For instance, diabetes is a major problem and new studies recently released have BPHC sponsored diabetes collaborative that have spoken to some of the successes …
To: National Rural Development Partnership NRDP Health Care Taskforce
Members
Date: June 18, 2003
Time: 3:00 ET
From: Barbara Quiram, Task Force Co-Chair; Heather Reed, Task Force Co-
Chair
Joy McGlaun, NRDP Health Care Taskforce Manager
Jmcglaun@hrsagov phone: 301-443-3932 fax:
301-443-2803
Re: Rural Healthy People 2010 Conference Call Meeting Minutes
Agenda
I Speaker
Larry Gamm, PhD
Larry D Gamm, PhD, is Professor of Health Policy and Management and
Director of the Master of Health Administration Program at the Texas AM
University Systems School of Rural Public Health He is also Associate
Director of the Southwest Rural Health Research Center at Texas AM where
he served as the Principal Investigator and lead editor for the recently
published document Rural Healthy People 2010: A Companion Document to
Healthy People 2010 He is currently engaged in national research on
rural health professions shortages and chronic disease management for rural
populations He is on the editorial board of the American College of
Health Care Executives Journal of Healthcare Management and has published
in that journal, in the Journal of
Rural Health, and in Health Politics,
Policy and Law, among other journals He received his PHD from the
University of Iowa after which he joined the faculty at Penn State
University He directed health administration graduate programs and
numerous rural health studies during over 20 years of work at Penn State
He joined the Texas AM School of Rural Public Health in 1999
II Task Force Meeting Content
Action: Send out website address to list serve
Dr Gamm will give an overview of the key points of Rural Healthy People
and then take questions Formerly released at the NRHA meeting last month
Funded by ORHP asking them to address rural priorities in conjunction with
Healthy People There are ten objectives in the original, but this one
touches base with a wider base of rural peoples and entities-SORH, SDH,
PCA, PCO, local level-rural hospitals, CAHS, RHC, CHCs Diverse group
surveyed and over 500 groups responded Unanimously decided on was access
to quality health services Heart Disease and stroke, oral health,
diabetes, mental health, tobacco, substance abuse, educational programs,
MCH and nutrition and overweight-making a top ten list of objectives
Public health
ranked diabetes 12, but diabetes 7, other orgs ranked the
problems differently, so there was a challenge at bringing these priorities
to a consensus This project makes clear that partnerships are necessary
because of overlapping interest and differences in interest
Q: breakdown on the diabetes priorities? Santa Fe
A: they did not break down by state, but did break down by region, so you
can see differences in the instances in diabetes by region The sample was
too large to break down to states
There were a few differences by region that were evident from the study,
particularly with substance abuse, for example There are regional
variations, and there should be regional opportunities for states to work
together
The role of the project was to identify rural health priorities and
identify rural disparities and be attentive to special sub-populations that
may be particularly disadvantaged The next step was to identify models
for practice so other communities may consult the study and learn possible
strategies for their community Volume 1 is useful for an overview, Vol 2
for a more in depth view
There are case studies identified that focus mainly on the community and
county
level in order to make this more appropriate for rural areas
One thing about these topic areas is that every day a new study comes out
on the importance of the issues that we have identified For instance,
diabetes is a major problem and new studies recently released have
reinforced what we found in our study Another issue is access to
insurance In the first priority we covered access to insurance, EMS, and
primary care
Q: what about obesity?
There is a large problem with people under the age of 65 being uninsured,
the rate of un-insurance jumps up in non-met areas, in minorities, and in
the chronically ill and poor
Q: where did you break it down according to race?
Im jumping from different parts of the literature reviews-a quick
overview, so you may find it difficult to follow along
Less insurance means less access to care, less preventive services, and
fewer checkups The rural working adults are less likely to have insurance
than urban working adults Employers are less likely to offer insurance
The rural working are more likely to receive lower wages, so they will find
insurance premiums too high-also seasonal workers are an issue
Another approach being examined is
from the state budget cuts to see how it
is affecting rural counties In Washington, there is a project to help
insure the rural areas by giving them help in joining public insurances or
low premium insurances KY has created something called Sky Cap that
covers basic health care for poor rural people
We dont deal with too many state-wide examples, but we do encourage state
models We are hoping to keep updating models on our website
One thing that we are counting in our document is models for practice, but
we did not want to duplicate Healthy People 2010, so there are additional
sources of data that they point to as well
Diabetes: Been called an epidemic by the surgeon general Most of the
HP2010 objectives have to do with screening They are highest in the
Northeast in the southwest, increasing in children and minorities
Prevention programs and lifestyle changes are being promoted BPHC
sponsored diabetes collaborative that have spoken to some of the successes
of the CHCs that have rallied around diabetes Also, disease management is
becoming integrated in some of the rural areas In PA, 6 FQHCs have shown
great success in diabetes prevention and looking at the financial
savings
of prevention They have also received funding to carry their program over
to other areas of PA bringing potential advantages to other areas
Closing comments:
All politics is local All health is local We have to find solutions on
the community level Many of these illnesses and diseases are local in
origin to these rural areas Doing more of these approaches from the
community level is where health care is moving in the US
Q: training professionals in rural areas Did this come up at all?
A: Almost in every field Most areas are in demand-every type of Dr, RN,
etc
Rural health will have to form alliances and look to communities to grow
their own health professionals and their own teachers
Q: Does this study talk about approaches to training professionals?
Northern NM is identifying leaders in communities to train
A: yes, we are looking at that strategy, and the one in RHP2010 One
at the southwest research center in Texas focusing on nursing professions
We will add this info to the website
Q: In Georgia, they are partnering with the technical colleges to establish
student training initiatives, and also bringing on the Georgia Farm Bureau
and trying to
increase the partnership We are seeing very good results
from this partnership and have also been welcomed into these
collaborations
That is an excellent approach, and some states are moving in that
direction, trying to increase the pool of health professionals
Case management and disease management: Medicare and Medicaid integration
The stuff around diabetes disease management is great, but we need to get
it out faster and to more people We have to figure out how rural can play
a stronger role in this in the future
Q: It appears that you might want to go beyond management and use
prevention strategies Also, how much nutrition education do people in the
medical profession receive to teach their patients?
A: I agree that this needs to be addressed in schools and with patients
Some programs are trying to address these issues This gets us into the
issues of education cuts and physical activity in schools
Perhaps discussion about these issues will raise the awareness and help get
prevention out into the schools
Barb: The TRHA has partnered with the TRDC and joined forces at the annual
conference with a theme around partnerships It is one small example of 2
state
organizations seeing a benefit from partnering Another group out
there is the public health training centers-multi-state partnerships that
can be a resource for people interested in partnering around these issues
Send out training center info
Dr Gamm: the Georgia health policy center also has worked with a number of
public health initiatives and perhaps people from GA on the call can get in
touch with this center
Also, we will be focusing on violence and will post updates on our website
Another will be public health infrastructure
III TAKE AWAY ACTIONS:
Post Public Health Training Center contact information
Post website address to Rural Healthy People 2010
