Rural patients struggle to access diabetes specialists due to long distances, specialist shortages, and lengthy wait times. Telehealth specialist visits are constrained by limited broadband coverage in rural areas and low user-friendliness. This limits timely advanced care and contributes to poor outcomes.

• Rural diabetes patients who need specialist care but face high co-pays, long travel distances, and limited telehealth access
• Physicians who require specialist inputs for management of complex cases

When a primary care physician identifies the need for a diabetes referral, they typically initiate an electronic referral after which the patient attempts to schedule and attend a specialist appointment. Drop-off points for this process include the following:

Before scheduling:

• Patients may opt to not schedule at all after learning about high co-pays for specialist visits.
• Limited specialist visit availability means that patients face wait times of 2-3 months, making them less likely to initiate care. This is not communicated to primary care providers in a timely fashion, and PCPs may learn of unfulfilled referrals 6 months to a year after making them.

After scheduling:

• Patients face 2–3-hour travel times for specialist appointments, often arrive late to visits, and can be turned away. Many offices deprecate patients after two late/missed visits.
• Limited interoperability/communication between primary care and specialist records and teams also means that specialists must start at the beginning in terms of history taking, slowing down the care process if patients make it to their appointments.
• Patients are put in the position of having to communicate their disease state and advocate for themselves, which is an additional burden.

Telehealth, while promising, is limited by poor internet connectivity and patients’ low technology literacy, especially in rural areas where many still rely on flip phones or spotty cell service. Even when patients have some internet access, technical difficulties frequently arise, with minimal support available to assist them. From a cultural perspective, many rural GA patients are skeptical of telehealth and prefer visiting their providers in-person. Providers also face financial disincentives since telehealth visits reimburse less than in-person care.

The alternative to a specialist referral involves a rural PCP managing complex diabetes cases with specialist support through programs such as the Medical College of Georgia’s Digital Health Network and Georgia’s Project ECHO, which provides ongoing complex diabetes management education for primary care providers.

NEEDS STATEMENT:

1. Enable rural primary care providers to manage complex diabetes cases by providing specialist support .

2. Deliver timely, affordable specialist diabetes care to rural patients—eliminating the need for long-distance travel—while providing technical support for those with limited tech skills and unreliable internet access.

REQUIREMENTS:

• Relies more on low-bandwidth or SMS-based communications rather than high-speed internet or connects patients to locations that do have these features.
• Promotes a timely feedback loop between specialist and PCP such that both are updated on where the patient is before and after the specialist visit.

ADDITIONAL CONSIDERATIONS:

What incentives need to be in place for providers to collaborate with each other?

If connecting PCPs with specialist consultations, how will that fit into their already packed schedule? Ex. pre-scheduling specialist support sessions for PCPs (e.g., weekdays 12–1 pm) to provide real-time guidance, or having both providers present for the visit with a patient.