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Early in the morning, pediatric subspecialist Claire Steinberg, CPNP-PC, BC-ADM, packs her gear and settles in for the two-and-a-half-hour drive from her home in the Missoula area to the Logan Health Specialty Care clinic in Helena, where she will be enthusiastically greeted by her young patients. She will have a long day in the clinic providing endocrinology and diabetes care: meeting with families, working through her lunch and using every hour of daylight before packing up, driving back and returning home tired but grateful. To her, the long days are well worth it because they allow her to fill a crucial need in the state of Montana. “Children deserve to have subspecialty care,” she says, “They deserve providers that are both trained in pediatrics and trained to help them with their unique health conditions.” Claire Steinberg in clinic

Likewise, Katie Flass, PA-C, also prepares to provide pediatric endocrinology and diabetes care at the Logan Health Specialty Care Clinic in Great Falls. Leaving from Kalispell, she drives for around four hours, taking in the scenery of West Glacier as she listens to an audiobook or podcast, and checks into a hotel to prep for two back-to-back clinic days. After providing as much care as she can during those two days, she makes the drive back home and takes satisfaction in knowing that everyone is taken care of. “It’s a long two days, but it is worth it to ease the travel burden for families,” she says.

Montana spans over 145,000 square miles and is the 4th largest U.S. state by size. Living in such a vast state, pediatric subspecialty care can be sparse, and families must often travel out of Montana for care. While new strides in telehealth have made specialty care far more accessible, face-to-face appointments are still very meaningful and helpful to providers and their patients.

Pediatric Physician Executive Dr. Courtney Paterson oversees Logan Health’s pediatric subspecialty outreach and describes how this outreach has been able to transform pediatric care in Montana, “The geography of Montana poses some unique challenges that are not seen in other rural states. Traditionally, families have traveled for hundreds of miles, many times out of state, to access pediatric specialty care. Since Logan Health Children’s opened in 2016, our pediatric specialists continue to travel over 100,000 miles per physician per year to see children all over Montana, rather than expecting families to always travel to Kalispell.”

Claire and Katie joined the outreach efforts when they recognized this need in their regions. “I have a unique position because my home clinic is an outreach specialty clinic in Missoula,” Claire says, “but I also drive to the Helena specialty clinic and provide care there. Both areas do lack pediatric subspecialty care. There are a lot of kids with type 1 diabetes, type 2 diabetes, thyroid disorders, or other hormone dysregulation disorders who need care that primary care providers are usually not trained in.”

At her regional clinic, Katie sees patients from all over. “Great Falls is one of the catchment areas for pretty much the whole Hi-Line and Central Montana when it comes to pediatric subspecialties,” she says, “A lot of the patients that I see there are already traveling several hours to get to the clinic, but it’s better than driving four additional hours to get to Kalispell.” In this way, Logan Health’s outreach clinics often serve as hubs for providers to visit, allowing families to reclaim their time and receive expert care while keeping their kids in state.

To provide this service for families, Claire and Katie switch off with other outreach providers and make the pilgrimage to their outreach clinics one or two days every other month. Sometimes they choose to drive straight through; other times they may spend the night to have an extra travel day. These trips are not without their challenges, and those serve as a reminder of how far away some families are from essential care. “You have to plan to be away from your family, your pets, whatever you have going on, so that can be difficult,” Claire says, “but every time I drive over to Helena, I remember that when my patients had an appointment with me, they would drive to Missoula. So, making that drive is a service we give them so they can have better access to care.”

A day in the outreach clinic passes in a blur, and the visiting specialists are incredibly thankful for the staff, who run the clinics like well-oiled machines. Katie enjoys the team atmosphere. “My schedule is pretty packed,” she says, “But we have a good core staff in the Great Falls clinic that live and work there, including the MA and nurse. They do all the prep and blood draws, and they can even set up telehealth with our dietitian and diabetes educator, so the patient can get everything done in one visit. It’s busy, but it runs very smoothly.” Claire also thrives in the dynamic atmosphere, “When you have an outreach day, you definitely want your schedule to be full. You really get to know the people in the specialty care clinic, and they are so helpful in knowing what you need for each patient, like their hemoglobin or A1C. They help us get everything we need.” Katie Flass with a patient family

When it comes time for their appointments, Katie, Claire, and the clinic staff would all agree that nothing beats seeing their patients in person.  “Sometimes, when my patients are getting checked in, they get a little peek of me,” Claire says, “They get so excited and want to say hi. I just love it. It’s so sweet.” Katie is always excited to help families gain new insight into their child’s condition. “We have a comprehensive team, which brings a lot of value to each visit. I’ve had many patients tell me that they have learned something new about their condition even when they’ve been managing it for a really long time.”

What also makes outreach rewarding for Claire and Katie is meeting people within the specific communities. “Getting to know my patients and their families is really fun,” Katie says. “There are a lot of ranching families out there and they love telling you about their lives. They’re really personable, sweet families, so it’s a pleasure to take care of them.” For Claire, being based in the Missoula outreach clinic allows her to connect deeply with her surrounding community. “I love the Missoula area. I’ve lived here for twenty years, so it’s really important for me to be here. Getting to know the families and see them grow in their knowledge of managing their condition is what ties me to my job. I get to see kids grow through different stages, from toddlerhood to middle school and beyond, and I get to be a part of their journey.”

As members of the Logan Health Diabetes and Endocrinology team and the broader Logan Health pediatric subspecialty team, Claire and Katie now find themselves inspired by the impact of their travels and look forward to the expansion of other pediatric services. “The Logan Health endocrinology team is so robust.” Claire says, “We are all pediatric trained and we have a provider on call 24/7. We get consults from hospitals in Missoula or Kalispell, or the ER in Libby or Great Falls. Our service extends so far, and we want providers in Western Montana to know that, so they can keep our kids close to home.” Dr. Paterson affirms that this is at the heart of both the Logan Health pediatric program and its enthusiastic outreach providers, “Our core mission is to deliver the highest quality care as close to home as possible. Montana children and their families deserve nothing less.”