Dr. Susan Emmett is an otolaryngologist and public health-trained researcher who leads the University of Arkansas for Medical Sciences’ (UAMS) Center for Hearing Health Equity. She led a UAMS study focused on school-based hearing screening programs in rural Alaska that showed that referring kids to specialists via telemedicine provided significantly quicker access to follow-up care than referring them to primary care providers.
The Hearing Norton Sound Study was conducted from 2017-2020 in 15 rural Alaskan communities. It involved 1,500 kids in the Bering Strait School District, and found that children in the telemedicine specialty referral pathway received follow-up care 17.6 times faster than those in the standard primary care referral pathway. In this Q&A, Emmett discusses the benefits telemedicine provides for rural Alaskans.
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State of Reform: How did researchers based in Arkansas determine that Alaska was a good place to conduct the study?
Susan Emmett: “The Hearing Norton Sound study was a collaborative effort that originated from stakeholders in Alaska for children in Alaska. One of the leaders of the study, Dr. Samantha Kleindienst Robler, has served as an audiologist and population health researcher in rural Alaska for nearly a decade. She continues to work part-time for Norton Sound Health Corporation in addition to her academic position at the University of Arkansas for Medical Sciences.
I was working as an otolaryngologist in Alaska at the time the ideas for the study were first developed, and I continued to spend several months per year in Alaska throughout the project.
The Alaska stakeholder team—which included parent, patient, educator, health care, and Alaska Native perspectives—was involved in identifying the need to improve hearing screening and follow-up in Alaska, and developing the telehealth-based approach. Alaska was a good place for this study because there is already state-of-the-art telehealth infrastructure in communities across the state that is routinely used for clinical care for ear and hearing problems.
The innovations the state has already made in telehealth meant that it was possible to test whether telehealth for routine clinical care could also be used to improve preventive care, such as follow-up after school hearing screening.”
SOR: Can you discuss some possible reasons why the kids using telehealth services received faster follow-up care than those using standard primary care referrals?
SE: “School screening programs often face challenges with follow-up. Even if children are identified through school screening as needing additional care, frequently they never enter the health care system to receive the care that they need. This is a challenge not just in Alaska, but in all screening programs across the US and internationally.
Compounding the challenge is a scarcity of specialists in rural areas to provide that follow-up care. In this study, children identified in school screening as needing additional care were more than twice as likely to receive follow-up in the telehealth pathway, and follow-up happened over 17 times faster.
One major reason for care being provided faster is that telehealth can overcome the geographic barriers to receiving specialty care in rural areas. Using telehealth, images and hearing data were collected as part of the study, stored, and sent for a specialist to review in a timely manner, in this case [to] an audiologist based hundreds of miles away. This process expedited children entering the health care system to receive needed care and reduced the geographic barrier to specialists.
A second reason is that the telehealth pathway supported schools and local clinics to work together to schedule telehealth visits, compared to the standard primary care referral pathway that involved a letter home asking parents to coordinate the follow-up appointment.”
SOR: While this study focused on hearing, what other health care services might be well-suited for delivery through telehealth methods for rural Alaskans?
SE: “One of the most exciting aspects of this project is that the model of specialty telehealth referral is applicable not just to hearing, but also to other preventive health services in the school setting, such as vision screening and evaluations for developmental disabilities and behavioral health.”
SOR: Rural Alaskans face barriers like inclement weather and geographic challenges when seeking health care. Could telehealth serve as a permanent method for improving access to care there and in other rural US areas?
SE: “Alaska has been a leader in telehealth for over 20 years and has demonstrated how the technology can be vital in overcoming geographic barriers to care. This project expands the applicability of telehealth from clinical care to also include preventive care in the school setting. It is exciting to see innovations that have originated in Alaska serve as a model for improving access to care across all of rural America.”
This Q&A was edited for clarity and length.