August 5, 2015 | Tags: Blog | Tags: Behavioral Health Integration , SBIRT , Rural , Central Oregon , Social Determinants of Health
In rural areas of our state access to the most basic health care services can be difficult, let alone treatment for substance use. The unavailability of health care in rural America has been the subject of many projects and studies, so there is a lot of information about the issues this poses for individuals in rural communities who are trying to manage their health and wellbeing. The uninsured rate is higher in the rural counties (nonmetropolitan) than in the urban (metropolitan) counties as reported by CDC’s National Center for Health Statistics. Healthcare workforce shortages are also a major challenge with less than 10% of all physicians choosing to practice in rural settings. Services available in rural areas are less likely to include specialized or high-intensity care. This exacerbates the problems with distance to care for people requiring higher levels of care. According to an analysis conducted by the South Carolina Rural Health Research Center of 2013 County Health Rankings dataset and the 2012-2013 HRSA Area Health Resource File, rural adults are more likely than their urban counterparts to abuse alcohol and other substances. Causes of health disparities in rural America do not just include health care access, but also factors like socioeconomic status, higher rates of health risk behaviors, lack of employment opportunities and the prevalence of chronic conditions. For additional information about the causes of health disparities in rural areas, visit the Rural Assistance Center’s topic guide, Social Determinants of Health for Rural People.
Considering these factors, it is important to recognized clinics in rural areas that are working hard to improve the health of their community. I had a chance to interview Sharon D. DeHart, PA-C, the District Manager for the Deschutes Rim Health Clinic in Maupin, OR about how her clinic has achieved higher than average rates of screening for substance use.
Screening, Brief Intervention and Referral to Treatment (SBIRT) rates for your clinic were stellar for the reporting period of Q Corp’s latest statewide report. What has Deschutes Rim Health Clinic done to ensure that SBIRT is being implemented in your area?
After receiving training on it, we decided to make universal SBIRT mandatory in our clinic. We work hard to ensure every patient we see gets an SBIRT every year. The first three months of every year is when we really hit hard on SBIRT, and all the other integrated measures we need to do and make sure we identify substance use issues and offer support.
Can you speak a little about why you personally think SBIRT is important?
Mainly it’s because depression, alcohol, and opioid rates are off the charts in Oregon. Even in remote areas. It is helpful for us to screen – to know where each patient is, and talk with them about how we can help.
And what challenges, if any, have you faced?
Occasionally people are opposed to completing the form, but we have overcome that by asking the questions one-on-one with the patients when they’re in the exam room if they refuse to fill the form out themselves. This not only gets it done, but then it is also in their electronic medical record and put in as structured data. This is helpful for us to be able to track and have quick access to reports to see how we are doing.
Do you have any advice for clinics that may not be doing as well in this area?
My advice would be making it a part of a regular process. We are in a very rural area, and have a very small staff; only four full-time employees. This makes it easier for us to get everyone on board and on the same page with SBIRT or any other change. For clinics that aren’t as small, it is partly a communication issue. You have to make sure you communicate why you want to do this and why it is important for the patients. It can be hard to get people involved in new things, especially if they have been in healthcare for many years. There are always changes and new things to implement, and that constant change can be hard. Our clinic has participated in several training opportunities through the Institute and with the Oregon Rural Practice-based Research Network, and the never ending projects can be trying. Working in the health care industry you really have to be willing to change and be adaptable, but it isn’t always easy.
Our clinic is the only medical resource of any kind in any direction for an hour, and so we really try to do as much as we can when a patient is right in front of us. Right now we are applying for a behavioral health integration grant to get tele-medicine set up in our community. In this way, SBIRT has really shown us what we need in order to better serve our community and we work very hard to continue to do so.
The Institute website offers links to a number of important SBIRT resources, including tools for training staff. There are also relevant webinars for those interested in learning more about health care in rural communities:
- Strategies for Rural, Small Independent Practices
- National Health Service Corps and Other Programs - Tools to Support Providers and Expand Oregon’s Health Care Workforce
The following organizations are doing to address rural health disparities in Oregon:
- Oregon Office of Rural Health
- Oregon Rural Practice-based Research Network
- Oregon Rural Health Association
Natalya Seibel is an administrative assistant for the Q Corp program team. She joined Q Corp in 2015 and supports work on various projects, including Total Cost of Care and continuing work with the Oregon Health Authority. For the past ten years, Natalya has worked in different roles in health care, cultivating a passion and focus on quality improvement. She has a Bachelor’s of Science in Psychology, and is pursuing a Masters’ in Health Care Administration at Portland State University. As a student, she is active in many local student/community groups centering on health care improvement and local government. She is an advocate for local mental health and the arts, and follows public policy intently. She moved to Oregon from New Mexico in 2007, and when not busy with work or school, she enjoys reading, local arts, karaoke and exploring nature around the Pacific Northwest.