Mobile cardiology clinic reaches rural, Native American populations in Oklahoma

Vascular surgeon Jim Melton, DO, co-founder of the CardioVascular Health Clinic in Oklahoma City, has spearheaded a mobile clinic program to provide cardiovascular services to rural and Native American communities across Oklahoma. The initiative aims to bridge the healthcare disparities gap in areas with limited access to specialized medical care.

The mobile clinic program, launched in 2015, sends teams of physicians to 14 remote locations across the state, including Enid, Chickasha, Ardmore, Clinton, Weatherford, Pauls Valley, Hinton, Altus, Woodward, Carnegie and Cherokee. The goal is to offer initial screenings and consultations for cardiovascular conditions, particularly focusing on peripheral artery disease (PAD) and critical limb ischemia (CLI), which are prevalent in these regions. Patients requiring advanced procedures are referred to the main clinic in Oklahoma City.

"Heart disease and diabetes are widespread in these rural areas," Melton explained. "But PAD and CLI rates are alarmingly high, especially among Native American populations."

Since starting this program, he said they have saved thousands of limbs, significantly improving mortality rates and the quality of life for these patients.

The mobile clinics are equipped with advanced diagnostic tools, including ultrasound machines for heart and vascular imaging, and mobile PET scanners for comprehensive cardiac assessments. The clinic teams coordinate closely with local healthcare providers to ensure a continuum of care, particularly for patients with diabetes-related complications.

Gaining access and trust of rural residents and Native Americans

Melton emphasized the importance of accessibility and trust in building successful outreach efforts. 

"The patients are very grateful to see specialists close to their homes," he said. "We try to make our services easily accessible and develop lasting bonds with the communities we serve."

While the Choctaw and Chickasaw nations in south and southeast Oklahoma have good general practice medical services, they are remote from major cities and have limited access to specialized medical services such as cardiology, vascular surgery and interventional radiology, which CardioVascular Health Clinic provides. Melton said they have a good working relationship with these two Native American nations, which has been built over the past decade. 

The diabetes, PAD and CLI rates among Native American populations are very high. Patients in remote areas often wait until their have severe, non-healing wounds on their feet and toes. Melton said they try to educate and screen patients during their remote clinic visits in an effort to build better awareness about these diseases and that the end result of untreated CLI is amputation of the foot or leg. He said amputation leads to a high of 60% rate of mortality within a a couple years of an amputation. It also costs many patients their independence and ability to live alone.

"Our mission is to lower amputation rates in Oklahoma by ensuring timely access to care," Melton said. "The Indian Health Service clinics do an excellent job with day-to-day care, but for more complex conditions, we step in to provide the necessary expertise."

The program has garnered positive feedback from both patients and local healthcare providers, highlighting the importance of specialized care in underserved areas. 

It is also important to build relationships with the local family practice physicians and endocrinologists patients already work with. Melton said these are the immediate providers these patients will continue to work with locally to manage their diabetes and other day-to-day health management concerns. 

How is the remote clinic program funded?

Despite the logistical challenges and lack of external funding, the program sustains itself through the procedures the group performs at its main ambulatory surgical center (ASC) clinic in Oklahoma City. While there is some reimbursement for testing and imaging, Melton said that alone does not cover the costs of sending physicians to the clinics. For trips longer than two hours, it is sometimes necessary to chart a plane to save time, but this can be expensive. 

Melton said the main goal is to help patients who otherwise would not have access to care. But, he said they do see ROI for the program in the form of screening patients and identifying those in need of cardiovascular care. He said they become life-long patients for the clinic. 

"We are going to have long, established visits with these patients because they're sick, and the care they need, whether that's a heart cath or an intervention to their leg , or a PCI with their heart because they're having angina, or a pacemaker or defibrillator, those all end up here. And so those are the things that we try to look down the road and see the long haul, the long picture, if you will," Melton explained. 

Encouraging other practices to consider similar outreach models

Over the past several years, there have been increasing numbers of sessions at cardiology conferences concerning PAD, CLI and the need to address growing health disparities. While there has been a lot of awareness raised, the question of how to address the disparities has been more of a challenge. 

Melton said his center's mobile clinic program has made a significant impact on the health and well-being of rural and Native American populations in Oklahoma, demonstrating the power of proactive, community-based healthcare initiatives. He hopes their program can serve as a model for peers elsewhere. 

"I believe in the spirit of independence and entrepreneurship in healthcare. If you see an opportunity to make a difference, talk to people that have done it and just go do it," Melton advised.

Watch the video at the top of the article for more insights from Melton.