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Health care providers, educators and students gathered in Asheville last week to discuss the region’s health care needs.

By Taylor Sisk

Visits to a doctor, nurse practitioner or dentist’s office are obviously critical elements of maintaining overall health. But the effectiveness of those visits is determined to a large extent by what happens outside of those offices – in the home, the workplace, the community.

Rural Rx: NC Health News coverage of rural health issues. This week: Western NC

This was a recurring theme at Friday’s first annual Western North Carolina Rural Health Symposium, hosted by Western Carolina University’s School of Nursing and held at the Holiday Inn Biltmore West in Asheville.

Creative approaches to helping people maintain or restore good health are critical in rural areas with fewer resources. This point was underscored by a number of symposium speakers.

Judith Long, executive director of The Free Clinics of Henderson County, which provides free health care services to low-income, uninsured residents, described the clinic’s caseload: “the hardest patients with the most complex medical conditions, exacerbated by procrastination of care, lack of financial means and all the life issues this encompasses.”

Among these issues, Long said, are illiteracy, transportation barriers, transient living situations and mental health and substance abuse concerns.

Several speakers stressed the need for “culturally congruent” services – figuring out what works best for a particular community – and the importance of going “upstream” to better understand the causes of health and health care deficiencies.

Lisa Harmon, chair of the nursing department at the State University of New York’s College of Technology at Alfred and a specialist on rural health nursing, was keynote speaker and a facilitator for discussions.

What’s needed, Harmon said, echoing what she was hearing from the audience, is collaborative engagement and innovative strategies. That audience of some 100 included a number of students in a variety of health care fields, and exchanges were lively.

Lisa Harmon, chair of the nursing department at the State University of New York’s College of Technology, served as the WNC Rural Health Symposium’s keynote speaker. Photo credit: Taylor Sisk

Those with the most critical needs

Public health officials from throughout Western North Carolina reported issues with health care access, particularly behavioral health care, and high rates of diabetes, obesity, heart disease and mental health and substance abuse issues. They also reported an increasing incidence of opioid overdose.

These concerns reflect national concerns.

Rural residents generally receive fewer preventive services than urban residents, leading to more chronic diseases and conditions according to the Rural Policy Research Institute.

And the use of heroin is on the rise in rural areas, with users likely to have previously abused prescription painkillers.

According to a report from the federal Agency for Healthcare Research and Quality, 1 percent of patients accounted for 21 percent of the nearly $1.3 trillion spent on health care in this country in 2010. Five percent of patients accounted for 50 percent of costs.

These patients are found disproportionately in rural areas, Long said.

What do our patients need? she asked. Certainly, a “tremendous amount of clinical intervention and care.” But perhaps most significantly, Long said, they need “recognition of their challenges, not punishment for bad behavior. They need empathy.”

“Life happens sometimes,” she said. “And with your patients, life happens more often than not, and dramatically.”

Possible Solutions

The symposium’s afternoon sessions involved breaking off into groups to discuss the primary issues rural Western North Carolina communities face and to suggest solutions.

Topics included the importance of knowing your patient’s social history and what they’ll be facing when they return home, and arranging supports accordingly.

Karen Cochran is director of WCU’s Rural Education and Support Scholarship Program. Photo credit: Taylor Sisk

A number of participants emphasized the urgency of addressing the stigma around mental health and substance abuse issues, which tends to be greater in rural areas.

Karen Cochran, director of WCU’s Rural Education and Support Scholarship Program and the symposium’s coordinator, said an idea that came out of the afternoon group discussions that particularly grabbed her attention was student-run community health fairs offering screenings, with educational booths that provide information related to the risks these screenings reveal. They could also offer, for example, gardening and cooking tips.

Such events could serve as students’ capstone or service learning projects, would be relatively easy to implement and would “have a lot of impact,” Cochran said.

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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