It’s a fact of rural life: Sick children and their families often need to travel to see the specialists who can treat them.

It’s a fact of rural life: Sick children and their families often need to travel to see the specialists who can treat them.

Youngsters with complex asthma who face frequent emergency room visits and hospital admissions need to see a pediatric pulmonologist and not just a pediatrician or family doctor, said Dr. Kris Kjolhede, co-director of the Bassett Healthcare Network’s School-Based Health Program.

“OK, you can’t pull those out of your back pocket," he said. "Those are all at the major medical centers, which are all a minimum of an hour and a half away,” he said.

“Virtually, the same applies for diabetes,” he added.

The Mohawk Valley has 0.5 pediatric sub-specialists (which includes pulmonologists and endocrinologists, who treat diabetes) for every 100,000 residents, the lowest number of any region in the state, according to the Center for Health Workforce Studies 2014 physician profile survey. New York City has 12.3 pediatric sub-specialists per 100,000 residents.

The problem isn’t so much that there’s a shortage, said Jean Moore, director of the Center for Health Workforce Studies at the University at Albany. It’s that there isn’t enough demand in smaller communities to support full-time doctors, she said.

“I think that when you’re dealing with small numbers, when you’re dealing with physicians who have some very, very specific specialties, it’s much more challenging to support the distribution that I’d guess you’d like,” she said.

But Bassett is hoping to cut down on travel time for some of its patients and their families by using telemedicine, a method that’s increasingly being used to link rural or mobility-impaired patients to far-flung medical care with the use of video conferencing. The network has received a federal grant of $297,419 a year for up to four years to add telehealth services to 18 school-based health centers in Delaware, Otsego and Chenango counties.

Here’s what the program will do, Kjolhede said:

• Help a network nutritionist counsel children across the network without spending all day driving between centers.

• Let a network dentist look at those children’s teeth when they’re treated by dental hygienists in the program

• Allow children to have follow-up visits with a pediatric endocrinologist and pediatric pulmonologist at the University of Rochester Medical Center – Golisano Children’s Hospital, or a child and adolescent psychiatrist in New York City without making their families drive long distances.

Child and adolescent psychiatrists are more spread out across the state, with 3.6 per 100,000 in the Mohawk Valley, compared to 4.8 in New York City and 8.2 in the Hudson Valley, according to the workforce center. But that doesn’t mean there are enough to go around.

“Child and adolescent psychiatric backup is really, really difficult in these rural areas," Kjolhede said. "We serve one county that doesn’t have a psychiatrist, let alone a child and adolescent psychiatrist."

Telemedicine is an intelligent solution to limited access to highly specialized doctors, whether for adults or kids, Moore said.

“I think what they’re doing is important and very relevant,” she said.

It is not the only solution, though, particularly in a field such as psychiatry, Moore said. Psychiatric nurse practitioners really can expand the number of patients receiving psychiatric services in a population with limited access, whether that’s among rural residents or city dwellers who don’t have access to private-pay psychiatrists, she said.

Kjolhede said Bassett’s telehealth services – which the network already uses to clear kids with concussions to return to play – could expand farther in the future, but that will depend on how reimbursements for the service work out.

“The grant will initially cover a lot of that, but one of my goals has always been to try to make school-based health centers sustainable,” he said.

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