Influenza

When I think about what I will be confronted with if I am the medical director in a school district or college, the flu virus is the first thing that jumps into my mind.  No matter where you are, urban or rural, the flu will also be there.  I have to be aware of the start of the flu season to make sure I am getting reminders for vaccines out to the kids and families as well as education on the flu, its symptoms and possible complications.  There was a sad case in Wayne County this winter where a teen died from the flu virus. Tyler Finn was a 14 year old boy who died from complications of Influenza B in February this year.  He did receive the flu vaccine but unfortunately still contracted the virus.  The article did not go into details about the complications that led to his death.  If the families are better educated on the flu, how the vaccine works, when to seek medical help, hopefully future deaths can be prevented.  As medical director at a school, I would take on the job of providing this education to the kids, the families and the whole community.

Patient-Centered Medical Homes

I found an article that discussed PCMH in New York State.  It discusses a program that will help primary care offices receive National Committee for Quality Assurance medical home recognition.  This recognition will help the provider and the patient because it qualifies the providers to receive the incentives, decided on in 2009 by the NYS department of health, for Patient-Centered Medical Homes developed and it will help improve health outcomes due to better coordination and integration of healthcare.  I also really enjoyed learning the "Joint Principles of the the Patient-Centered Medical Home" that were decided upon by the AAFP, AOA, AAP and ACP.  These principles described the individual elements of the PCMH and helped me better understand the practice.  It also showed me that this is the type of healthcare I want to be a part of.  As a PA, I want to be able to help my patients is the most efficient manner and with all the support they need to have the best outcome.  I also want to be a part of a team that not only includes myself, a physician and other healthcare providers but the patient and their family as well.  I think healthcare is on the right track with the development of Patient-Centered Medical Homes and other patient-centered practices and hopefully the end result is a healthier community with less healthcare costs.

http://www.ipro.org/index/patient-centered-medical

The Geriatric Assessment Program-Wayne County

While researching healthcare teams in Wayne County, NY I came across the Geriatric Assessment Program.  It is a program that helps senior citizens, 65+, in rural Northern Wayne County get access to health care.  It is for those who have recurrent health issues such as urinary incontinence, dementia, frequent falls, overall decline, etc.  The team consists of Dr. Mohamed Mohamed, a geriatrician, a geriatric nurse practitioner and a care manager.  This program offers patient's non-emergency care.  It consists of home visits and office visits.  For convenience, the patient's office visits can be at Wolcott Internal Medicine or at Newark-Wayne Community Hospital's state-of-the-art Telemedicine office.  In addition to all of that they offer transportation to the office visits through their partnership with Wayne County Department of Aging and Youth.  If you do not have insurance this program is of no cost to you and if you do than it is just your normal co-pay.  This program has been so successful that its grant for federal funding was just extended.  I think this seems like a wonderful program that has lots of potential to grow.  I was surprised to see that it was only a 3 member team.  I think as more people become aware of the program and start utilizing it more they may want to consider adding a Physician Assistant to the team!
http://www.co.wayne.ny.us/departments/ageyouth/documents/Fall2012_000.pdf
http://www.rochestergeneral.org/centers-and-services/geriatric-assessment-program/
http://www.waynepost.com/yournews/x1958455247/Geriatric-Assessment-Program-extends-medical-help-to-seniors

Wayne County Health Indicators

Overall Wayne County is ranked 46 in health outcomes out of 62 counties in NYS.

Mortality-premature deaths for Wayne County is 6,516, for NYS is 5,812 and for the national benchmark 5,466.  To evaluate mortality premature death was measured.  This is represented in the number of years of potential life lost before age 75 per 100,000 population.  An example is a 25 y.o. dies, this is 50 years of potential life lost.  I think that the reason Wayne County has a higher number of potential life lost compared to the state and the national benchmark is due to it being a predominantly rural county.  The access to healthcare is more difficult and knowledge of preventable health or healthy lifestyles are not as well known or as easy to implement.
In regards to morbidity, an equal percentage of people in Wayne County and NYS (16%) thought that their health was of poor to fair condition and the national benchmark was 10%. The average number of days people felt their physical health was not good out of the past 30 days was 4.9 days. Compared to NYS that was 3.5 days and the national bench mark of 2.6 days.  Poor mental health had a similar representation to poor physical health: 4.9 days in Wayne County, 3.3 days in NYS and 2.3 days for the national benchmark. The percentage of births that were considered low birth weight in Wayne county were 6.7% , NYS 8.1% and the national benchmark was 6%.  I believe people feel poorly about their health in Wayne County for the same reasons I mentioned before.  They do not have easy access to healthcare.  Social interaction and an active style of living can be difficult in rural areas and these things are important in overall physical and mental health.
Looking at social economic factors you see that Wayne County has a high high school graduation percentage of 85% and 59% of the population have some college education.  The percentage of unemployed is almost equivalent to that of NYS but is 3% higher than the national average.  Wayne county has a lower percentage of children in poverty than NYS but is almost equal with the state in percentage of children with inadequate social support and children who live in a single parent household.  The violent crime rate in Wayne county is 178 which is drastically less than NYS at 399 but still a great deal higher than the national benchmark of 73. I think a lot of these social economic factors are not as impacted by the rural setting.  Poverty is a problem in many inner city populations along with inadequate support.  Being a child of a single parent household is something I think you will see in all areas and all social economic statuses.  It was very understandable to see that violent crime was lower in a rural county versus the state of NY because this consists of violent face to face encounters.  There is a smaller population in rural counties and the people are more spaced out making violent crime less probable.

One of the health behavior factors that stood out to me was the rate of motor vehicle deaths in Wayne County compared to NYS.  Wayne county had a rate of 16, double that of the state which had 8.  There are a few factors that I thought may have played a roll in this difference.  One is the terrain in rural areas.  Roads are often a little more narrow, curvy or hilly.  These types of roads with poor weather conditions alone can create a more dangerous environment.  In addition, you often see tractors on these roads or buggies and drivers like to pass by these slow moving vehicles.  If they are not using proper technique for passing vehicles and being extra cautious the result can often be deadly.  These roads and situations exist in non-rural counties too just not in as high of a percentage.  Another factor that I thought may have contributed to this higher death rate could be the lack of police enforcement on country roads.  Small towns do not have large police forces that allow them to effectively monitor the country roads and people take advantage of this by speeding and driving recklessly.  The last factor is drunk driving.  This piggy backs off the lack of police enforcement but also has to do with the lack of alternative transportation.  The more rural you are the less likely you are to see a Taxi.  It would be interesting if this statistic were to be broken down to show those accidents caused by people driving under the influence.

Looking at the clinical care statistics it is not hard to see that there is a great need for primary care physicians in Wayne County.  Their ratio of population to primary care physicians is 2,615:1.  This is hard to imagine but also makes some of the earlier statistics easier to understand.  This is why programs like Upstate, that encourage doctors and PAs to practice in rural areas, are so important.  It is not possible to train enough doctors to satisfy that demand so physician extenders like PAs and NPs are a very important asset for healthcare in rural communities.

http://www.countyhealthrankings.org/app/new-york/2012/wayne/county/2/2

"Fresh Air and Warm Hearts"

I feel like I have heard a lot about intervention programs that target adults to be heart healthy but not necessarily children.  This article discusses a program "Fresh Air and Warm Hearts" which allows a kid from the city to visit a rural family for 2 weeks during the summer.  This allows them to be more active and participate in many more outdoor activities that are not available or safe for them in their home neighborhood.  Without too much preaching this teaches these kids a more healthy lifestyle.  They will spend more time running around outside than they will inside on the computer or playing video games.  I am not sure where the program started, how far it reaches or how many people are involved but it sounds like awesome opportunity.  The family was able to see the impact they were having on this child's life as they noted that when they first met 7 years ago he was growing outwards but now he is just growing upwards.
http://waynetimes.com/community/fresh-air-and-warm-hearts-in-macedon

Nurse Home Visiting Program for Asthma Patient's in Wayne Co.

I think one of the most challenging things in health care is getting the patients to understand and use their treatments appropriately.  The more involved the practitioner can be with their patient the better the outcome.  I was looking on the Public Health web page for Wayne County and found that they have a program for children with asthma that offers those who meet certain criteria home nursing visits.  Basically the criteria is that the child's asthma is not well controlled meaning that they are using their rescue inhaler too frequently, they are unable to participate in physical activities with other kids their age, missed school due to their asthma, or have gone to the emergency room and/or stayed in the hospital because of their asthma.  The nurse will come to the house and educated the parents and the child on asthma and will be able to see the home environment and point out possible asthma triggers.  The nurse will also help make sure the school understands the child's condition so they can receive their medications at school when needed.  There are other benefits that come with the program too like the child will get a mattress and pillow.  I think this is an awesome program.  This program is not just going to increase the families knowledge on the condition but it is going to strengthen the communication and trust between the patient/patient's family and the caregiver.  Asthma can be a very scary diagnosis for parents and kids to handle and difficult to fully understand how to control it.  In rural areas, such as Wayne County, it can be even more difficult for all these patient's to see their provider frequently enough to ensure that they are controlling their asthma and using the medications properly.  Hopefully this program will help to decrease the number of asthma exacerbations that limit the children and improve their quality of life.

http://www.co.wayne.ny.us/departments/publichlth/Asthma.html

Take-Back Day

Substance abuse can be a difficult issue to treat especially if the drug is readily available to the abuser.  In rural areas specifically, prescription drug abuse is more common than illicit drug abuse.  Some people are taking prescription drugs that are not their prescription and others are abusing their own prescription whether intentional or not.  One of the ways to try and reduce prescription drug abuse is to minimize the number of old prescriptions in people's medicine cabinets. 
I came across an article about September 29th being "Take-Back Day" in Wayne County. On this day there are going to be numerous stations set up across the county for people to bring their old prescriptions, anonymously and without questions, and have them properly disposed of.  I think this is a great idea and I was happy to see that it is being sponsored by Wayne County Narcotic Enforcement Team as well as the DEA.  This shows that they recognize the increasing abuse of prescription drugs in rural areas.  These types of programs allow us as providers to present patients with a means of disposing of their old medications and the opportunity to counsel them on why that is so important to do so, for example preventing them from accidentally taking them, so that they are not available to be stolen from their homes and abused by others and to keep the water supply safe from improper disposal.

http://www.waynepost.com/latestnews/x1238768628/Prescription-drug-Take-Back-Day-held-this-weekend