Princess Health and Princess Health andUK College of Medicine graduate Ashley Loan makes commitment to practice emergency medicine in rural Kentucky .Princessiccia

Princess Health and Princess Health andUK College of Medicine graduate Ashley Loan makes commitment to practice emergency medicine in rural Kentucky .Princessiccia

COPD rural medicine

Gusty 09:11 Add Comment

Ashley Loan

Ashley Loan graduated from the University of Kentucky College of Medicine on May 17 and plans to practice emergency care medicine in rural Kentucky, Elizabeth Adams reports in a UK press release.

Loan began working toward her goal four years ago as one of 10 graduating students who participated in UK's Rural Physician Leadership Program, where she believes her roots in Greenup County prepared her for a future responding to medical emergencies in rural Kentucky, Adams reports.

Loan told Adams that her earliest experiences in emergency medicine were watching her mother, Elizabeth Loan, respond to accidents in the farming community because she had an associate's degree in nursing and was the most educated health care provider within a 10-mile radius of the Loan farm.

Her daughter recalled that when the neighbor's son went into a diabetic coma, her mother rushed to their house to administer sugar. Another time, her mother administered CPR to a farmer who was pinned under a tractor until the emergency responders arrived.

"There have been a lot of instances when my mom was the sole health care provider," Loan said.

Loan told Adams that she understands cultural characteristics that influence health in rural populations, such as an attitude of self-reliance that results in attempts to self-medicate or postpone visits to the doctor. It's often difficult for doctors from urban environments to appreciate those cultural variances.

"I get why people don't go to the doctor�rural people are raised to take care of themselves," Loan said. "Before they come to the doctor, they've tried a few things."

Loan told Adams she also understands first-hand some of the health challenges found in rural communities. Her father, a longtime tobacco farmer and user, suffers from chronic obstructive pulmonary disease.

Kentucky has the nation's highest rate of COPD, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause, but air pollution and genetics can also play a role.

Loan told Adams that growing up in a rural area isolated from hospitals fueled her desire to deliver more efficient emergency medical care to rural communities. She said she "enjoys the challenge of being the first doctor on the trauma scene and 'Macgyver-ing' her way through emergencies with limited resources."

"I love the fact that patients who come to the emergency department are the sickest patients you are going to see," Loan said. "You lay your eyes on them; you have no previous notes�you are the person who has an hour before the patient crashes to figure out what's going on."

Loan's experience in the Rural Physician Leadership Program allowed her to gain more hands-on experience with patients because of the hospital's smaller medical staff and fewer residents in the program, Adams reports. She has delivered more than 10 babies, assisted attending physicians with bowel surgery and helped stabilize a coding patient in the emergency department.

During her stint, Loan participated in a clerkship and lectures at St. Claire Regional Hospital in Morehead. Dr. Phillip Overall, the emergency clerkship director at the hospital, told Adams that Loan has already demonstrated the calm and decisive qualities needed in an emergency-room doctor.

"She is able to think very quickly on her feet and subsequently provide excellent patient care," Overall told Adams. "We take care of critical patients on a daily basis, and she is absolutely able to step back and assess the entire situation calmly and come up with a plan to take care of the patient."

The assistant dean who recruited Loan to the Rural Physician Leadership Program, Dr. Anthony Weaver, said that rural practices and hospitals need physicians who are committed to living and working in small towns. Loan's closeness to her family and ability to "have conversations with anyone about just about anything" made her an ideal candidate for the program, he told Adams.

"Ashley Loan has the intelligence and drive to succeed as a physician, but more importantly, she cares about her family and her neighbors," Weaver said. "Improvements in the health of rural Kentucky will come from people like Ashley."

Loan also received a certificate in health systems leadership upon graduation from medical school and will work toward a master's in business administration during her medical residency, which she is also completing at UK. Loan aspires to serve as the director of a rural emergency department.

Loan was once a high-school girl who wanted to escape rural Kentucky. Now, she not only has committed to practicing medicine in rural Kentucky, but she and her fianc� Ryan Brown have bought an 87-acre farm in Greenup County and built a house there. She plans to raise beef cattle when not practicing emergency medicine in a nearby hospital or responding to emergencies, Adams writes.

"I'm definitely a small-town person," Loan told Adams. "I feel an obligation to come back and serve the people who have really believed in me for so long. It makes my day when someone says, 'You are coming back here?' I'm Ashley�I'm the girl who sold corn with her dad on the side of the road�they trust me, and I like that." (Read more)

Princess Health and Pikeville Medical Center joins Mayo Clinic Care Network.Princessiccia

Princess Health and Pikeville Medical Center joins Mayo Clinic Care Network.Princessiccia

Appalachia hospitals rural health rural medicine

Gusty 17:33 Add Comment

Pikeville Medical Center President Walter May and Dr. 
Stephen Lange, Mayo Clinic's Southeast medical director

Pikeville Medical Center joined the Mayo Clinic Care Network last week, extending the clinic's knowledge and expertise to PMC staff, which the hospital says will improve health care delivery for 420,000 Appalachians while allowing them to stay close to home.

Some of the resources that will now be available to PMC physicians and providers include its online point-of-care information system and electronic consulting that connects physicians with Mayo Clinic specialists about diagnosis, therapy or care management, says a PMC news release.

�Pikeville Medical Center is honored that we have been asked to become a member of Mayo Clinic Care Network,� says Walter E. May, president and chief executive officer of PMC. �I have admired Mayo Clinic for many years and tried to make Pikeville Medical Center more like the Mayo Clinic. This new agreement will take our hospital to the next level.�

The primary goal of the Mayo Clinic Care Network is to offer Mayo Clinic expertise close to home so that patients only travel when necessary, says the release. The network was launched in 2011 and has member organizations based in Arizona, Florida, Illinois, Kentucky, Michigan, Minnesota, Missouri, Montana, New Hampshire, North Dakota, Puerto Rico and Mexico. See details about specific hospitals in the map below.

�We are pleased to welcome Pikeville Medical Center and its more than 2,000 employees into our Mayo Clinic Care Network family,� says Stephen Lange, M.D., southeast medical director of the Mayo Clinic Care Network. �Our mission is to work collaboratively to improve the quality of health care and value for our patients. We are very excited to work together with Pikeville to find bold and innovative ways to enhance the quality of life for the patients in that region of the country.�

PMC serves 420,000 people and 15 counties in Kentucky, Virginia and West Virginia, and the hospital is currently undergoing a $150 million expansion.

Princess Health and U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage.Princessiccia

Princess Health and U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage.Princessiccia

medical education physician recruitment physicians rural health rural medicine rural-urban disparities University of Louisville

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The University of Louisville School of Medicine Trover Rural Campus in Madisonville was rated third best in the nation for preparing medical students to practice in rural areas, which is critical to the state since most of Kentucky's rural counties are considered to be short of health professionals.

�From the president and the deans to the individual faculty and staff, our team has proven the value of a collaboration of a rural campus and an urban university. The beneficiaries are our students and the rural Kentucky communities who receive these new doctors who are well prepared to care for them,� Dr. Bill Crump, right, associate dean for the Trover campus, said in a UofL press release.
  
The study by researchers at the University of Colorado, which will be published in Academic Medicine in August, ranked 35 programs across the nation and found that 62 percent of Trover graduates practice medicine in rural areas, says the release.

�This national recognition is the fulfillment of Dr. Loman Trover�s vision outlined almost 60 years ago of providing first class medical education in a small town with the goal of producing more physicians for rural Kentucky, and is a testament to the strong support we�ve had from the Louisville Campus over the past 15 years,� said Crump.

Nationally, there is a physician shortage in rural areas because only 3 percent of medical students report want to practice rural medicine, while 16 percent of Americans live in rural areas. This problem is especially large in Kentucky, says the release, since a majority of the state's 59 counties classified as rural are considered to be short of medical professionals..

�Our Trover campus is vital to fulfilling this mission and especially critical now because our state faces such a significant shortage of physicians, especially in rural areas. Dr. Crump�s leadership of the program is one of the reasons for its success. We view the program as a model that has the potential to be implemented in other areas of Kentucky,� said School of Medicine Dean Dr. Toni Ganzel.

Princess Health and Frontier Nursing University in Hyden helps bring better family health care to rural America with distance learning.Princessiccia

Princess Health and Frontier Nursing University in Hyden helps bring better family health care to rural America with distance learning.Princessiccia

Affordable Care Act health care access health care law health reform medical education midwifery nurse practitioners nurses Patient Protection and Affordable Care Act rural health rural medicine

Gusty 06:20 Add Comment

Midwives and nurse practitioners who recently graduated from Frontier Nursing University in Hyden address the unique challenges of rural areas, including shortages of health care providers, by bringing local health care to rural communities across the country. FNU was featured in a recent report from the Robert Wood Johnson Foundation.

FNU, a graduate program that offers distance education to nurses with an interest in nurse-midwifery and family nurse practitioner and women�s health specialties, aims to build a pipeline of highly educated nurses serving in rural or underserved areas, reports RWJF, one of its funders.  Many scholars and grantees sponsored by RWJF go on to spearhead projects to improve access to high quality nursing care in remote areas, the foundation says.

�We�re trying to introduce primary care providers into rural areas in such a way that they can provide high quality care and preventive services too,� says Suzan Ulrich, associate dean of midwifery and women�s health at FNU and an RWJF executive nurse fellow.

Demand for health care is rising nationwide because of an aging population that is living longer, but sicker, with multiple chronic conditions. The need for health care providers will intensify next year, when millions of new patients will become eligible for health insurance under the health-reform law.

Rural parts of the country face unique challenges and shortages of health providers, including nurses, can be particularly acute in rural areas, said Alan Morgan, CEO of the National Rural Health Association. These nurses and other providers have less access to education programs, which tend to be located in more densely populated areas. Programs that offer advanced degrees, from the baccalaureate to the doctorate, can be especially difficult to access for students living in rural areas, according to RWJF.

Identifying and educating nurses from rural areas is a key goal of FNU, which offers distance education programs that enable students to remain in their home communities and a �bridge� program that allows nurses with associate�s degrees to move more easily into master�s and doctorate programs. �These students really love where they live,� Ulrich said. �If we can educate them to stay within their communities, then those communities are going to have a provider who�s going to be there a long time." (Read more)

Princess Health and Care in rural hospitals is just as good as that in urban hospitals, study concludes.Princessiccia

Princess Health and Care in rural hospitals is just as good as that in urban hospitals, study concludes.Princessiccia

health reform hospitals rural health rural medicine

Gusty 15:19 Add Comment

While rural Americans have less access to primary care and have worse health outcomes, the care at rural hospitals is equal to, if not better, than that at urban hospitals, a National Rural Health Association report says.

The study also found rural health care is not more expensive than urban care. "However, urban residents rarely out-migrate to rural settings for either routine or advanced treatments or care yet many rural patients are referred to or voluntarily travel to urban providers based on the myth of better care," a summary of the study says.

The study was compiled by iVantage Health Analysis, a private health-care research company. It collected data on Medicare costs and health outcomes for doctors and hospitals for 12 months and divided the results into rural and urban groups based on zip codes, to give a picture of the state-by-state importance of rural hospitals.

In Kentucky, nearly half of its Medicare beneficiaries lived in rural counties in 2010. Nationwide, just 21 percent of them do, though there were western states with much higher percentages. In Wyoming, for example, 69 percent of Medicare beneficiaries live in rural places. Spending per Medicare beneficiary in Kentucky was nearly $8,000 in both urban ($7,851) and rural ($7,879) settings in 2010. That spending is high compared to the rest of the country, however; only nine other states had higher spending.
The study could have wider wider ramifications given changes in the federal health-care reform law and the move toward accountable care organizations, in which doctors and other providers are encouraged to team up to give coordinated care for a population of people and be paid financial incentives to do so.

"Value in health care is created by doing a few things well and not by trying to do everything," the summary reads. "The rural findings may just suggest that by national selection, rural has figured out what it does well and has optimized those services for the patient's benefit." (Read more)

Princess Health and Online training could help rural doctors offer better mental health care.Princessiccia

Princess Health and Online training could help rural doctors offer better mental health care.Princessiccia

mental health mental illness rural health rural medicine rural-urban disparities telemedicine

Gusty 19:23 Add Comment

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage � combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Princess Health and Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary.Princessiccia

Princess Health and Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary.Princessiccia

Affordable Care Act Patient Protection and Affordable Care Act rural health rural medicine

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The Patient Protection and Affordable Care Act is already making an impact, including for people who live in rural America. That was the message from Agriculture Secretary Tom Vilsack today on the second anniversary of the enactment of the federal health-care reform law.

In a teleconference, Vilsack noted several pieces of the law that are benefitting people, including the 2.5 million young adults who have insurance coverage because parents can keep them on their plan up to age 26. "That's providing a degree of comfort to moms and dads," he said.

The law has also helped 3.6 million seniors on Medicare, who saved $2.1 billion on their prescription drugs in 2011 because the law allowed them to get a 50 percent discount on brand-name drugs. Vilsack said seniors saved an average of $600 last year and were also "able to get a number of services, including preventive services like mammograms, for free."

Under the law, insurance companies are now required to spend 80 percent of their premium dollars on "actual health care, not overhead," Vilsack said, and they are not allowed to increase their premiums by more than 10 percent without an explanation. Children who were previously denied coverage because of pre-existing conditions can no longer denied, as per the law's mandate, and "in a couple of years that will extend to all people," Vilsack said. And thousands of new primary-care doctors and nurses are being encouraged to practice in rural areas and will receive higher payments.

Vilsack said his Department of Agriculture is working to improve the rural health-care landscape, through a joint effort with the USDA Rural Development division and the Department for Health and Human Services. In the past three years, Vilsack said 730 counties have received grants so they can "embrace telemedicine." Nearly 600 health-care facilities in rural communities have received money to fund equipment like CT scans, MRIs, ultrasound and lab equipment, Vilsack said. And rural citizens can now get care from a hospital outside their health plan's network when there is no time to get to a hospital that is farther away.

"No one should have to go without health care because of where they live, and for too long, rural Americans have been getting the short end of the health-care stick," he said. "The Affordable Care Act is helping millions of young people access health care, strengthening Medicare, and training thousands of new doctors to serve rural areas to give middle-class families the health security they deserve." (Read more)