By Kim Walter
WINCHESTER -- Local health care representatives gathered Thursday morning at the Our Health campus to discuss what they felt must be included in the 2013 Virginia Rural Health Plan for it to be successful.
The plan is designed every three to five years -- the most recent one came out in 2008. While that one focused more on health care infrastructure in rural areas, problems were presented that still need solutions.
The upcoming plan started taking shape last summer when more then 1,000 individuals submitted their responses to a survey distributed by the Virginia Rural Health Association and the Virginia Public Health Association. The survey needed to identify the main issues having an impact on the public health in the state.
That data was used during discussions held at the Rural Health Action Conference in October. Now, the survey results and other issues brought up at the conference are the topic of five public forums taking place throughout the state, which will help form the final 2013 plan.
Valley Health, Shenandoah University and the Lord Fairfax Health District were represented at this first forum. Rep. Frank R. Wolf, R-10, also attended.
Some startling facts were presented on the health status of rural Virginians: they tend to die at an earlier age than non-rural residents. Some rural areas have an average life span up to 19 years below the state average, or 59.6 years compared to 78.5 years.
Rural areas also tend to have higher poverty rates and lower educational levels than urban parts of the state, which correlates with rural residents having limited health opportunities.
All those in attendance were given a chance to say exactly what they thought had to be included in the plan so that the state could start working toward solutions. For the most part, they all agreed on a few major themes.
It was made clear that access to health care - financially and through available transportation - needs to be improved upon in ways that made it efficient and effective for patients and their physicians.
Charles Devine, Lord Fairfax Health District director, cautioned that it isn't as simple as just sending a doctor to a home just because the patient is located in the middle of no where.
"It's not an efficient use of the doctor's services or time," he said.
However, Juliana Fehr, associate professor of nursing and coordinator of the nurse-midwifery program at Shenandoah University, said she found a way to do some home visits that benefitted a number of woman, as well as herself.
"I would go initially to visit a pregnant woman, but once women in the area around her found out I was coming, they would all want some kind of help," she said. "So, in the morning, I'll do some pap smears and breast exams and answer any other questions they have. I'd charge them for the exam and ask for an extra $5, and they would make a potluck meal, so I was happy."
Shortages in the health care workforce is affecting all areas of the state, but more so in the rural areas.
Travis Clark, Page Memorial Hospital president, said that a few times a month different physicians and specialists travel to free clinics from Winchester to provide services to Page County residents.
"If there's a student that graduates from Luray High School who wants to be a nurse, they need to be able to get some of that education and training right there at home," Clark said. "The minute they go off to Shenandoah, JMU, VCU, UVA ... we never see them again."
Todd Way, Valley Health senior vice president of regional operations agreed, saying that the state needed to find some kind of incentive or grant program to get more doctors to practice in rural areas.
The health officials said that it takes a special kind of health care provider to choose to offer services in a rural area, as culture and social norms can vary from their academic background.
Clark noted that, "There's still plenty of people around here who say, 'Grandma didn't go to the doctor, so I'm not going either.'"
He said more focus was needed in establishing "home-grown health care." He said he feels that residents of rural communities might be more likely to seek medical attention if the physician is someone they know and grew up with them.
"The doctors who come from the academic hospitals and residency programs are great, but I think they intimidate some of the folks who need to see them the most, especially if they've never been in a rural area before." Clark said.
Survey responses indicated that issues like obesity, lack of physical exercise and dental health all needed attention in the 2013 plan as well.
Clark said poor dental health made sense, since people in rural areas used a private well system with no added fluoride.
Fehr asked if the need for better dietary and physical lifestyles could be integrated more into education, but it was pointed out that in order for it to truly be enforced, the topics would need to be added to schools' Standards of Learning curriculum.
Something that has been discussed recently concerning health care is the need for more focus on prevention and early education, rather than reacting.
"We want people to want to be engaged in a fit lifestyle, to get them used to the thought of exercise being a part of their daily routine, rather than a chore," Fehr said.
Sidewalk walking trails, YMCAs and better utilization of state and local parks were all mentioned as venues that could seem appealing in a rural setting.
While David Stegmaier, director of community outreach for Wolf, said he firmly believes in the power of face-to-face consultation, others said that the power of tele-medicine and tele-education shouldn't be dismissed.
In Page County, Clark said tele-medicine is used often, both for patients to speak directly with doctors as well as for physicians to get second opinions and advice from providers in Winchester or even at larger academic hospitals.
Way agreed, and said the method could help with the physician shortage the health care system faces. The technology could also help if Medicaid is expanded in Virginia, and more people begin to use free clinics.
Fehr said it could be taken a step further in rural areas, especially in home visits.
"When I go to see a pregnant woman, and I find that her home is cluttered or she lives with her mother who has a number of issues, I should be able to take a video, or even pictures, and show them to another type of doctor who can help with that," she said. The thinking relates back to a "continuum of care," something that Valley Health is beginning to look at as they face the changes to come with the Affordable Care Act.
Clark said mental health patients might do better with tele-medicine as well.
As for tele-education, Fehr said it could expand on the number of RNs and LPNs, while keeping them at home. Shenandoah University already uses the technique in coordination with a few other large universities.
She said it was needed to increase faculty numbers as well.
"Radford had to turn away 50 percent of their qualified nursing applicants because they just didn't have the faculty," she said. "We need to figure out a way to make health care providers who are working their way through the tiers of education also help in peer mentoring or get into teaching at the same time."
All those in attendance said they felt the forums, as well as the final plan, needed to be better advertised.
Clark said, "This needs to be something that every member of local government, every teacher, everyone who is a leader in a rural community, knows about and has. What good is a plan if no one reads it and does things to put the ideas into action?"
After gathering input from the other four forums, the Virginia Rural Health Association expects to have the final 2013 plan by June or July.