SIOUX CITY | Mercy cardiologist Frank Addo folds up an echocardiography machine and places it in a carry case before getting into a hospital-issued vehicle and driving with an echo technician to satellite clinics in Primghar, Storm Lake, Hawarden and Le Mars, Iowa, several times a month.
"It's a small machine, but it does a lot of magic," Addo said of the echocardiography machine, which allows him to perform an ultrasound of the heart. "We go with a vascular probe, so we are able to look for stenosis in somebody's carotid arteries and decreased blood flow in the arteries to their legs."
Mercy Cardiology began serving patients at satellite clinics in December 2010. In addition to Addo, two other Mercy cardiologists also see patients in rural areas. Other satellite clinics are located in Pender, Wayne, Oakland and Macy, Nebraska; Elk Point, South Dakota; and Kingsley and Cherokee, Iowa.
"Patients tend to live very far away from a major facility, so they may have to drive long distances. In older populations, that may not be possible or convenient for them to do. That is where outreaches become very important," Addo explained. "Iowa has one of the oldest populations; and we've learned over a long time that patients can't get to us if we do not go to them either, because of their failing health or just not having the support."
Most of Mercy's satellite clinics, which are predominately located in hospitals, have treadmills on site, so Addo said he and his colleagues can conduct stress tests. He said patients can also receive an electrocardiogram, a test that records the heart's electrical signals, and laboratory work at satellite clinics. Patients who need a nuclear medicine stress test or a cardiac angiogram, he said, will need to go to a medical facility such as Mercy Heart Center.
"Otherwise, we will see you out there and try to do everything out there," said Addo, who cautioned that chest pain, heart palpitations, dizziness, shortness of breath and fainting are symptoms that shouldn't be ignored.
Addo said his rural patients are generally referred to a satellite clinic by primary care providers, who often call his office and schedule appointments for the dates he is in a particular city or town. He said he usually sees patients from around 9 a.m. to 5 p.m., or until the work is done.
On occasion, Addo said a "savvy" patient arrives at a satellite clinic without an appointment, after seeing a notice about the clinic in a local newspaper.
"I've had patients walk in without referrals and say, 'I hear the doctor is here today. I'd like to see him,'" he said. "It's something we need to do. They really need our help, and that's all there is to it."
When he's out on the road, Addo said he keeps in contact with his nurse in Sioux City in order to meet the urgent needs of patients receiving care at Mercy Heart Center. Being able to remotely access patient records through the hospital's computer system via laptop, he said is vital to manage in-town patients.
"If I'm out there and there are calls about a patient that I don't remember, then I can go to the computer, assess it and give the nurse advice as to what to do," he said. "If it's somebody who really needs to come, either I have one of my partners take care of the patient or some people are sick to the point where they have to go to the emergency room."
Besides juggling patients at multiple locations, Addo said getting authorization from health insurers to conduct testing at satellite clinics is sometimes challenging. Before a patient walks into the clinic, he said cardiologists don't always know which tests he or she needs. He said they try to anticipate those tests and get approval beforehand, but not all insurers allow this.
"Patients get disappointed, because most of the time they want everything done the same day. More and more, we have to jump through these loopholes to get these tests authorized for patients," said Addo, who advises patients to go to the nearest emergency room if their symptoms worsen in the days and weeks while waiting for authorization. "It's all about safety and communication."