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Rural America Comes to HRSA

HRSA rural policy chief Tom Morris
"There's a lot we can learn from each other," HRSA rural policy chief Tom Morris told more than 300 attendees at last week's rural grantees conference. "The fact is that you're all doing great work out there." The meeting showcased HRSA-funded projects -- from the island towns of the Chesapeake Bay to the Mississippi Delta and the plains of Oklahoma.

 

At left, Jody Diebold of the Mississippi County Health Department in Charleston, Mo. described how her agency used an initial grant from HRSA to build a digital network (center) across 13 high-poverty rural counties with high rates of chronic disease. Known collectively as "The Bootheel Counties," the region encompasses vast tracts of open farmland west of the Mississippi River and is considered one of the most flood-prone areas in the U.S.

Incubators of change: At left, Jody Diebold of the Mississippi County Health Department in Charleston, Mo. described how her agency used an initial grant from HRSA to build a digital network (center) across 13 high-poverty rural counties with high rates of chronic disease. Known collectively as "The Bootheel Counties," the region encompasses vast tracts of open farmland west of the Mississippi River and is considered one of the most flood-prone areas in the U.S. 

The network links residents to six far-flung health centers, local mental health providers, self-help classes and support groups through a "geo-fencing" system. Residents receive automatic alerts to their cell phones of upcoming events and available services whenever they venture near a provider who can help.

At right, Karen Nichols of South Carolina's Upper Midlands Rural Health Network gave a detailed report on a HRSA-supported project that teams "personal coaches" with isolated chronic disease patients to help them -- on the phone, online or in personal home visits -- maintain mobility, solve prescription problems and "stay on track" with their own care regimens. Residents live in an eight-county area that straddles the Savannah River, in the state's famed Sandhills region.

Nichols noted that the project cut readmissions at three local hospitals with its initial trial group of 115 patients. The state has since introduced the program to seven more rural hospitals -- and 900 others nationwide are piloting the approach.

 

Michael Blodgett, former paramedic and now program coordinator for FORHP's Opioid Program with Opioid panelists: Kerry Palakanis, telehealth nurse-practitioner, Crisfield, Md.; Garrett Moran, of AHRQ; Kami Anderson of the Clarion Drug and Alcohol Commission in Shelocta, Pa. (pop.: 150), with Clarion supervisory recovery counselor Mike Krafick, who personally struggled for nearly a decade with narcotics addiction.

A public health crisis in the heartland: (from left) Michael Blodgett, former paramedic and now program coordinator for FORHP's Opioid Program, which provides funding to rural communities to establish addiction services. FORHP previously invested $1.5 million in training first-responders how to use overdose reversal medications.

Opioid panelists: Kerry Palakanis, telehealth nurse-practitioner, Crisfield, Md.; Garrett Moran, of AHRQ; Kami Anderson of the Clarion Drug and Alcohol Commission in Shelocta, Pa. (pop.: 150), with Clarion supervisory recovery counselor Mike Krafick, who personally struggled for nearly a decade with narcotics addiction.

"People have to get used to the idea that addiction is a chronic, relapsing condition," said Palakanis, a HRSA-funded, traveling telehealth nurse who serves the tiny fishing towns and island settlements that dot the southernmost tip of Maryland's Eastern Shore. "The challenges you face are really not much different than what you face with any other chronic disease.

"A lot of these folks have co-occurring health conditions, and addiction just happens to be one of them ... there should be no division in who gets treated for what, or where they have to go to get it," but the stigma is similar to that often faced by rural HIV patients.

Krafick -- who overdosed five times before he "got straight" in 2005 -- further observed that new opioid treatment programs attract "a lot of people we didn't necessarily expect to see, like late-stage alcoholics." In remote communities, where health services may not have existed before, addicted patients grow weary of "cycling in and out of emergency departments" and police custody at public expense "because they don't have any place to go."

Moran of ARQH pointed to new care models HRSA Exit disclaimer with proven track records, but said that housing and transportation are persistent problems in getting patients into consistent treatment far from home. In the absence of alternative resources, he said, "relapse is what people do."

 

Attendees from 43 states met at the Bethesda North Marriott Hotel and Convention Center to discuss FORHP programs that target such problems as Black Lung Disease, radiation exposure, allied health workforce shortages and rural opioid misuse.
Face to face: Attendees from 43 states met at the Bethesda North Marriott Hotel and Convention Center to discuss FORHP programs that target such problems as Black Lung Disease, radiation exposure, allied health workforce shortages and rural opioid misuse. More than 30 seminars were offered over three days. Grantees form networks with existing community groups to pioneer new ways of serving some of the most isolated populations in America. See the full listing.

 

Deputy U.S. Surgeon General Sylvia Trent-Adams saluted the group for "the level of understanding you have of rural communities and rural patients ... your spirit of innovation serves as an example to the rest of the country" -- particularly as the nation grapples with the opioid crisis.
Deputy U.S. Surgeon General Sylvia Trent-Adams saluted the group for "the level of understanding you have of rural communities and rural patients ... your spirit of innovation serves as an example to the rest of the country" -- particularly as the nation grapples with the opioid crisis.

Date Last Reviewed:  March 2018