7 minute read
The Pacesetters
Before the pandemic forced a rise in telemedicine, UIC launched two telemedicine clinics with the Illinois Department of Corrections and set a model for care that continues to expand and demonstrate wide-ranging benefits.
On a warm and sunny Monday afternoon, Dr. Juliana Chan begins a phone call by apologizing for her voice. It’s weak and hoarse, the byproduct of a morning spent in constant conversation.
Chan spent nearly four hours on Monday, October 2, virtually shuttling between 20 patients spread across Illinois prisons as the head of UIC’s hepatitis C telemedicine clinic run in partnership with the Illinois Department of Corrections (IDOC).
“Twenty-minute visits with new patients and five-minute follow-ups with those who have finished treatment,” explains Chan, a clinical pharmacist and clinical associate professor in the College of Pharmacy’s Department of Pharmacy Practice.
Chan’s efforts, which began on Sunday with appointment prep work that included inspecting patient charts and preparing notes and will extend into Monday evening with a concluding review of the appointments,
are involved and taxing. The telemedicine clinic requires constant attention to detail and an earnest commitment to collaboration with other health professionals, including an on-site nurse as well as a remote physician and social worker.
The work is also groundbreaking. One of the earliest examples of a pharmacist-led telemedicine program, the UIC-IDOC partnership has improved patient health among a vulnerable population under the state’s care, unlocked novel opportunities for UIC trainees, and established a sustainable model for others to follow.
TRANSFORMING CARE
In early 2010, IDOC came to UIC seeking collaboration and a better plan to tend to the healthcare needs of those under its supervision.
At the time, individuals in IDOC custody were not receiving any standardized care. Medical care, for example, might be provided by a retired specialist or generalist and attention to chronic conditions might be best described as choppy.
UIC presented a novel solution in telemedicine—remote patient care empowered by technology. Though in its infancy at the time, telemedicine offered a cost-effective and streamlined way for IDOC to elevate its care.
In the summer of 2010, Chan started UIC’s hepatitis C telemedicine clinic alongside IDOC while fellow clinical pharmacist Dr. Melissa Badowski launched a telemedicine clinic devoted to HIV care. Both techinfused clinics started with three IDOC facilities and the goal of adding three additional facilities each month throughout year one.
“We got moving and quickly learned what worked and what didn’t and applied that to the next set of clinics,” Chan says, adding that both telemedicine clinics reached their ambitious rollout targets.
Badowski’s and Chan’s efforts got individuals with Hepatitis C and HIV who were in IDOC custody started on front-line regimens. Working closely with UIC’s dispensing pharmacy team, which was charged to distribute medications to the IDOC facilities, the respective clinics created a closed-loop system ensuring responsive action to supply issues or the latest treatment guidelines.
“Because we’re the specialists, we know what’s working in these [subspecialty] areas and can provide the appropriate care to improve outcomes,” says Badowski, a clinical professor in the Department of Pharmacy Practice.
Today, the Badowski- and Chan-led clinics work with 28 IDOC prisons and treatment centers spread across the state, each equipped with telemedicine equipment, such as electronic stethoscopes and high-definition electronic exam cameras. Collectively, Badowski and Chan see and treat about 1,500 HIV and hepatitis C patients each year, reviewing patient histories, medication adherence, and interpreting labs or imaging for the patient to inform next steps in care. They also provide education to prevent reinfection or spread of the respective viruses.
“We’re another set of eyes, and we advocate a lot for the patients,” Badowski says.
To that advocacy point, clinic protocols have evolved over the years. Initially, for example, Chan only saw hepatitis C patients at advanced stages. Now, any individual with the virus may receive care. The clinics also aim to see every new intake within two weeks of their arrival in the IDOC system.
Most notably, the clinics have produced impressive results. Before UIC’s arrival, in fact, about 50 percent of IDOC-housed patients living with HIV were virologically suppressed. Today, that number approaches 99 percent.
“We’ve moved the marker,” Badowski says. “There’s no denying that.”
EXPANDING HERE AND BEYOND
The success of the UIC-IDOC telemedicine clinics has generated widespread attention and expanded services. As telemedicine adoption accelerated amid the COVID-19 pandemic, for instance, professionals from other states and medical specialties regularly contacted Badowski and Chan for insights on their established practice.
“These telemedicine clinics have set a model for clinical practice others can and have followed,” says Dr. Edith Nutescu, head of the Department of Pharmacy Practice at the UIC College of Pharmacy.
And last year, UIC expanded its relationship with IDOC when it introduced a telemedicine clinic devoted to diabetes management. A complex and chronic condition, diabetes affects an estimated 2,000 individuals in IDOC custody.
Dr. Julio Rebolledo serves as the clinical pharmacist leading IDOC’s diabetes management telemedicine program, a collaboration with the UIC College of Medicine akin to the HIV and hepatitis C clinics. While
patients typically receive diabetes care on-site from a primary care provider, many have multiple comorbidities and require specialized diabetes care. Those individuals are referred to Rebolledo, who conducts a remote comprehensive diabetes assessment, ensures medication optimization, and oversees all follow-ups.
After seeing but a handful of patients each week throughout his opening months, largely limited to IDOC’s Dixon and Stateville facilities, Rebolledo’s caseload continues swelling as new IDOC facilities come on board. As of September 2023, Rebolledo is following 120 patients.
“Access to optimal diabetes care is complicated enough for the general population, and it’s a positive for the patient, the community, and the whole system when these individuals have access to first-line therapies, timely care, and education that keeps them healthy,” Rebolledo says.
MORE OPPORTUNITIES FOR GROWTH
Nutescu calls UIC’s telemedicine effort with IDOC a critical and important practice serving a vulnerable patient population, advancing health, and preserving cash in a budget-challenged state.
“With disease states like hepatitis C, HIV, and diabetes being high cost and high risk, this is a novel and effective way to provide the necessary medications and clinical pharmacist expertise for this population,” Nutescu says.
The College of Pharmacy, meanwhile, captures benefits from the relationship as well. In particular, students, residents, and trainees can work alongside top chronic disease experts during rotations and gain valuable experience in a tech-charged practice likely to become more commonplace throughout their careers.
“The telemedicine rotation is like no other,” Badowski says, adding that students can also take a telemedicine elective to gain an overview of the emerging service and its role in healthcare systems. Badowski recently taught that course alongside Chan.
Yet more, learners can also gain clinical research experience. Over the years, IDOC has approved a host of trainee-led, retrospective research studies examining clinical outcomes.
Given the relationship’s benefits to various stakeholders—the College of Pharmacy, IDOC, individuals in custody, and learners among them—it’s no wonder many hope to see the model grow.
Nutescu says the college is working with IDOC to identify other high-need disease states and strategize its next wave of action, which might include conditions such as hypertension or pulmonary disease.
Thereafter, the college hopes to export its model to other state correctional agencies, many of whom have already inquired about, if not studied, UIC’s model. Across the United States, many states continue struggling to meet the health needs of those in correctional custody, frequently battling budgetary, social, and political realities.
“There’s a clear need for a service like this, so how can we bring clinical pharmacy services to all prisons?” Badowski asks. “We’ve had excellent outcomes and been able to advocate for our patients, so there’s a successful model others can follow.”
But until then, Badowski, Chan, and Rebolledo will continue their purpose-driven work.
“Another Monday is just around the corner,” Chan says.
