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 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 andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

Princess Health andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

food deserts food stamps nutrition research rural-urban disparities

Gusty 21:12 Add Comment

A study has found that nutritious foods are more expensive in impoverished rural counties than in urban counties, a phenomenon that doesn't help public health officials who teach healthy eating as a proven, effective strategy to prevent chronic diseases to rural Kentuckians.

"The results of this study find that individuals living in rural areas, particularly food desserts, may be at increased risk of negative health effects as a result of more limited access to higher quality foods compared to those living in urban areas," says the report of the University of Kentucky study, "Food Cost Disparities in Rural Communities," published in Health Promotion Practice.

Researchers analyzed the per-serving cost of 92 foods four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. One rural county was considered a food desert, meaning that fresh produce isn't relatively available. The commonly purchased foods in the study were assigned to one of four categories based on their nutritional value.

Not surprisingly, the cheapest foods were those with the least nutritional value, such as canned fruit in heavy syrup, cereals with high-fructose corn syrup, and processed meats.

Foods that are a bit more nutritional, but mainly processed convenience foods, were more expensive in rural counties than urban counties.

Foods that were considered nutritious, but not the most nutritious, such as white rice, oats, whole-grain bran cereals and frozen fish, cost the most in the rural county with the highest poverty rate.

The cost of the most nutritional items varied by county, with the "most striking finding" being that "the rural food desert had significantly higher per-serving costs among the most nutritious food items, compared to the other three counties," 6 to 8 cents higher per item, the report said.

Within each county, the study did not find much difference in food cost among the foods in each of the four nutrition categories.

However, it did find that highly processed convenience foods in urban counties were more expensive than more nutritional foods, and suggested that those living in urban areas could afford more plant-based foods and fewer processed foods as an "effective strategy to improve overall dietary quality without increasing food budgets."

The study draws attention to the SNAP or food-stamp program, which makes no allowances for food cost differences between regions or counties, and suggests that its model be changed to be more like the Women, Infants and Children program, which uses a portion-based system: Participants buy a set number of ounces or servings of dairy products, whole grains, and fresh produce each month, irrespective of price. This approach "has the potential to adequately meet all participants' nutritional needs, irrespective of differences in food prices," wrote the researchers, Frances Hardin-Fanning and Mary Kay Rayens of the UK College of Nursing.

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 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 andCarlisle hospital closes, making Nicholas County the 40th Kentucky county without a hospital.Princessiccia

Princess Health and Princess Health andCarlisle hospital closes, making Nicholas County the 40th Kentucky county without a hospital.Princessiccia

health reform hospitals jobs rural-urban disparities

Gusty 13:04 Add Comment

Fully one-third of Kentucky's counties will not have a hospital, following the closure of Nicholas County Hospital in Carlisle. That will make Nicholas the 40th county without a hospital, according to the Kentucky Hospital Association.

The hospital board said it searched "every possible option to keep the hospital open," but it has filed for bankruptcy and will close later this week, reports WLEX-TV. Officials reported that the 14-bed hospital was losing more than $100,000 per month, which they say resulted from a decrease in the number of patients and slow state and federal reimbursements, Sam Smith reports for WKYT-TV.

"It's a trickle-down effect that's going to impact the entire community and then there's the more critical life-saving aspect. There's a number of people within the community who are alive today because they were able to receive treatment at the hospital," hospital spokesman Stephen Scalf told WKYT.

Scalf said the hospital's clinics will close by Friday except for one rural health clinic that will likely remain open. Johnson Mathers Nursing Home, which operates on the same campus as the hospital, will not close. "Nicholas County Hospital is operated by a private nonprofit organization, JMHC Inc., and has 44 full-time and 40 part-time employees who are being laid off," Karla Ward reports for the Lexington Herald-Leader.

The hospital's board said in a news release that it has been negatively affected by a national transition to "larger, urban-centered hospitals' that had forced many other rural health centers to close."

The fiscal court will be looking for options to create an "urgent treatment or ambulatory care facility that will provide for the community's medical needs in the future," WLEX reports. The county owns the hospital's property, and Judge-Executive Mike Pryor said other healthcare provers are considering taking over the space, Smith reports. "It's just another hit to us," said Pryor. "It's going to be something we are going to have to deal with, like we have in the past."

Princess Health and Princess Health andHealth reform law isn't as sweeping when it comes to dental coverage, but Appalachian dentists say it should help.Princessiccia

Princess Health and Princess Health andHealth reform law isn't as sweeping when it comes to dental coverage, but Appalachian dentists say it should help.Princessiccia

dental care dental health dentists health reform Medicaid obamacare oral health Patient Protection and Affordable Care Act rural-urban disparities

Gusty 20:28 Add Comment

Dr. Heather Whitt explains costs to Anita Slone at the Eula Hall
Health Center in Floyd County. (C-J photo by Jessica Ebelhar)

In Floyd County, almost 40 percent of adults have lost six or more teeth to decay or gum disease, more than 50 percent of adults have had at least one tooth pulled, and 25 percent of people older than 65 have lost all of their teeth. But "When it comes to dental care, the Affordable Care Act's reach is limited," Laura Ungar reports for The Courier-Journal.

The Patient Protection and Affordable Care Act requires health plans to cover children's oral health, but adult coverage is optional. Kentucky's Medicaid benefits only cover certain services, such as oral exams, emergency visits, X-rays, fillings and extractions, and rural areas are dealing with a shortage of dentists who increasingly do not accept Medicaid.

Despite these obstacles, Dr. Heather Whitt, director of dental services for a network of health centers called Big Sandy Health Care, said she thinks the reform law will help people who live in Central Appalachia, a hotbed of bad oral health. She said the number of uninsured�which for a long time was almost 75 percent of her patients�is finally beginning to decrease. "Now, there are more adults having Medicaid. It's definitely improved the patients we see here. . . . We stay very busy," she said. "I'm excited more people have benefits."

"She and other dentists said Medicaid, which is covering most of the area residents newly insured through the ACA, does not cover every service they might need," Ungar writes. Whitt noted that Medicaid doesn't cover costs for dentures or root canals for patients older than 21, and some dentists said Medicaid managed-care organizations do not send reimbursements quickly enough.

Whitt said that she and her staff try to teach patients about brushing, flossing and regular checkups. They also teach those things in schools, encouraging children to visit dentists. Dentists say that if the law and Medicaid can get more people to visit the dentist, they'll learn to take better care of their teeth. "A lot of our patients just kind of fall through the cracks," said Dr. James Stambaugh, another dentist at the clinic. "Small problems just grow exponentially." (Read more)