Rural residents get access to care

Published on Saturday, 15 June 2013 19:36 - Written by

BY COSHANDRA DILLARD

cdillard@tylerpaper.com

 

VAN — When Elizabeth Oliver, 63, arrived at Van Junior High gymnasium for free medical screenings offered by state health officials on Tuesday, she didn’t expect to get the news she received: Her blood pressure read 194/90.

An ideal blood pressure should be below 120/80 as anything above that increases the risk of heart attack and stroke.

“I feel fine,” Ms. Oliver said. “But it was up there, almost in stroke territory. Too many of my friends are having strokes. It just leaves them completely incapacitated where most of them can’t talk, can’t do anything for themselves. They have to have 24-hour care and they’re just in their late ’50s, early ’60s.”

Ms. Oliver said it was important that she take advantage of the opportunity to get a mammogram and other vital screenings at a medical mission held by the Texas Department of State Health Services and the Texas State Guard’s Medical Brigade. It brought out physicians, nurse practitioners and UT Health Northeast residents.

The medical mission was modeled after Operation Lone Star, a successful program that aids residents in the Rio Grande Valley. As a member of the Texas State Guard, it was something state Rep. Dan Flynn thought would be useful in the area he represents.

“We have just as many needy people here in East Texas as there are in the Rio Grande Valley,” he said.

Flynn said emphasizing healthy behaviors and making resources more readily available would help reduce medical costs accumulated from emergency room visits.

“It truly is education,” he said. “We educate people and let them know the opportunities that are available.”

Medical personnel performed disease surveillance, prescribed 90 days’ worth of medicines, if needed, and ensured that patients would follow up with a physician.

“Our demographics show that we have higher incidences of chronic illness: hypertension, diabetes and tobacco use,” said Dr. Jonathan MacClements, who leads UT Health Northeast’s family medicine program, is Smith County’s Health Authority and also a member of the Texas State Guard Medical Brigade.

“We’re here to try to educate our patients, get them sufficient prescriptions until we can get them into a patient center medical home.”

Ms. Oliver may have been taken aback by her diagnosis, but she doesn’t seem to be worried. Instead, she is optimistic about her health. Like others who trickled into the junior high halls, the Ben Wheeler resident received one-on-one health and nutrition education.

“Everything I’ve been eating, I guess it was wrong,” she said, noting that she now has to cut back on fried foods and sweets.

Ms. Oliver admits that she had taken medicine for high blood pressure in the past but was gradually taken off it when the blood pressure consistently improved. But she hasn’t seen a doctor in at least four years.

Formerly a 30-year hospital worker, she is unemployed and without health insurance. Getting to a doctor means coming up with money she doesn’t have for an office visit.

“That’s one of the reasons I came out here,” she said. “If you don’t’ have insurance, it’s pitiful. It’s pitiful out here.”

RURAL HEALTH CARE

With a large geographic area and residents thinly spread over it, health problems in rural areas can be attributed to limited access to health care, among other factors. Van Zandt County is no exception. 

The patient to doctor ratio there is 7,523:1, compared to the state average of 1,766:1.

“It’s multifaceted in that we have to ensure there’s efficient providers in the community,” MacClements said.

“We have to find ways to practice more cost-effective medicine so that we can use the resources that we have to provide as much quality and safe care to as many patients are we can. That’s how we’re going to change communities, putting people with expertise into the communities. To do that though, we have to train more people who are interested.”

Besides access to care, education about healthy behaviors also was emphasized at the mission. The Community Transformation Grant, a federal program through the Centers for Disease Control and Prevention, is intended to support community-level efforts to promote healthy living.

Among the concerns are heart disease, cancer, stroke and diabetes. Last year, NET Health obtained a five-year grant to address these problems in Smith County. The state, which awarded the grant to the district, wanted local officials to also tackle two rural counties with looming health and environmental issues: Wood and Van Zandt.

Stephanie Taylor, director of community outreach and assistance at NET Health, said they are creating environmental and systems changes in the counties under the grant. That may include partnering with Texas A&M’s Agrilife Extension Service, implementing safe-routes-to-school programs, and city park renovations. Canton’s recent designation as the Walking Capital of Texas may also help bring in grants for healthy living initiatives.

“We’re looking at it from a health efficiency standpoint,” Mrs. Taylor said.

Van Zandt County residents who are under- or uninsured often choose Tyler or Dallas hospitals for care, health officials said. The county, which has a population of about 52,776, has a higher premature death rate than the state or national benchmark. About 29 percent of residents are obese, 23 percent smoke and 11 percent have diabetes, according to data compiled by the annual County Health Rankings. In addition, 32 percent of adults and 18 percent of children in the county are uninsured.

“I don’t think that the concerns of the rural environment are any different from those of the urban environment,” MacClements said. “I think the difficulty is simply getting the resources. You’ve got a certain amount of people distributed over a larger area. Trying to get the education resources out to those individuals may be a little more challenging.”