Phones Enable Smart Wound Care in Rural Areas
by Candi Helseth
Kristi McClellan, a Saint Francis University health sciences student, demonstrates how smartphone technology can be used for wound care.Leslie Wilson spends a lot of time on her smartphone looking at what some people might term disgusting photos. Wilson, a registered nurse with advanced certification as a wound ostomy continence nurse (WOCN), uses cellular technology to monitor, assess, and develop treatment plans to heal nasty, persistent wounds. On the other end of that cellular connection is a home care nurse who applies Wilson’s advice and a homebound patient whose wound is getting proper care.
WOCNs like Wilson are in short supply nationwide. Meanwhile, the number of patients suffering from chronic wounds has risen to nearly six million throughout the United States, according to Brenda Guzic, St. Francis University (SFU) CERMUSA Assistant Director for Telehealth. SFU’s Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA) in Loretto, Penn., and Wilson’s employer, Home Nursing Agency (HNA) in Altoona, Penn., are collaborating in a project to assess the success of cellular technology wound home care throughout the HNA service area, in what they believe is the first and only rural program in the United States to use smartphone technology in this way. HNA has provided home health and other services in 13 west central Pennsylvania counties since 1968.
In her Altoona office, Wilson receives cellular images from HNA home care nurses who travel to patients’ homes. They give a verbal report of their findings while Wilson views the photographs. Then she consults with the nurse and patient while the nurse is still present in the home. In the past, Wilson said, she spent travel time going to a patient’s home for an initial assessment and often returning for follow-up visits. Now she sees more patients more frequently.
“My role is to provide wound assessment and topical treatment using the best product for that wound,” she explained. “This is definitely a collaborative effort. These images can easily be sent instantly to physicians or other providers involved in care. And patients still get that home visit from a nurse. There’s a good medical reason to keep that home visit because nurses can identify potential problems in the home that we wouldn’t know otherwise. The nurse also provides education so the family is involved in the care.”
Guzic said home care patients with wounds are the largest population nationwide for visiting nurses. Non-healing surgical wounds and pressure ulcers are the most common types of wounds in HNA patients, and the majority of those patients are diagnosed with a co-morbidity of diabetes and/or heart disease. Other patients who frequently need wound care treatment include those with diagnoses of strokes, multiple sclerosis and trauma injuries.
The majority of HNA patients are homebound and elderly, have trouble walking or moving, and/or are bedridden. Traveling to clinics for care is difficult due to the distance, patient’s condition, lack of transportation, weather conditions and other barriers.
“Use of smartphones effectively increases patients’ access to specialized wound care, increases the number of encounters for patients and allows agencies to better utilize hard-to-find specialty nurses more effectively,” Wilson said. “An average smartphone consult lasts 26 minutes compared to an in-home visit averaging 78 minutes. For in-home visits, there’s an additional 65 minutes in travel time, on average. The extra time required for one in-home visit equates to four visits that could occur with the use of smartphone technology.”
Guzic said patient satisfaction surveys indicate patients like the personal visits and are glad their wounds are being inspected more frequently. Hospital readmissions and emergency room visits have decreased.
When the project began seven years ago, nurses carried nearly 20 pounds of video conferencing equipment into the homes along with their clinical supplies. The smartphone can be tucked in a pocket and is more user friendly for nurses, Guzic said. With expansion of cell coverage in recent years, almost all HNA service areas have adequate coverage. Where it doesn’t exist, the nurses still use the video conferencing equipment.
The U.S. Army Medical Research and Material Command (USAMRMC) Telemedicine and Advanced Technology Research Center (TATRC) at Fort Detrick, Md., funds the project. In May, HNA and CERMUSA began compiling a study that will include assessment of wound healing rates, rehospitalization rates and quality of life scores resulting from the use of smartphone technology.
“We have a lot of young men and women who’ve been deployed in active duty and are returning to their rural communities for treatment and care,” Guzic said. “The military wants to be able to evaluate if they can get care equivalent to what they’d get in urban areas.” Results of the study should be published by fall.
For more information, contact Brenda Guzic at St. Francis University at 814-472-3273 or email her at bguzic@cermusa.francis.edu.
AROUND THE COUNTRY
Center Inspires Active Living in New Hampshire Communities
by Candi Helseth
Participants in the annual Circle Trot run/walk event in Plymouth, N.H., raise money for local fitness programs while having fun.At the foothills of the White Mountains in New Hampshire’s North Country and Lakes Region, the scenic forested and lake-covered terrain is a popular attraction for outdoor enthusiasts like rock climbers, bikers, hikers and skiers. Yet many of the region’s 35,000 residents don’t take advantage of these recreational areas. Instead they struggle with the same health problems marked by inactivity and sedentary living that are epidemic in rural areas nationwide, according to Barbara McCahan, Ph.D., director of the Plymouth State University (PSU) Center for Active Living and Healthy Communities (CfALHC). Using research, education and community partnerships, CfALHC attempts to change residents’ lifestyles for the better.
“What we’ve found is that we have an aging population with virtually few or no amenities that make it easier to be physically active,” McCahan said. “Not everyone is able to rock climb, ski or bicycle. Even walking forest trails may be a challenge, because it requires outdoor confidence and a level of comfort in dealing with obstacles such as insects, animals, poison ivy, ice and snow. Hypokinetic diseases such as obesity, hypertension, high cholesterol, osteoporosis and adult-onset diabetes are prevalent. And these small rural towns are not equipped with adequate places and spaces with safe and easy access to physical activity.”
Tapping the talents of PSU students, CfALHC has initiated several programs in surrounding towns that are changing those small-town dynamics. At Inter-Lakes Senior Center in Meredith, adults ranging in age from 60 to 86 exercise under the direction of PSU student teachers. Center Director Becky Carey said participants routinely show improvements in balance, bone density and cardiovascular endurance when PSU staff conducts six-month follow-up assessments. Seeing improvements in their patients, local physicians refer other patients to the class, Carey added.
“This class is just incredible, I just can’t say enough good about what this program has done for our members!” Carey exclaimed. “Barbara and her staff put in a lot of groundwork before we started and that really paid off. Our members improve physically but they get so much more out of it too. They learn from the students and the students learn from them. It’s so fun to see how that age gap disappears.”
A collaborative partnership between CfALHC and The Circle Program of Plymouth also blends the generations. Designed for 10 to 16-year-old socio-economically challenged girls, Circle’s programming includes an intensive summer camp followed by a one-on-one relationship year round with an adult mentor. PSU students also plan and execute a fundraiser, The Circle Trot, to support program expenses. Circle Trot features a 10K run, 5K run and walk options.
“Participation has doubled the last two years,” McCahan said. “Circle Trot attracts all kinds of community members, including walkers, joggers, runners, parents with children walking and in strollers, older adults and dogs!”
PSU senior Lacey Mailman, who has been involved in Circle Trot and the Inter-Lakes class, said the hands-on experience benefited her in ways she’d never have experienced “out of a book.”
“I learned so much better than I would have sitting in a classroom writing a paper about something,” she said. “I was a bit anxious when I started at the senior center, but I really loved it. I’ve been an athlete myself and had worked with younger kids but never with older adults. Getting out into the community really helped me better use what I am learning in college.”
CfALHC also partnered with the Eco-Learning Farm Stand (ELFS) in the development of collaborative community gardens. Adult volunteers and area children reconnect with the land as they plant and harvest gardens. At the local elementary school, teachers incorporate gardening into their curriculum. Area food pantries and other community help organizations benefit from garden donations of fresh, pesticide-free produce.
Through the Partners Enabling Active Rural Living (PEARL) project begun in 2009, CfALHC faculty and student researchers team with community residents to identify environmental, personal and organizational factors that enable or prevent active living in the residents’ communities. Then they plan projects that address needs specific to those communities.
Students and resident volunteers used digital cameras and GPS navigation to map environmental features that encourage or obstruct active living in three surrounding rural towns. Activity models using Google-style maps, which identify what is needed to make these towns “activity friendly,” are in various stages of progress.
“We involve communities in planning and working on projects important to their community,” McCahan explained. “We bring the expertise in terms of research and evidence-based practices. We also bring undergraduate and graduate students from the university to help with these programs.”
Local residents enjoy gardens that students from Plymouth State University help them plant.In Rumney, the ballpark used primarily by adult teams has been upgraded. In Warren and Plymouth, where skateboarding is popular among youth, skate parks are getting exciting new additions. New children’s playground equipment is being installed in Plymouth’s town park. Residents from Alexandria, Bridgewater, Bristol and Hebron are working with PSU to build non-motorized transportation paths for walking and bicycling around Newfound Lake, a major attraction for all four towns.
CfALHC is funded by a grant from the Centers for Disease Control and Prevention (CDC). McCahan said a full report of CfALHC’s research and results is being compiled, which will be published in the Journal of Rural Social Sciences.
As a 23-year PSU faculty member, McCahan lives what she preaches. A personal trainer, swimmer and skier, she has more than 25 years of experience as an exercise specialist, fitness trainer and lifestyle coach. She is a full Professor in PSU’s Health and Human Performance Department, teaching classes in exercise science and health promotion.
To learn more about CfALHC, contact Barbara McCahan at 603-535 2578 or cfalhc@plymouth.edu.
