Team Harnett Health

Rural Health Practicum, Fall of 2019

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R2. Analyze the governmental, social, economic, and professional factors that influence the availability and quality of health professionals in rural areas-including public health professionals as well as health care providers.

Harnett Health Foundation is a non profit organization that is located in a rural community and focuses on accessibility of healthcare services in Harnett county. Craig Lloyd our preceptor and foundation director of the Harnett Health Foundation. Harnett Health foundation focuses on: fundraising for Harnett Health hospitals, expanding access to healthcare, raising awareness on factors that influence healthcare by engaging with the community and improving the quality of healthcare in Harnett Health facilities. 

Our preceptor organization Harnett Health Foundation helps to reduce the health disparities rural communities are challenged with, some factors that are barriers to access to healthcare in rural areas due to geographic isolation consists of: lack of resources, limited services available, and a shortage of healthcare providers. One way our preceptor help us to meet some of the criteria's to help meet the needs of the community is organizing our first event, the campus blood drive. My practicum group and I decided to partner with The Blood Connection for the campus blood at Campbell University Health Sciences campus. The Blood Connection is a community blood center, meaning the donated blood collected at Campbell will be kept and used solely in Harnett county hospitals. We had a total of 53 donors and collected 47 units of blood, the results of the blood drive was successful and most likely be used within the Harnett Health System hospitals such as Betsy Johnson and Central Harnett Health. 

Both hospitals are located in Harnett Health and widely used by residents for primary care and treatment services. Due to high numbers of patients seeking care at the Harnett Health system hospitals, the Harnett Health Foundation was able to expand its services due to generous donations and fundraisers. Outcome of Harnett Health expanding services is a huge deal, residents were no longer challenged with being limited to services and being forced to travel outside of their county for continuous treatments. Central Harnett Hospital now offers specialty services such as: a cancer treatment center, cardiac lab, hospital pharmacy, and orthopedic services. To improve local access and availability of these services we went out into the community during our survey collection data to raise awareness to residents of the services available locally. 

The specialty services available in Harnett County could possibly reduce a shortage of healthcare providers. Campbell University Main campus and Medical Campus being in a rural area, can be beneficial to Harnett Health Systems. Expanding learning experiences and opportunities for students to volunteer, gain practicum experience, and complete internships at the Harnett Health systems will prepare for healthcare professionals to help meet the demands and needs of patient care in rural areas. Due to the Harnett Health Foundation residents of Harnett County are offered a better quality of life. Overall, our continued involvement within the community as Public Health students and students of Campbell’s Health Sciences programs, will help come up with solutions as well as opportunities to impact the recruitment and retention of health care providers in rural areas.

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F14. Advocate for political, social or economic policies and programs that will improve health in diverse populations.

Team Harnett Health focused on telehealth and mental health in rural America. Telehealth is defined as: the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services (Mayoclinic.org). 

For our advocacy project we researched mental health services and availability in communities. The data we found during our research was alarming, research showed the ratio of the population of Harnett County to mental health professionals is 1470:1, with the average for North Carolina being 520:1 and top US performers coming in around 390:1. From the data found during our research and community health needs assessment, our group decided to take action and use the data gathered to create our infographic, letter to the senator, and advocated for our bill to our representatives at the state capitol in Raleigh. 

Team Harnett Health was well aware of rural challenges that create barriers and health disparities. Telehealth creates opportunities to expand access to care for patients by reducing travel time to providers who are not conveniently located, those without reliable transportation are still able to seek care, and eliminates stigmas surrounding mental illness within rural communities which may encourage patients to seek treatment. After finalizing our research and creating our deliverables, our preceptor set up a meeting for us to attend the legislature building to advocate for telehealth and mental health in Harnett County. 

During our meeting with Senator Burgin we discovered there was a current policy being discussed related to our advocacy project named House Bill 721. House Bill 721 advocated for telemedicine- mental health assessment and treatment. One issue that was brought up during our meeting was insurance reimbursements, the rate of cost a patient should pay and the how much providers should earn from providing the services. The Senate and House of Representatives had different viewpoints, Senator Burgin sided with insurance, which he believed patients should not have to pay the same amount for services for telehealth as a in office visit and the House of Representatives sided with the consumer/provider. He believed the provider should be paid the same amount for their service rather it is a in office visit or via telehealth. 

Overall, from a financial standpoint telehealth has the potential to be a cost effective method for care delivery in the US and rural communities. For rural communities, telehealth would increase access to physicians, specialists, and other healthcare services in underserved areas. The use of telemedicine in mental health will help address the 3 A’s: access, availability, affordability. A few programs in rural communities have been successful and seen positive outcomes implementing telemedicine. For an example, Daymark Recovery Services is a non-profit organization established to provide comprehensive behavioral healthcare services as defined by those in the community in need of mental health or substance abuse treatment options. 3 telehealth machines are used constantly, according to one worker at Daymark, there is only one full time psychiatrist in Harnett county, and he works for multiple counties. Telehealth has made it possible for the psychiatrist to see a number of patients on a daily. Implementing the use of telemedicine worldwide will also help to reduce the serve shortage of mental health professionals.

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F2:Select quantitative and qualitative data collection methods appropriate for a given public health context.

Team Harnett Health did a survey collection to assess the perceptions of Harnett Health systems and utilization of healthcare services in Harnett County. Our preceptor, Craig Lloyd, the foundation director of the Harnett Health Foundation expressed during our first practicum meeting that the emergency room (ER) was used a lot by community members as a means for primary care. Meaning a lot of people seek treatment for minor/acute illness or injuries through the emergency room instead of seeking care from a primary care provider or urgent care. 

My team and I created a survey to figure out if people in the community were aware of all the healthcare services and facilities that were available to them in Harnett County and their opinions/comments on the healthcare services locally available to them as well as their experiences from receiving care at one of the following Harnett health systems/services. In Harnett county residents can receive care from the following places: Angier Medical Services, Betsy Johnson Hospital, Central Harnett Hospital, Coats Medical Services, Dunn Medical Services, etc. 

Our survey questions community members if they were traveling to other counties to receive care and if so, why? Then we asked 1) have you or your family accessed Harnett Health services? 2) What is your satisfaction rating of Harnett Health? 3) What is your preferred primary and specialty healthcare provider/setting? 4) What influences your healthcare choices? Does insurance influence where you choose to get your healthcare? 5) Are you aware of the new specialty services offered at Central Harnett Hospital? 

Team Harnett Health collected survey data at four locations: Carlie C’s in Lillington, Walmart in Dunn, Harnett Public Library and Qualtrics Survey Online. We had a total of 92 responses overall from the four collection sites and we only included residents that lived in Harnett County. Once we analyzed the data we found that the majority of residents have not been to a Harnett Health System hospital. Shockingly, a lot of respondents answered they would go see their primary care provider if needed treatment. I believe those who responded of having a primary care provider, most likely are insured through their employer, pay out of pocket, or may have Medicaid. The respondents who answered they go to the ER to receive care regularly do not have a primary care provider and then there was a handful of responses that reported they do not seek medical care at all. 

All of the data we collected reflected information that was discussed in our classes taught by Dr. Tillman. He addressed the challenges rural communities face regarding healthcare. Such as the idea and lifestyle of seeking medical treatment was not favored, the idea of  health as hardiness was observed. One community member made the comment “they would not step foot in a medical center unless they were dying from a gun shot wound”.  Access to health insurance and availability to pay for services was also another key decision and role that played into regards of where community members would go to seek care and treatment if needed. The information gathered was presented to our preceptor in graphs, tables, and maps so he could inform Harnett Health system and board of the community members opinions, therefore improvements could be made to help meet their needs. 

Also, people in the community were unaware of that Harnett Health provide the following services: ER Express, Cancer Center, Orthopedic Services, and Cardiac Cath Lab. Harnett Health expanding services locally is a benefit because people do not have to travel far distances to seek treatment. Also, offers a diversity of services of care needed locally in the community. Increasing awareness of the services available in Harnett county will not only benefit residents in the community but help to attract more providers to work in rural areas. 

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Team Harnett Health working hard to prepare for our group presentation and working on filming our video to share with the class our practicum experience and projects! (: 

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Our findings from our survey collection in the community. We collected our survey data in Harnett County at 4 locations: Carlie C’s in Lillington, Walmart in Dunn, Harnett County Public Library, and Qualtrics Online Survey. 

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Stephen, collecting data for our survey collection on Harnett Health Systems and use of healthcare services in Harnett County at Carlie C’s in Lillington. 

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Advocacy Project- Letter to Senator

Team Harnett Health

Campbell University’s College of Pharmacy and Health Sciences

School of Public Health

P.O. Box 1090

Buies Creek, NC 27506

October 28th, 2019

Dear Senator Burgin, 

This semester as a part of our Public Health curriculum, our group is advocating for the use of telemedicine for mental health assessment and treatment. As our school is based in Harnett County, we have researched the mental health resources in the surrounding areas, and have found that there are limited options. Per the data from County Health Rankings, Harnett County’s ratio of population to mental health providers is 1,470:1. Looking more broadly at the state of North Carolina as a whole, we found that a lack of mental health providers is a common occurrence. The average ratio of population to mental health providers for North Carolina was 520:1, with the range being 11,570:1 through 180:1. This data is quite alarming when compared to the top performers in the United States ratio of 390:1. 

This is why we are advocating for the increased use of telemedicine for mental health concerns. Per the definition of telemedicine provided by the North Carolina Division of Medical Assistance’s “Medicaid and Health Choice Manual,” telehealth is a resource that utilizes a two-way real-time interactive online experience that enables medical professionals to provide their services to those in different geographic areas. South Carolina, who recently increased their use of telemedicine services through the South Carolina Telehealth Alliance, found that telehealth improved the quality, cost, access, and demand for the services provided therein. 

Thank you for taking the time to read this letter and review the materials that we have included. 

We were excited to learn more about and advocate for House Bill 721, which will require insurance providers to cover telemedicine visits, thus enabling more North Carolina residents to utilize services that might have otherwise been unavailable. We hope to see this trend continue in the future, as the legislators of North Carolina continue to work for the betterment of their constituents. 

Sincerely, 

Team Harnett Health

Aubrey LaVoie                 AnnaScott Cross             Stephen Holly    

Quinton Edwards             Alexis Rogers                Danielle DuFresne

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My group and I had the amazing opportunity to visit the Legislature Building and meet with Senator Burgin and Rep. David Lewis to discuss our advocacy project on telehealth medicine. 

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To prepare for our advocacy project and trip to the Legislature Building to discuss Telemedicine with Rep. David Lewis and Senator Burgin, my team and I have been researching the use of telemedicine in mental health care settings. We have put together this infographic of our findings on the mental health needs of Harnett County. 

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Team Harnett Health preparing for our next event, my group and I made a survey for our data collection project. We will be going out into the community to assess Harnett Health System and use of healthcare services in Harnett County. 

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Our campus Blood Drive with The Blood Connection was a success! (: A total of 47 units of blood was collected and 52 donors showed up to donate! From our data collected during the Blood Drive, majority of the donors were Campbell students or faculty members. We were excited about the outcome, we exceeded our goal we had planned on getting people to sign up and donate blood. Being able to give back to the community and save lives was a great feeling! Looking forward to our next upcoming events and working with our preceptor Craig, stay tune!

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First event of our practicum experience was planning the community blood drive on the Health Sciences campus at Campbell University. We passed out our flyers all around Campbell and inside the local businesses by Campbell. We are exicited about our upcoming Blood Drive and are expecting a good turn out! 

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To begin preparing for our practicum experience, my team and I did some research. From the research we did by reading the Community Health Assessment for Harnett County, we learned the health needs and issues of the people in Harnett County through analyzed data collection. Understanding and having knowledge of specific characteristics and development of healthcare in rural communities, prepared my team and I for working with Craig to plan and promote health strategies and care in the community. 

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On August 26th, Monday morning, my team and I meet with our preceptor, Craig Lloyd. I am excited and looking forward to learning more about the field of Public Health and helping the community.