Abstracts

Rationale: The management of individuals with Epilepsy presents special problems when poverty and physical isolation coexist with the diagnosis. Often these individuals receive medical care through periodic inappropriate emergency room visits. People living in rural areas have difficulty in accessing any type of care due to their geographic isolation. In Texas it is estimated there are at least 193,000 people who have epilepsy and over 8,500 new cases are diagnosed each year. In addition, Texas has one of the highest rates of uninsured in the country (25%). Methods: In 2001, The Epilepsy Foundation of Southeast Texas joined the University of Texas Medical Branch to create a program to help meet the needs of individuals with Epilepsy who are uninsured and live in rural communities. This program, The Telemedicine Epilepsy Management Program of Texas (TEMPT), provides care to residents of 105 of the 254 Texas counties who have been diagnosed with epilepsy. Of the approximately 143,000 individuals in this region diagnosed with Epilepsy, 35,750 would be expected to be indigent and have limited or no access to health care services. The TEMPT project is funded by a competitive grant from the Texas Department of Health and Human Services. The funding is intended to help with access to medical care, diagnostic testing and methods for obtaining medications. Due to the distance between clinics, telemedicine services are used to deliver care to the more remote counties. Currently, the TEMPT project has 8 clinic sites, all of which are connected through telemedicine. The model of care utilized in the project includes an advanced practice nurse as the provider in collaboration with a general neurologist. Both individuals see patients through telemedicine and in an ambulatory care setting. Collaboration between an advanced practice nurse and physician has been reported for many disease-specific situations including rheumatology (Hill, 1997) and Congestive heart failure (Paul, 1997l West et al, 1997). Previous work (Hartshorn and Rasmusson, 2005) demonstrated that this model is equivalent to the traditional face to face clinic in terms of decreasing Emergency Room visits and hospitalizations. Results: Currently, over 800 patients are seen in the eight clinics. Patients are referred to the clinics by neurologists in the area, local emergency rooms and county clinic programs. Clinics are scheduled routinely in all eight sites and patients are seen as often as needed. All diagnostic and laboratory tests are performed locally and the services are paid by grant funds. Preliminary data shows that as a result of this program, patients have been able to decrease their reliance on emergency rooms, the incidence of seizures has decreased and there has been an increased perception of quality of life. Conclusions: Results of this program demonstrate that telemedicine can be used to improve the provision of care to individuals in rural communities and those who have no medical coverage.