For a smaller Veterans Administration hospital, the John J. Pershing VA Medical Center in Poplar Bluff, Mo. has a large service area, including 27 counties in Southeastern Missouri and Northern Arkansas. One of the biggest challenges facing the medical center is finding innovative ways to care for veterans who sometimes have to drive several hours to get medical care.

“The extreme travel distances for our patients is something you just don’t see in an urban setting,” said Glenn Costie, CEO. Before coming to the Poplar Bluff facility last fall, Costie was the COO of a much larger VA Medical Center in Baltimore, Md.

“The biggest challenge I hear from patients is the long travel distance to get healthcare, whether it is an hour to an hour and a half to get to the hospital or two to three hours to get to St. Louis or Memphis for services we don’t provide here,” Costie said. “For some of our treatment, that could be a weekly, or even a daily, event. If you are being treated for cancer and need to drive that far every week for chemotherapy or radiation treatment, it can be really draining.”

Because of the lack of public transportation and the greater distances between locations that are not as problematic in urban locations, there is no single solution to the challenge. However, Costie said the Pershing VA is taking steps to make care more convenient for veterans.

“We recently did ribbon cuttings for two outpatient clinics, one in Cape Girardeau and one in Sikeston,” Costie said. “These were significant expansions for us, doubling the size of both locations and adding services and space. We now have an area where we can deal with mental health issues in an outpatient setting.”

The medical center is now able to provide radiology services at both locations as well. “We’ve added mobile X-ray units at these locations,” Costie said. “They are they types that are usually rolled up to a patient’s bed in an inpatient setting. We’re going to use these in the outpatient setting to see how much demand there is for radiology services and how it improves patient satisfaction.”

If there is a great demand for the services, Costie said the medical center would consider adding a permanent radiology room to the locations. “For now, it is an innovative service where we can plug some of our gaps,” he said. “In a rural facility, you don’t have a lot of money, and you have to find creative ways to make things happen.”

Changing needs

With the US involved in ongoing wars on multiple fronts, Costie said the VA is cognizant of the needs of more current veterans. “The thing I am noticing with the current veterans is the need for increased communication; they really want to be involved in their healthcare,” said Costie. “I met with one veteran recently who knew exactly what he was being treated for, what the effects of his medication were, and how it would affect his weight and metabolism. He almost sounded like he was being his own doctor.”

Like the veteran he met with recently, Costie said there are many current veterans who want greater access to information and more direct access to their health records. “They want to be able to e-mail their doctors and pass on information about how they are doing,” he said. “Those are the types of issues we are just starting to work on with our My HealtheVet program.”

The MyHealtheVet program is a Web site where patients have access to parts of their medical records, such as lab results and appointment schedules. Costie said the medical center is working on a secure messaging program that allows patients to text or e-mail their physicians to inquire about sensitive medical information.

“The Korean- and Vietnam-era veterans don’t seem to expect as much with electronic communications as current veterans do,” he said. “I think we are a little bit behind the curve in what the expectations are, but I am confident that with the latest updates to our My HealtheVet Web site, the patients are going to have greater access to information about their healthcare.”

Healthcare over the airwaves

Another way the medical center has increased access to specialty care in the community is through its telemedicine program. Essentially, it’s a sophisticated video teleconferencing system that gives patients greater access to specialized care.

“We are limited in the number of specialists, such as psychiatrists and psychologists, we can get to the outpatient clinics,” Costie said. The high quality video feed can provide help with any number of specialties.

“It’s another way we are trying to address the issue of drive times and the remoteness of some of our veterans,” he said. “Dermatology is one specialty that can be hard for us to fill, but with the teleconferencing, we can put the TV cameras in our outpatient clinics. The patient can be in the clinic, and the doctor may be anywhere in the world but is generally within the state of Missouri. The quality of the images is so high that the dermatologists can diagnose skin cancer and check on other types of ailments.”

Over the coming years, Costie said the medical center will continue its push to make care more accessible to patients. “The other big issue we are pushing with the VA is patient-centered care and the implementation of the medical home model,” he said. “The philosophy is to treat the patient in a more proactive or preventive manner rather than in an episodic way—the patient only comes in when he has as ailment.”

Costie said he remains positive about the level of care the VA will continue to provide to US veterans, especially those who will be returning home from the wars in Iraq and Afghanistan. “We believe we are being given the resources we need to give high quality care to the veterans,” he said.

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