Online training could help rural doctors offer better mental health care

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)

Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary

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)

Farmers work long past regular retirement age, and many doctors lack the knowledge to help keep them healthy

"Farmers' stark commitment to work is borderline obsessive, and researchers are beginning to develop new guidelines to better understand farmers, whose strong cultural and emotional ties to the farm drive their work ethic," reports Karin Pekarchik of the University of Kentucky College of Agriculture about a study by the UK College of Nursing's Deborah Reed. Findings show that 40 percent of 1,423 Kentucky and South Carolina farmers aged 50 and over defined health as the "ability to work," causing them to work well after retirement age. Reed told Pekarchik she hopes these results will help medical personnel better understand farming culture so they can better relate to farmers.

"The average Kentucky farmer is 57 – 13 years older than the average worker. Kentucky's farming population mirrors that of the entire United States, making this a nationwide topic," Pekarchik writes. Reed told her most farmers have two jobs and don't list farming as their primary occupation, keeping doctors from screening for things like skin cancer and cataracts, common ailments associated with working outdoors.

Another alarming statistic is that farmers have the highest suicide rates of any occupation, most likely because they're "exposed to unrelenting and multifaceted stress and pressure," Pekarchik writes. The resulting stress from hard physical labor, long work days throughout the year, enduring vagaries of nature and livestock, adverse weather conditions, market fluctuations, government policy changes and family pressure can lead to suicide.

Reed told Pekarchik farmers, even from a young age, should be aware of the physical and mental problems that could ail them later in life. Reed suggests farmers use sunscreen, wear wide-brimmed hats, use hearing protection and wear sturdy shoes and use a walking stick to eliminate falls. (Read more)

Frontier Nursing Service sells Mary Breckinridge Hospital to Appalachian Regional Healthcare

Following the nationwide trend of independent hospitals joining larger organizations in order to stay viable, and ending an era, Hyden's Mary Breckinridge Hospital has been acquired by Appalachian Regional Healthcare.

The hospital was sold by the Frontier Nursing Service, which was founded in 1925 by Mary Breckinridge, whos eefforts greatly reduced infant mortality in the area. The hospital employs 150 people and will now be called Mary Breckinridge ARH Hospital, The Associated Press reports.

ARH President and CEO Jerry Haynes said the health system hopes to enhance health-care services in Leslie County. It is the 10th hospital in the Central Appalachian network, which began with takeover of United Mine Workers hospitals about 40 years ago. (Read more)

3 universites and federal agency join to improve oral health in Appalachian Kentucky

With money from the Appalachian Regional Commission and some of their own, three very different Kentucky universities will collaborate "to enhance sustainable, collaborative dental health education and care" in the state's eastern coalfield, where both are sorely lacking, they announced in a press release.

Morehead State University, the private University of Pikeville, and the University of Kentucky's College of Dentistry will design the Appalachian Rural Dental Educational Partnership Plan "to train more dentists to practice in rural areas and give them the tools necessary to set up thriving dental practices in Eastern Kentucky," the release said. The funding is $400,000 from ARC, $127,293 from UK, $82,035 from UPike and $47,873 from Morehead State.

“The majority of Eastern Kentuckians have struggled to sustain quality dental health, and one of the barriers to maintaining good dental health is poor access of quality dental care,” state Department for Local Government Commissioner Tony Wilder said. His agency handles ARC matters in Kentucky.

Said new UK President Eli Capilouto, a dentist by trade, “We know that if we can break a cycle of poor health, we can begin to break cycles of poverty. Cycles of despair can become legacies of hope. We also, increasingly, know that partnerships and greater collaboration are the best – and, perhaps, only – way to address major challenges.” He called the project a unique partnership among a federal agency, a governor and “the state’s flagship institution, Kentucky’s public institution dedicated to serving the people of Eastern Kentucky, and a critically important college with deep roots in Eastern Kentucky.” (Read more)

Seven UK docs-to-be off to Morehead to train in rural medicine

Learning how to practice in rural areas is the goal of seven University of Kentucky medical students, who are off to Rural Physician Leadership Program in Morehead. (From left: Shea Poynter, Lesley Jackson, Katherine Johnson, Nathan Hudson, Katrina Winkler, Crystal Norgren and Miranda Smith)

The program "trains physicians to become practitioners and leaders for rural areas," Julie Meador writes for UKNow, the university's news service. "It was created in response to the growing health care needs evident in rural areas of Kentucky and the rest of the nation."

The training is primarily done at St. Claire Regional Medical Center and with physicians with the Northeast Area Health Education Center, who are serving as preceptors. The students will also take courses at Morehead State University's Department of Business and Public Affairs on the medical use of information technology, financial issues and debt management and community engagement for health policy.