The Family Physician As A Rural Healthcare Provider A Personal Prospective

1
The Family Physician As A Rural Healthcare
ProviderA Personal Prospective

• Ground Rounds for
• Community Medicine
• Katrina N. Poe, MD
• November 6, 2006

2
Presentation Goal

• To heighten your understanding and
  appreciation of the many facets of family
  medicine in a rural setting by sharing my
  experience

3
Objectives

• Audience will
• Gain knowledge of the enormous need for primary
  care in the rural setting
• Gain enlightenment of the broad array of the
  medical conditions presenting to the rural family
  physician
• Gain greater understanding of the limited access
  to specialized care in a rural setting
• Understand the challenges of the limited
  resources available in the rural healthcare
  setting

4
Rural America

• 20 of the US population lives in rural areas
  
• (70 million Americans)
• Often defined as regions falling outside
  metropolitan statistical areas (MSAs) although
  finding a single uniform definition is extremely
  difficult
• This is about 80 of the land over 3 million
  square miles
• Frontier regions have less than 6 people per
  square mile

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What Does Rural Mean?

• Is it like medical quality?
• difficult to define but I know it
• when I see it
• We all have images of what rural
• represents
• But in NYC - their rural is my big
• city in MS

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Rural, But Not This Rural
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General Themes in Rural Health

• Higher rate of chronic disease and unhealthy
  lifestyles
• The population seeking care is generally older,
  poorer and less educated
• There are fewer hospital beds, nurses,
  generalists, and specialists available to provide
  care

8
General Themes in Rural Health

• Death rates from unintentional injuries and MVCs
  are disproportionately higher
• Few economies of scale due to low populations
  and fixed overhead costs
• Limited access to providers
• Inadequate healthcare insurance

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Providers of Rural Healthcare

• Less than 10 of the nations
• physicians practice in rural areas
• Family physicians constitute nearly 90
• percent of all primary care rural
• physicians

10
The State of Rural Healthcare

• Cannot generalize to all rural areas
• Glass is both half full and half empty
• Rural Truths
• Greater prevalence of chronic health problems
• Economic and social inequities
• Lower realized access to care
• Rural Hope local solutions and advocacy for
  national policy change

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The Road Home

• two roads diverged in a wood, and I... I took the
  one less traveled by, and that has made all the
  difference-- Robert Frost

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All Politics Health Is Local

• Montgomery County, MSDemographics
• Health Profile

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Montgomery County Demographics

• Population
• Kilmichael 830
• Montgomery County population 12,138
• Sex and Age
• 53.6 Females, 46.4 Males
• 17.1 65or older
• 25.1 less than 18
• Race 53.6 Caucasian, 45.9 African American

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Montgomery County Demographics

• Educational attainment
• 37.9 with no high school diploma
• 7.3 with Bachelors degree
• 3.6 with advanced degrees
• Poverty Status
• 21.9 of families below poverty level
• 56.3 with single mother families
• 25.4 65 years and older

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Montgomery CountyHealth Profile

• Maternal and Child Health
• Percent Low Birthweight Newborns (2000)
• Source MSDH Vital Statistics

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Montgomery CountyHealth Profile

• Births to Unmarried Mothers
• Percent of Total Live Births, 2001
• 75.6 of all Non-White births
• 20 of all White births

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Montgomery CountyHealth Profile

• Infant Mortality
• Rate per 1,000 Births, Infants aged less
  than one year (2001)
• 36.8 per 1,000 for Non-Whites
• 13.9 per 1,000 for Whites
• The rates of both White and Non-White infant
  mortality have increased in Montgomery County
  over the last ten years

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Montgomery CountyHealth Profile

• Neonatal Mortality
• Proportion of deaths in the first 28 days of life
  in every 1,000 live births (2001)
• 24.5 per 1,000 for Non-Whites
• 8.4 per 1,000 for Whites
• Both White and Non-White Neonatal mortality
  rates greatly increased in Montgomery County over
  the last ten years.

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Montgomery CountyHealth Profile

• Post-neonatal Mortality
• Postneonatal Mortality is measured as the
  proportion of deaths among infants aged 28 days
  to one year in every 1,000 live births. (2001)
• 12.3 per 1,000 for Non-Whites
• 5.6 per 1,000 for Whites
• The Postneonatal Mortality rate in Montgomery
  County has decreased for Whites and increased for
  Non-Whites over the past ten years.

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Montgomery CountyHealth Profile

• Births to Teenage Mothers
• Percent to total live births (2001)
• Births to teenage mothers were 15.9
• THE BAD Teenage motherhood in Montgomery County
  occurs in about the same percentage as is seen
  Statewide.
• THE UGLY Mississippi has the highest rate in the
  nation of births to teens.

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Montgomery CountyHealth Profile

• Illness and Death (Rate per 1,000 population)
• Heart Disease 262.5
• Cancer 254.3
• Stroke 65.6
• Hypertension and/or hypertensive renal disease
  49.2 (State 10.0)
• Emphysema and other chronic lower respiratory
  diseases 32.8 (State 7.4)
• These causes of death that are most common and
  most preventable.
• Statewide, the leading causes of death are heart
  disease, cancer, stroke and accidents.

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Practice Profile

• Clinic Practice
• Solo Physician with NP
• Over 8,000 Patient Visits per Year
• Hospital Practice
• Chief of Staff
• Only Full-time Physician
• On-Call 28.5 in 31
• Other Practice
• Over 50 Nursing Home Patients
• Hospice Medical Director
• Group Home Medical Director
• Home Health Oversight
• Occasional Veterinarian

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Primary Care in the Rural Setting Clinical
Presentations

• Broad scope of family medicine
• Limits based on training, experience and
  demonstrated abilities
• Clinical skills of rural family physician
• Functioning effectively with limited resources
  and staff.
• Most common presentations in rural setting

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Clinical Presentations My Experiences

• Pediatrics
• Well-baby care
• Chronic childhood illness
• Growth disorders
• Learning disorders
• Pediatric trauma
• Preventative health management

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Clinical Presentations My Experiences

• Women's Health
• Emergency obstetrics
• Gynecologic preventative care
• Screening management
• Reproductive issues
• Weight control
• Depression

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Clinical Presentations My Experiences

• Occupational Health
• Agricultural
• Industrial
• Environmental and communicable diseases
• Workplace stressors

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Clinical Presentations My Experiences

• Geriatrics
• Chronic disease treatment
• Home health and hospice case management
• Social issues
• Mental health
• Immunizations
• Health screens

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Clinical Presentations My Experiences

• Musculoskeletal Medicine and Sports Medicine
• Reduction of dislocations
• Splinting and referral of fractures
• Radiographic recognition of common and serious
  fractures
• Team physician services, athletic training
• Consultation and management with outreach
  orthopedic surgeons
• Soft tissue injury management

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Clinical Presentations My Experiences

• Behavioral Medicine
• Counseling Parental, marital
• Domestic violence
• Developmental problems
• Psychopharmacology
• Crisis management
• Chronic mental illness management

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Clinical Presentations My Experiences

• Surgery and Procedures
• Surgical emergency evaluation and management
• Consultation and collaborative management with
  outreach surgeons
• Postoperative care in collaboration with surgeons
  
• Office procedural skills dermatological
  procedures)

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Clinical Presentations My Experiences

• Trauma and Emergency Care
• Emergency cardiac care
• Interpretation of acute-condition radiographs
• Trauma initial assessment, stabilization, and
  transfer
• Laceration evaluation and repair
• Psychiatric emergencies

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Clinical Presentations My Experiences

• Community-oriented primary care
• Public health education
• Health advisor
• Health education classes targeting specific
  disease
• Community health fairs

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The Challenge

• So Much Work to Be Done
• And
• So Many people Who Need Help