Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Appalachia books obituaries public health rural health rural hospitals

Gusty 05:35 Add Comment

Forrest W. Calico

Dr. Forrest W. Calico, a nationally recognized expert on rural health-care quality, died Monday at his home near Crab Orchard "after striving against multiple myeloma for several years," said his obituary in the Lexington Herald-Leader. He was 75.

A native of Garrard County, Calico received his medical degree from the University of Kentucky in 1966. He also held a master's degree in public health from Harvard University. In the U.S. Air Force, he was a flight surgeon at Area 51 in Nevada, a family physician, residency director and hospital administrator, earning the Bronze Star. He was president and CEO of Appalachian Regional Healthcare from 1993 to 1999, a health-systems adviser to the federal Office of Rural Health Policy and a senior quality adviser to the National Rural Health Association. In 2007 he was named a Rural Hero by the National Rural Assembly and in 2010 entered the UK College of Public Health Hall of Fame.

In retirement, Calico remained active at the state and local levels, serving on the boards of the Foundation for a Healthy Kentucky, the Friedell Committee for Health System Transformation and the Lincoln County Board of Health. In 2012 he published a memoir, Out of the Blue, with the subtitle "How open doors and unexpected paths set the course of my life."

Calico is survived by his wife Patricia Calico, their son Jefferson and wife Cari, daughter Tricia and husband Wes Cohron, his sister Helen Eden, a nephew and six grandchildren. A celebration of his life will be held Saturday, June 18, from 2 to 5 p.m., with a memorial service at 3 p.m., at The Church at Cedar Creek at 5787 US 150, east of Stanford. Memorial donations may go to The Friedell Committee, PO Box 910953, Lexington KY 40591, or the Dr. Patricia A. Calico Endowed Nursing Scholarship at UK, 315 College of Nursing Building, Lexington KY 40536.

Princess Health and Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

Princess Health and Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

behavioral health Centers for Disease Control and Prevention guns health care access mental health research rural health suicide

Gusty 09:11 Add Comment

By Melissa Patrick
Kentucky Health News

After a decade of decline, suicide is becoming more common in the United States, increasing by 24 percent from 1999 through 2014, according to the federal Centers for Disease Control and Prevention.

The CDC report looked at cause-of-death data between 1999 and 2014 and found that suicide rates increased for both males and females in all age groups from 10 to 74.

Graph: CDC Age-adjusted suicide rates by sex

Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

And while the suicide rates for males continues to be higher than those for females, the report notes that the gender gap is narrowing. Among females, the rate of increase was 45 percent, compared to 16 percent for males.

Suicide rates for middle-aged women aged 45-64 were the highest, in both 1999 (6 per 100,000) and 2014 (9.8 per 100,000), showing a 63 percent increase. In females, the largest increase occurred among girls 10-14 (200 percent), though the actual number of suicides in this group was relatively small, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014.

For men, suicide rates were highest for those 75 and over, with approximately 39 for every 100,000 men in 2014. However, men 45-64 had the greatest increase among males, increasing from 20.9 per 100,000 in 1999 to 29.7 in 2014, a rise of 43 percent.

In 2014, poisoning (34.1 percent) was the most common method of suicide in females and firearms (55.4 percent) was the most common in males.

The CDC report didn't address why suicides are up, but several studies offer clues about possible reasons among the middle-aged, including a study published in 2015 in the American Journal of Preventive Medicine that found that "job, financial, and legal problems" are most common in adults aged 40-64 who had committed suicide, and a 2011 CDC study which found that suicide rates increased during periods of economic recession and declined during economic growth among people aged 25-64 years.

Rural areas have highest suicide rates

Suicide is the 10th leading cause of death in the nation and the state, and with nearly 700 Kentuckians dying by suicide annually, Kentucky is one of the top 20 states for it.

Suicide is more prevalent in rural areas, where the rate is almost twice as high as in urban areas (17.6 suicides per 100,000 vs. 10.3 per 100,000), according to a separate CDC study.

"The myth is that suicide is an inner-city, urban problem, but the reality is that it is not," Melinda Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, said in a telephone interview.

Moore, also the chair of the Kentucky Suicide Prevention Group, attributed some of the increase in suicide rates in rural Kentucky to its "gun culture."

"We have a culture that is very familiar with guns and that familiarity, unfortunately, can really lead to people using very lethal means when they are suicidal," she said.

And when you add gun culture to economic distress, which is common in much of rural Kentucky, it can be a "cocktail for disaster" for those who are suicidal, she said.

Another challenge is the lack of access to mental-health care in rural Kentucky, Moore said, noting that even if people have access to mental-health providers, many providers aren't trained to work with suicidal people. She said this should be improving, since the state now requires all behavioral health providers get suicide training when they renew their licenses.

Julie Cerel, psychologist and associate professor in the University of Kentucky College of Social Work, attributed the increase in rural suicides to several things, including the Gun culture, lack of access to mental-health care and the stigma that surrounds mental-health issues that deters people from seeking help.

Cerel, also president-elect of the American Association of Suicidology, said one reason for the national increase in suicides could be that coroners have become better trained on how to report them. She said that is very important, because people who were close to a person who died by suicide need to know so that they can seek their own mental-health support.

Cerel said 47 percent of Kentuckians knew someone who died by suicide, "and people who are exposed to suicide, especially if it is someone close to them, are more likely to have their own depression and anxiety and thoughts of suicide."

What should you do if you have suicidal thoughts or are concerned about someone?

Moore and Cerel said the first line of defense, especially in areas that don't have great mental-health resources, is to call the national suicide-prevention lifeline, 800-273-TALK (8255). This is a free, 24/7 service that can provide suicidal persons or those around them with support, information and local resources. It also offers a website at www.suicidepreventionlifeline.org .

Moore said community mental health centers are also great resources for those who are suicidal in rural Kentucky, and Cerel stressed the importance of telling someone if you are having suicidal thoughts, including your primary health-care provider.

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

accountability drug abuse economy health care access Medicaid obesity Patient Protection and Affordable Care Act rural health rural hospitals

Gusty 18:04 Add Comment

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

�We're able to do more for Kentucky patients,� Christy Elliott, the hospital's case management supervisor, told Meyer. �For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.�

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

�The care here is excellent,� a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. �Whatever you need, they are right at the door, and everyone is really friendly.�

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

�A lot depends on economic development in these communities,� Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. �What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.�

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

�There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,� Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. �You can't draw more patients if you don't have enough people to take care of them.�

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, �People would die for lack of health care if we didn't have a hospital in this community.�

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

cancer colorectal cancer health reform lung cancer Medicaid obamacare Patient Protection and Affordable Care Act rural health rural-urban disparities smoking smoking bans

Gusty 09:11 Add Comment

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Princess Health and More Kentucky patients are recuperating in their local, rural hospitals after surgery in an urban hospital. Princessiccia

Princess Health and More Kentucky patients are recuperating in their local, rural hospitals after surgery in an urban hospital. Princessiccia

rural health rural hospitals urban health

Gusty 18:53 Add Comment

By Melissa Patrick
Kentucky Health News

Rural residents are increasingly being transferred out of big urban hospitals to recuperate in rural hospitals, many of which are struggling financially and can use the business.

"We have seen trends of this around the state," said Elizabeth Cobb, vice president of health policy for the Kentucky Hospital Association, said in an interview.

Oregon's legislature voted recently to encourage the trend in that state, by appropriating $10 million for rural health-care improvements, with the largest part encouraging such transfers.

In Kentucky, Cobb said the transfers would have to make sense from procedural, convenience and financial perspectives, but when it works out it is great for both the urban and rural hospitals, and also for the families.

"Certainly when there is a treatment or procedure that will take a significant amount of recovery, it is a wonderful thing for rural Kentuckians to be able to transfer back to their community facility to finish off their recuperation," she said.

Oregon's program aims to create a more consistent patient population in its rural hospitals, which will help stabilize their funding. At the same time, the program will relieve pressure on strained urban hospitals, Chris Gray reports for The Lund Report.

Rural hospitals are struggling financially all over the country and often have inconsistent patient volumes, while urban hospitals struggle with reaching capacity, and often worry they might have to expand, Gray notes.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition and suggested that to survive, they might have to adapt to new business models, such as merging with larger hospitals or hiring them as managers, forming coalitions with other hospitals, or finding a health-care niche that hasn't been served, such as creating a partnership with urban hospitals to allow rural patients the ability to recuperate closer to home.

While it sounds like a "common-sense system," Gray reports that the program is costly to set up, between $4 and $7 million, but once it is up and running, and the hospitals learn how to coordinate, "it should be self-sustaining, since money from insurers, Medicaid and Medicare will follow the patient," according to an interim workgroup of rural health officials from Oregon.

A rural health physician told Gray that "local hospitals and healthcare access, along with good public schools, provide the backbone for a viable community when employers are looking to invest in a community," he writes.

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Foundation for a Healthy Kentucky health policy rural health University of Kentucky

Gusty 07:29 Add Comment

University of Kentucky College of Public Health Professor Ty Borders was recently appointed to the National Advisory Committee on Rural Health and Human Services.

Ty Borders

This committee is part of the Health Resources and Services Administration and includes a 21-member panel of nationally recognized rural health experts that is responsible for making recommendations to the Department of Health and Human Services on issues related to rural health. Borders's appointment will continue until April 2019.

�This appointment is an honor not only for Dr. Borders and his family, but also for Kentucky,� Rep. Andy Barr, R-Ky., said in a UK news release. �Dr. Borders possesses a broad and deep understanding of the health care challenges facing rural Kentucky and America. His unique insight about evidence-based strategies that could improve rural health and health care delivery will greatly benefit the committee.�

Borders is the chair of the Department of Health Services Management and the Foundation for a Healthy Kentucky endowed chair in Rural Health Policy. He also serves as a founding co-director of the UK Institute for Rural Health Policy and is the editor of the Journal of Rural Health, an academic publication devoted to rural health research.

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Appalachia diseases drug abuse drug use drugs health hepatitis c prescription drug abuse rural health rural-urban disparities

Gusty 08:18 Add Comment

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths�a majority of which are from prescription drugs�in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

Princess Health andUK HealthCare offers help to primary-care clinics; university's top health official calls it 'a game changer' for rural health providers.Princessiccia

Princess Health andUK HealthCare offers help to primary-care clinics; university's top health official calls it 'a game changer' for rural health providers.Princessiccia

doctors physicians primary care rural health

Gusty 20:01 Add Comment

The Kentucky Primary Care Association and the University of Kentucky have announced a new partnership to provide support services to primary care providers throughout Kentucky.

This "groundbreaking partnership" will provide KPCA, which includes more than 800 patient care providers, access to UK HealthCare's support services, such as supply chain contracts, medical professional placement services, practice transformation support and training, and an after-hours pediatric call triage center, according to press release.

The most notable feature of the partnership is that KPCA members will have access to UK's group purchasing contracts, giving them access to services at heavily discounted rates at no charge to the facilities. This is expected to create "significant" savings for more than 250 clinics throughout the state. UK's top health official called it "a game changer."

�Primary care physicians, especially those in rural areas, have the extra burden of high patient volume, limited staff, and stretched resources,� Dr. Michael Karpf, UK's executive vice president for health, said in the release. �By partnering, UK HealthCare and KPCA members can grow important programs and services for their patients while also controlling and reducing operating costs.�

KPCA Executive Director Joe Smith said, "By addressing some of these issues related to costs, clinics with already scarce resources can instead focus on improving the quality of care.We�ve had a longstanding association with the university and UK HealthCare, and this partnership elevates that relationship by adding a strong commitment to assisting rural doctors, nurses and practice managers, who face some of the toughest transitions taking place in medicine today.�

The partnership will also allow KPCA members access to staffing services that link candidates to vacancies across the state; to Patient Centered Medical Home consultants, who help practices transition to quality and value-based models of care; and to UK HealthCare's after-hours pediatric call triage service.

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

business health health care access hospitals newspapers rural health rural hospitals rural-urban disparities

Gusty 13:22 Add Comment

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Princess Health andTennessee churches encourage healthier living.Princessiccia

Princess Health andTennessee churches encourage healthier living.Princessiccia

churches politics public health religion rural health walking

Gusty 19:28 Add Comment

Sulphur Wells Church of Christ in Henry County, Tennessee, a few miles away from Paris, Ky., is challenging people to eat and think healthier, Amber Hall reports for Public Radio International.

Bob Palmer, lead pastor at the church, said, "We do draw some hard lines on alcohol and tobacco use and tattoos�we think, 'Oh, you're not taking care of the our temple that God has given you.'" He said the church hasn't looked at the issue holistically. "We've just kind of picked out the things we weren't going to do anyway, and we feel self-righteous about that�that we don't do them."

Then Palmer saw the County Health Rankings, a project by the Robert Wood Johnson Foundation that measures health risks, Hall writes. He said that "when we confirm someone's spiritual health and give them a thumbs up and an A-OK, that's often the end of the rehabilitation process." However, he said if he were outside the church and had only the health indicator numbers to look at, "it might make me run in the opposite direction."

In Tennessee, the Governor's Foundation for Health and Wellness is helping groups such as churches improve health in evangelical hubs through the "Healthier Tennessee" initiative, which is a "wellness program and an online wellness tool that provides faith leaders with tips, ideas and actions to get their members healthier," Molly Sudderth, the director of communications at the foundation, said.

One of the suggestions is called Walk and Worship. "You can walk and pray for those you feel need extra prayers or are going through difficulties . . ." said Barabara Kelly, a public-health educator.

About 150 churches statewide are participating in Healthier Tennessee's "Small Starts" program, but none of the churches in Henry County have joined yet. Palmer said "there could be some stigma tied to healthy living in this largely conservative area," Hall writes.

"Right-wing religious folk have kinda viewed that as 'liberal' thinking," Palmer told him. "But that hasn't been correct, I don't think. At all. Just read through early Genesis, and the very first commission that God gives anyone is to essentially take care of this created world. We don't talk about that very often for some reason�to our detriment, and these numbers reflect that." (Read more)

Princess Health and Princess Health andPanel of physicians at national conference discuss future of rural primary care, how to solve doctor shortages.Princessiccia

Princess Health and Princess Health andPanel of physicians at national conference discuss future of rural primary care, how to solve doctor shortages.Princessiccia

doctor shortage physicians primary care rural health rural-urban disparities

Gusty 17:56 Add Comment

More needs to be done to address the shortage of primary-care physicians, a big problem in rural areas and much of Kentucky, according to a panel of physicians at "Rural Health Journalism 2014," Kris Hickman writes for the Association of Health Care Journalists, which sponsored the conference.

Almost half of rural U.S. counties, 44 percent, struggle with primary care physician shortages, said Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care of the American Academy of Family Physicians. According to a presentation at the 2013 Kentucky Rural Medical Educators Conference, Kentucky had a 1,287:1 primary care physician to citizen ratio, which is 557 short of the national average.

The national shortage is expected to worsen soon because almost 27 percent of those providers are older than 60, said Mark A. Richardson, M.D., dean of Oregon Health and Science's School of Medicine.

Bazemore said the medical community needs to draw more attention to the need for more primary care physicians in rural areas. He also said that for every dollar spent on health care, only six or seven cents are spent on primary care. "States facing a shortage should remember that primary care is the logical basis of any health care system," Bazemore said.

Richardson recommended that medical schools try to recruit students who have rural backgrounds because they're more likely to return to practice in rural areas. He and Bazemore agree that students who practice in rural areas should be given loan forgiveness or scholarships. "Debt prevents many people from choosing primary care," Bazemore said.

Richardson said the most important factor for where medical students end up practicing is where they completed their training. "Rural training is one of the highest predictors of a rural practice and should be required," he said. To do this, the government-imposed cap on graduate medical education spending would have to be abolished.

"Medical care is not a free market dynamic," Richardson said. "We pay for health care transactions, rather than health." (Read more)

Princess Health and Princess Health andMorehead State, UK and Morehead hospital sign agreement to form Appalachian Health and Research Center.Princessiccia

Princess Health and Princess Health andMorehead State, UK and Morehead hospital sign agreement to form Appalachian Health and Research Center.Princessiccia

Appalachia hospitals medical education research rural health University of Kentucky

Gusty 05:57 Add Comment

Morehead State University, St. Claire Regional Medical Center and the University of Kentucky's Institute for Rural Health Policy signed a memorandum of understanding April 30 to form the Appalachian Health and Research Center.

�The primary mission of the AHRC is to increase the capacity for innovative, collaborative research based out of Morehead, which directly addresses health issues faced by residents of Appalachian Kentucky and beyond,� said Dr. Michael Henson, Morehead State's associate vice president for research and graduate-school dean. �AHRC will seek to improve local educational opportunities related to health research and to facilitate the translation of research findings into local health policy.�

From left: Reynolds, Andrews and hospital CEO Mark Neff

Dr. Brady Reynolds, UK's Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy and co-director of the Institute for Rural Health Policy, said, �This partnership stands to greatly increase capacity for health-related research in the Morehead area and northeastern Kentucky, with the ultimate aim of improving health and health policy in the region. Through this partnership we will be able to accomplish research and community health goals that may not otherwise be possible.�

Morehead President Wayne Andrews said the agreement will �allow us to focus on some areas of research that will help us improve the lives of the citizens in East Kentucky.� The specific AHRC goals are to:

• Create new and productive research partnerships with regional colleagues at the two universities and the hospital in the areas of health and wellness;
• Increase infrastructure for health research in Morehead and the surrounding area;
• Enhance opportunities for faculty, students, and medical residents to participate in cutting-edge biomedical research;
• Streamline the required review process for collaborative projects and increase the number of behavioral and clinical trials into which local residents and patients may be enrolled;
• Promote dialogue with the public about health, wellness and biomedical research; and
• Actively work to identify and translate specific research findings to local health policy to improve health in the region.

The research center will be housed in Morehead State's Center for Health, Education and Research, which was created in 2010 as the first such partnership involving a regional public university, a land-grant research university and a nonprofit hospital corporation. The $30 million, 90,000-square-foot facility is the largest construction project in the history of Morehead State, according to a university press release. 

Princess Health and Princess Health andPoll: most Kentuckians support tobacco-free campuses, school nutrition standards and student physical activity requirements.Princessiccia

Princess Health and Princess Health andPoll: most Kentuckians support tobacco-free campuses, school nutrition standards and student physical activity requirements.Princessiccia

exercise physical activity rural health school lunch schools smoking tobacco tobacco-free

Gusty 10:47 Add Comment

Kentuckians overwhelmingly support several school policies than can influence student health but are not all embraced by Kentucky schools, according to the latest Kentucky Health Issues Poll, taken in October and November.

The poll showed that 84 percent of Kentuckians�and 72 percent of smokers�support tobacco-free campus policies, which have been adopted by only about a third of Kentucky school districts. The survey also found that 72 percent strongly favor the tobacco-free policies, while 12 percent said they favored it somewhat.

The survey found that 57 percent of Kentucky adults strongly supported, and 21 percent somewhat supported, the U.S. Department of Agriculture's new standards for school nutrition, which reduced salt and saturated fat, increased offerings of whole-grain foods, fruit and vegetables, and put stricter controls on calories and portion size.

Because the U.S. Department of Health and Human Services recommends that young people exercise for 60 minutes per day, KHIP's survey asked Kentucky adults if they think Kentucky schools should offer 30 minutes of physical activity per day for students. It found that 88 percent strongly agreed and 9 percent somewhat agreed with the policy. Physical activity is an important topic for Kentucky because 18 percent of Kentucky children are obese, according to the Kaiser Family Foundation.

Democrats were more likely to be supportive of tobacco-free campuses and the new school menus, but there was no partisan difference on physical activity. "Poll findings show that support for the health of our children cuts across party lines," said Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which sponsors the poll with Interact for Health of Cincinnati. It is conducted by researchers at the University of Cincinnati.

Princess Health and Princess Health andEar, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children.Princessiccia

Princess Health and Princess Health andEar, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children.Princessiccia

Appalachia hearing otolaryngology rural health rural-urban disparities telemedicine

Gusty 13:18 Add Comment

Dr. Matthew Bush, an otolaryngologist at the University of Kentucky, is working to reduce the state's high rate of hearing loss, especially in Appalachia and among children. He was born in Charleston, W.Va., and attended medical school at Marshall University in Huntington. "In the course of his extensive training, Bush 'fell in love' with hearing health care, ear surgery and technologies like cochlear implants that offer revolutionary opportunities for people who are deaf or hard of hearing to rejoin or enter the hearing world," Mallory Powell writes for UK. 

"It was the clinic setting that informed and fueled my efforts and interests because the patients that we see have some tear-jerking stories," Bush said. "They didn't have access to services, or they were totally unaware that there were options to help their hearing impaired child. So they show up at the clinic very delayed, well past the optimal age for intervention, and the child has already lost a lot of language development potential."

About 1 in 1,000 children experience pediatric hearing loss, and Bush said the rate is much higher in Kentucky, 1.7 out of 1,000 in Kentucky. Though hearing loss isn't life-threatening, it can greatly impact the quality of life, influencing speech, language and cognitive development in children. Early detection is important for successful treatment. "The consequences of delaying care in the first few years of life are amplified dramatically," Bush said.

Rural residents deal with many health disparities, and "delays in pediatric hearing health care are unfortunately common," Powell writes. "Children with hearing loss in rural areas are diagnosed later than children in urban areas and subsequently receive interventions like hearing aids and cochlear implants at a later age."

This rural hearing-health disparity results from factors such as distance from health-care facilities and inadequate knowledge of the importance of timely care for pediatric hearing loss. Bush says he hopes to employ telemedicine to reduce the effects of distance from facilities, with "diagnostic testing, patient counseling and hearing loss rehabilitation with hearing aids and implants. These services have not been offered before in Appalachia."

Bush is also working to increase parental knowledge about pediatric hearing loss and educate rural primary-care physicians in diagnosing and treating pediatric hearing loss. "This is not something that they're seeing on a daily basis, so provider knowledge about next steps and resources is limited," Bush said. He and his colleagues have created online educational modules that will be circulated to providers.

"In an ideal world . . . there would be a seamless transition from the birthing hospital to resources for hearing testing and treatment, whether face-to-face or via telemedicine. We'd like the quality of care and access to care to be the same for all children. That's really what our passion is," Bush said. (Read more)

Princess Health and Princess Health andRoy Butler, 'father of Medicaid' in Kentucky, passes.Princessiccia

Princess Health and Princess Health andRoy Butler, 'father of Medicaid' in Kentucky, passes.Princessiccia

Medicaid rural health

Gusty 14:40 Add Comment

Roy Butler, called "Father of Medicaid" in Kentucky, died Monday morning of complications from Parkinson's disease. He grew up during the Great Depression on a farm in Franklin County, where he learned to work hard, reports Kristie Hamon of The State Journal. He served in the Army with occupation forces in Japan, then Georgetown College and the University of Kentucky. In 1951 he began working with the commonwealth of Kentucky; he spent more than 41 years with the state, and he prioritized "health and social programs within the Cabinet for Human Resources," Hamon writes.

Roy Butler and his family (State Journal photo)

Butler had a very positive influence on Kentucky Medicaid. "The most satisfying aspect was being able to expand the program in terms of the number of health services being offered as well as increased benefits to the providers of care," Butler said recently. He acknowledged co-workers' contributions: "The second-most satisfying aspect of the job was the number of terrific, talented people that I met, especially the staff of people that I worked with such as Janie Miller and Mark Birdwhistell, and having a major impact on the direction of the program."

Miller, a former secretary of health and family services, now runs the Kentucky Health Cooperative, a non-profit insurer created under federal health reform. Birdwhistell, a UK HealthCare executive, told Hamon, "Roy Butler is an extremely phenomenal administrator, extremely knowledgeable and hardworking. . . . I owe him a great deal of gratitude for teaching me everything I learned."

Butler was named to UK's College of Public Health Hall of Fame last fall. He remained married to Elise Lois Watkins Butler for 53 years until she died in 2004, and they had three children. One, Lane Butler Jacobs, recalled an occasion when he father was very upset that someone required a medical procedure and no apparent way to get it covered by Medicaid. Jacobs said she asked her father if he knew the person, and he said, "No, but then what difference would that make? What if this was your mother or your aunt or your daughter? Wouldn't you want to do everything you could do to save their life?"

Jacobs told Hamon, "He also benefited the lives of many other people. Probably more than he can possibly imagine." The story requires a log-in and password to view.

Princess Health and Princess Health andKentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation.Princessiccia

Princess Health and Princess Health andKentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation.Princessiccia

Appalachia economy poll public health rural health rural-urban disparities state government survey wellness

Gusty 13:32 Add Comment

Kentucky ranked 49th in the nation in a survey that measures perception of well-being, ranking higher than West Virginia and lower than Mississippi, and its 5th Congressional District ranked dead last in the nation.

"The survey assessed people's emotional and physical health; behavior that affects health, such as smoking or exercising; job satisfaction and access to basic needs, including food and housing; and their outlook on life," Bill Estep reports for the Lexington Herald-Leader. The Gallup Organization and Healthways, a Tennessee-based company that provides services to improve well-being, administered the survey.

Kentucky has ranked 49th each year except for 2008, the year the index began, when it ranked 48th. Factors contributing to this result include high poverty, top smoking rates, many uninsured people, high depression rates, drug abuse, obesity and other health issues. "Our health status is dismal in Kentucky," state Health Commissioner Stephanie Mayfield told Estep.

Louise Howell, a consultant for Kentucky River Community Care, said Eastern Kentucky has "profound health disparities." Harlan County lost 13,054 years of individual lives due to premature death, according to the survey. In Breathitt County, only 25.1 percent of people have access to satisfactory exercise opportunities. In Martin County, 37.4 people smoked.

Shaping Our Appalachian Region, a program Gov. Steve Beshear and 5th District Rep. Hal Rogers began last year, is forming strategic plans to improve the region's economy through expansion and diversification. This summer the public meeting will take place to brainstorm ideas and promote involvement. "I think this is the toughest most difficult region we've worked in, ever," said Charles W. Fluharty, who heads the Rural Policy Research Institute and is interim executive director of SOAR. However, he said the region will benefit from people's awareness that the coal-depend region has to try to a new strategy, Estep writes.

Dee Davis, president of the Center for Rural Strategies in Whitesburg, told Estep: "People realize if we've got any chance at all we've got to seize the reins; we've got to diversify the economy." (Read more)

Princess Health and Princess Health andTelemedicine can help delay Alzheimer's, especially in rural areas, where it starts sooner, Appalachian health conference is told.Princessiccia

Princess Health and Princess Health andTelemedicine can help delay Alzheimer's, especially in rural areas, where it starts sooner, Appalachian health conference is told.Princessiccia

Alzheimer's disease Appalachia dementia rural health rural-urban disparities telemedicine University of Kentucky

Gusty 14:07 Add Comment

By Melissa Landon
Kentucky Health News

Telemedicine is a strategy that can be used to help prevent and treat Alzheimer's disease, especially in rural areas, where the disease comes sooner in life, Dr. Gregory Jicha, clinical-core director of the University of Kentucky's Disease Center, said today at the fourth annual Appalachian Translational Research Network Summit in Lexington.

Dr. Gregory Jicha

While mortality rates for prostate cancer, breast cancer, heart disease and HIV are going down, the rates for Alzheimer's are going up, and by 2020, it is estimated that 5.6 million Americans could be affected by it. Rural areas have higher incidents of the condition, and the onset of dementia averages four years younger in rural areas than in urban areas, Jicha said.

The university's Telemedicine Cognition Clinic offers appointments that involve video interaction with patients and caregivers in remote areas. In rural areas in general, telemedicine can be particularly helpful for patients who live great distances from the nearest specialist. "I cannot drive to Paducah and fill an entire clinic every week," Jicha said. But he explained that he can "travel" to a different city every hour and provide care to patients. "Telemedicine really is the wave of the future," he said. 

During telemedicine appointments, medical experts can talk about the patients' history, administer cognitive tests, and even observe patients walking or performing tasks to diagnose them. The goal of the program is to provide high level care and cognitive evaluations in rural areas by partnering with primary care physicians and clinics in rural areas, Jicha said.

Another important aspect of the growing program is education, both for patients and for physicians. Alzheimer's disease has no sure, but some risk factors associated with it�such as hypertension, alcohol use and depression�are treatable. If rural residents had better access to specialists who can detect the early symptoms of the disease, its onset could be delayed.

The conference was a forum for hundreds of research efforts. Among the topics discussed during the conference were the connection between physical fitness and academic performance in children, and environmental enrichment to promote healthy aging brains.

Todd Gress, a professor at Marshall University in Huntington, W.Va., presented a study about a pilot test of a text-message reminder system to advance diabetes awareness, compliance, and education�particularly in remote areas where cell phone service might be unreliable.

The advancing telemedicine strategy and these other research agendas should serve as a reminder that gifted researchers are searching for ways to improve rural health.

Such conferences "represent the best of what's happening out there in the world of universities and the world of communities," UK Provost Christine Rirodan told one session. She said the Appalachian gathering "represents the passion of people who are dedicated to solving these problems" in the region, "which require a great deal of collaboration to solve. . . . They're not small problems."

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

cancer cigarettes county health education health rankings lung cancer poverty rural health rural-urban disparities smoking smoking cessation tobacco tobacco prevention

Gusty 10:55 Add Comment

Clay County has a dubious distinction. It has the highest rate of smoking for any U.S. county with a population under 15,000. Researchers at the University of Washington pointed that out, and The New York Times focused on it in reporting the larger finding: Some poor, rural and working-class counties have increasingly high rates of smoking, while the smoking rates in wealthy counties continue to decline.

Ed Smith Jr.
(NYT photo by Tim Harris)

In Clay County, the smoking rate was 36.7 percent in 2012. �It�s just what we do here,� Ed Smith Jr., 51, told the Times, which reports, "Several of his friends have died of lung cancer, and he has tried to quit, but so far has not succeeded." (Institute for Health and Metrics map shows adult smoking rates by county; Clay and Knox counties are the red area in southeastern Kentucky. The interactive map shows how rates have changed since 1996, overall and among men and women. To view it, click here.)

The smoking rate among adults has decreased 27 percent since 1997, but only 15 percent among poor people, and haven't changed at all for adult smokers living in deep poverty in the South and Midwest, the study found. "The findings are particularly stark for women," Sabrina Tavernise and Robert Gebeloff write. "About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did." Education also plays a role. "Americans with a high-school education or less make up 40 percent of the population, but they account for 55 percent of the nation�s 42 million smokers."

Clay County is one of the nation's poorest, and only 7 percent of its people have a college degree. The county seat, Manchester, passed an indoor smoking ban in 2012, and Manchester Memorial Hospital "runs a smoking-cessation program that offers free nicotine patches and gum in an effort to reach low-income smokers," the Times reports. �Smoking cessation is our biggest uphill battle,� Jeremy Hacker, the hospital�s community outreach coordinator, told the newspaper. Smoking is no longer a normal activity in urban places, he said, but in Clay, �It�s not viewed as a problem.� (Read more)

Princess Health and Princess Health andHumana Inc. bus travels the rural roads of Mississippi, looking to enroll people in Obamacare by March 31 deadline.Princessiccia

Princess Health and Princess Health andHumana Inc. bus travels the rural roads of Mississippi, looking to enroll people in Obamacare by March 31 deadline.Princessiccia

health care health care access health insurance health journalism health reform obamacare obesity Patient Protection and Affordable Care Act poverty rural health

Gusty 13:13 Add Comment

Insurance providers have been scared off by Mississippi, one of the poorest and unhealthiest states in the country. Only nine percent of eligible residents have signed up for insurance under federal health reform, ranking Mississippi near the bottom of all states in Obamacare, with only 25,554 residents having signed up as of early March.

Politico photo by Madeline Marshall: Humana bus

Louisville-based insurance company Humana Inc. is attempting a unique way to try to get Mississippi residents signed up. The company has a bus that travels the state, having made more than 200 stops "pulling into hospital parking lots and Wal-Mart shopping centers, parking at churches large and small and hitting other obvious targets to find and convince the uninsured that President Barack Obama�s signature health achievement will benefit them," Jennifer Haberkorn reports for Politico. "Sometimes the company�s agents see dozens of people per stop. Other times, just a few individuals climb aboard."

Mississippi is the only state where Humana has a bus, Haberkorn writes. "It�s also the only state where the company is covering the co-pay for customers� first doctor�s visit before June, immediate cash savings that it hopes will get people to start a relationship with a primary-care physician. Officials declined to say exactly how much is being spent on the dual strategies."

Based on the dismal number of residents signing up, the bus hasn't exactly been a hit. Part of the problem is that rates in Mississippi are the third highest in the country, and that Humana is only one of two insurers in the state. "Despite all the political rhetoric about a government-run health program, Obamacare relies on private insurers to sell policies on the state and federal exchanges. If there�s no insurance company, then there�s really no Obamacare," Haberkorn writes. "And Mississippi is one of the last places the typical risk-averse health insurance company would choose to sell policies under the law. Statistically, it�s one of the unhealthiest states, topping the charts in all kinds of negatives such as obesity, diabetes, hypertension and cardiovascular disease � conditions that can be stabilized with treatment or kill without."

"But Humana has every incentive to sell as many policies as possible," Haberkorn writes. "The math involved is simple: Insurance works when there are more people enrolled, which spreads the risk of high costs across hundreds or thousands of customers. To succeed in a state like Mississippi, it had to go all out to get customers."

Humana originally offered policies in only four counties, but the state insurance commissioner persuaded it to go to 40. The company's Mississippi market director, told Haberkorn, �Back in August, when we added on an additional 36 counties, we had to act really quickly on how we would get to all of the people in those counties at such a last minute. Operating this mobile tour has allowed us to get to people, instead of waiting for them to come to us.� (Read more)

Princess Health and Princess Health andRural health advocate pleads with legislature to 'end the tobacco epidemic in rural Kentucky'.Princessiccia

Princess Health and Princess Health andRural health advocate pleads with legislature to 'end the tobacco epidemic in rural Kentucky'.Princessiccia

General Assembly legislature rural health smoking smoking ban tobacco tobacco prevention

Gusty 14:13 Add Comment

Sen. Julian Carroll, D-Frankfort, looks at a Smoke Free Kentucky
display in the state Capitol. The group added black wreaths after the
smoking-ban bill died. (Courier-Journal photo by Jonathan Palmer)

The day that the bill for a statewide smoking ban died, the Kentucky Rural Health Association published a column in KyForward calling on legislators to "step up to the plate to help us save future generations from the scourge of tobacco use, disease and early death."

Tina McCormick of Henderson, the group's executive director, began her piece this way: "We have an epidemic right here at home and rural Kentuckians are the hardest hit." She added later, "The General Assembly must act now to fix the tobacco epidemic in rural Kentucky. Those of us who live in rural areas start using tobacco at a younger age, we use it more heavily, and we are more likely to breathe secondhand smoke at work and at home than those who live in the cities and suburbs in the commonwealth."

McCormick concluded, "This is a cry for help from rural Kentucky. We are tired of waiting for clean air. The facts are there. We need and want smoke-free air. Let�s make the tobacco epidemic history in rural Kentucky so that our children can expect a long, prosperous and healthy future. Please help us clear the air and end the tobacco epidemic in rural Kentucky." For the full column, click here.