of
the blood pressure to take
a medication
that's called anti-platelet agents,
such as aspirin and so on.
Also, if no contraindications,
they should take mitigation.
That's called the Staten.
That's a medication that helps
lowering the levels of cholesterol
and protect against the inflammation that
occurs and then not smoke.
So these are what we call the divorce,
for example, indicates of
atherosclerotic cardiovascular disease.
So the big four we
all try to pay attention to,
which are extremely important in
rural populations as
many people probably don't realize,
the rural population 50 years ago had
a longer lifespan than the urban population,
but now they have a shorter lifespan.
And they have more poverty.
They have more smoking,
more smokeless tobacco.
The kids are more obese and compounding.
That is these other issues we talked
about where they have to go
farther to a hospital.
It's a critical access hospital.
So she presented a time
and doesn't have all the facilities.
Why do you think these rural populations
have more risk factors?
Now? That's, that's a great question.
I think the problem has It's
a complex situation with multiple levels.
That one of those one of
those reasons is difficult
access to care providers,
difficult access to a primary provider.
And then it gets hard for those patients to
get certain information that they need to
take care of themselves themselves.
And so I think that's
a very significant barriers, Barrier.
And other issue is,
let's say that's very significant.
In rural communities are
the barriers to transportation.
So often we have elderly people who live in
these remote areas and they don't have,
they can't drive and who is going to
take them to the clinic.
So that's, that's one barrier.
Another barrier is, you know, do they have,
in this era of technology,
do they have access to computers?
And if they have, even if
they have a computer,
can they use the computer that they have,
can they use the system that they have?
So there are barriers
that I would say both at
the patient level and
also at the systems level.
And then.
That transportation
also significant that barrier.
Certainly, when they get
need to get transportation and candidly,
the ambulance has to come farther,
is probably going to be volunteer EMTs.
The it takes longer to get there.
And then when they get there,
they have less providers
available to treat them,
not as high technology.
It really is an almost overwhelming burden
we have to overcome.
And then finally, the reimbursement is
less in the rural communities,
so it really gets to be difficult.
The, so you talked about
the big four things to focus on.
How do you what
is your system that you're trying to
implement within the Mayo
Clinic Health System to
overcome this to great question.
So our system also tries,
we created a system that
we tried to address some of
these barriers that patients are encountered.
So in addition to these
factors that we mentioned,
there is also the shortage of providers.
And the fact that
the secondary prevention for
these patients is usually
delivered only by physicians.
So we created the system that
empowers teamwork for delivery off this, ah,
for, ah, recommendations that have
proven benefit on secondary prevention
of this patient's wonderful.
Now, in the Big Four are trackable.
We can track them, you know,
the medicines they get,
et cetera, the blood pressure they have.
But how are we
doing with the things that
we can't track so easy?
Like how physically active are they?
Because we know there's more sedentary
lifestyle in the rural community,
which is really surprising to me.
How do we track diet deal is
this is a future project. I would think.
Absolutely. That's a future project. For now.
We are in our opinion,
we had to start somewhere.
And when we built
this novel system for delivery of care,
um, we did that in conjunction
with the local providers
and also with the local patients.
And the what was considered,
let's say low-hanging fruit
are those four recommendations.
And another important aspect is
that with the assistance
of technology, providers can,
after one click of the mouse,
they can evaluate the current status
of a given patient, the situation,
what's happened with beige,
and then identify the gaps in care and assign
the right patient for direct provider that
would deliver the care
that that person needs.
For example, if a patient is a smoker,
that person could be
assigned to a tobacco cessation counselor.
And then for information
on how to strategists to
discontinue smoking or if
a person doesn't have
a prescription of establishing,
my prescription has not
been renewed. What do I do?
That person could be would be
connecting with a pharmacist that
has the privilege is for writing
prescription and
then the person gets their prescription.
So then using this identification
of the gaps and then assigning
the right person for the right provider for
the targeted delivery of
these recommendations is
essentially the core offer.
This new system for
delivery of care for this rural communities.
You see that's a beautifully designed system
because you you have
the information on the patient
within the male clinic electronic record.
Do they have they had an event
they're secondary prevention.
How's their blood pressure or are they
on these medicines or not?
And the other thing is huge.
You're, you're kind of not relying
necessarily on a physician. You were lying.
You said the pharmacists can
prescribe antihypertensives
and anti lipid drugs,
both smoking cessation and then the habit,
the antiplatelets or
clopidogrel or something like that.
So with the anti-platelets, the pharmacists,
they addressed that in
conjunction with the primary provider
or the primary np.
And then they come up with a recommendation.
So it's really a team, it's a teamwork.
And then for the blood pressure management,
we have a wonderful team of nurses
who have strategies for
optimization of blood pressure control.
And I think one big,
one of the many strengths
of these strategies is that
we do have with
the Mayo Clinic Health Record
and this teamwork,
we have the opportunity
for continuity of care.
So if you change
the blood pressure mitigation for
a given person, we can also.
Monitor so that person will have
the follow-up and so on.
And then how to get access,
you know, the person, the patient.
Because the patient will
have the option to say,
Oh, I don't have transportation access today.
Can we just do this discussion by phone?
Absolutely. Phone, phone encounters are
very important part of
this access to health care.
But there are other individuals, other,
especially the elderly patient that
just I love going to
the clinic just to get out of the house.
Yeah. So that's another option is just well,
you are welcome to go to the clinic
and visit people and
have your, your discussion.
So the option of how to get connected with
your health care provider is going to
be based on the patient's preference.
Sorry, the way that they want to do,
even if they wanna do telemedicine,
computer savvy, and love to do that stuff.
Absolutely. We can we can arrange. Wonderful.
So once you've identified
this patient more centrally,
probably from the medical record,
then we'll these reports go
out to the provider.
There'll be a single provider or a team at
the sites that will get
reports on these different big four.
Excellent, So good question
what we have, we have a,
a centralized system that
we make an analogy with,
let's say air traffic controller.
So the air traffic controller is
the person who has access
to this application that we have
created that's populated
by medical record data.
And then that person
assigns assigns a patient's care providers,
they do the communications
between the different team members.
I including the primary care doctor,
the nurses, and all these providers
that we're talking about.
Then this information gets added
to the updated to
the patient's medical record.
Which by the way, as you know here at Mayo,
we have a wonderful system where each one
of the clinics that
we have across all these rural communities,
they all use the same medical record system.
That's great.
And another big, big
strength and a big need that there
was raised by the rural people
who live there in
these areas was our patients.
They really enjoy receiving care by
providers that work there
in the rural communities.
And so we facilitate,
so all the providers that will be connecting
the patient work locally.
And whereas let's say
the air traffic controller
can cover many different clinics.
And then let's say, Oh,
today we don't have a tobacco
cessation counselor in community a,
but we have one community B.
Then the person from community B
could help in our resident in that community.
But these are all rural providers.
So we're not bringing someone
from urban area to
take care of these patients.
It's all local.
So really optimizes efficiencies of using
the personnel that are available.
That's tremendous.
And then will this be a pilot?
Are you going to do so many patients are
so many years and then look at
the data or what's the plan?
So currently, we are actually using
our pilot number two that
is happening in
opportunity in Austin, Minnesota.
And this fall, the intention
is to implement or deploy
the system in outsides of
the Mayo Clinic Health System
in southeast Minnesota.
Wonderful. Now you're 54% of
Native Americans live in a rural community.
We, do, we have any,
we don't have any really
a Native American pockets
within the Mayo Clinic Health System,
Dewey or not that I'm aware of.
Up by Red Wing, there may
be there is a community there,
but that's pretty interesting.
So you can approach
all the different aspects of this care.
The now you have this is a publication.
It will be coming out soon.
What is the journal it will be
in and when do we expect it?
So it's Journal of
Medical Internet research Jamie here.
And it's impress, it should
be coming up within less than a month.
Well, that's a big journal in this area.
I know that that's
a very well-respected journal.
So overall, this will approach kind of
the the on-the-ground issues
that we can deal with with the patient.
This won't be able to
approach the bricks-and-mortar that
we need more hospitals,
we need more communication,
transportation, we need better reimbursement.
But hopefully this research will start
to lead to questions
of what we need to fix next to help
our, our rural communities.
So this is a very exciting project
Dr. Rudolph's and thank you
for visiting with us today.
Any final words or
insights you want to give our listeners?
Yes. I think
this whole new system of care was
created together with the local providers
and with the input for the local patients.
And I think it was very
important to critically important
to get their input on how to access
this health care and how to address
these health disparity by
optimization, often local resources.
So far as it's being
privileged to be part of this group,
boy, that's great insight and wisdom.
Include the communities include
the patients, include the caregivers,
and not just the physician providers,
the nurses,
the pharmacist,
the tobacco cessation, et cetera.
That's wonderful. Well, that's
been a great conversation.
We're looking forward to the results of this.
Probably the next year or two,
we'll probably come back
and give you results.
The again of Steve
can pesky talking today with
Dr. Adelaide or rude Olson
about rural communities
and secondary prevention.
Thank you for listening. Good day.