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Rural Health is Public Health

Nearly 1.5 million Arkansans live in primary care health professional shortage areas (HPSAs), according to the U.S. Department of Health and Human Services Health Resources and Services Administration. While the HPSA map provides a glimpse of the status of health care access in Arkansas, local clinicians know the true scope of our rural health care gap. With National Rural Health Day falling on Thursday, November 16, 2023, let’s take a minute to learn about Arkansas’s rural health landscape and the work we have to do to help people get the help they need.

HPSA designations are used to identify areas within the United States that are experiencing a shortage of health care professionals, including primary medical, dental, and mental health care services. Currently, Arkansas ranks 33rd (among all 50 states and all U.S. territories) in total primary care HPSA designation at 143. Arkansas currently needs 160 additional practitioners to remove the HPSA designation.

Arkansas’ HPSA designation reveals the magnitude of the nationwide shortage of primary care physicians, especially family practitioners. However, these designations often do not cover the nuances of rural health. Native Arkansans in the health care field know that every county has rural pockets with individuals who all lack access to health care services.'

What social determinants of health are at play in rural Arkansas?

Mellie Bridewell, president and CEO of the Arkansas Rural Health Partnership and regional director of the UAMS office of strategy, management, and administration, says several economic factors are at play. “In our most rural counties, we are seeing poverty, lack of insurance, and unemployment as the major economic barriers.”

There are also several barriers that limit or completely prevent rural citizens’ access to health care, including limited health care facilities, lack of health care providers, and a lack of transportation. “This is especially true for maternal health and mental and behavioral health services in Arkansas,” Ms. Bridewell says.

While the overall scope of rural health has evolved over the past decade, several challenges and areas of improvement remain.

Workforce Development

“There is a greater need today than ever before for a rural health care workforce,” Ms. Bridewell says. The Arkansas Rural Health Partnership (ARHP) and several universities across the state are working to train and educate rural students in the health care field. ARHP’s health workforce continuum is an initiative designed to recruit, educate, and retain a local health care workforce that ensures patients and providers have access to current best practices and continuing education.

ARHP’s health workforce mobile unit travels across the state to inform individuals about the critical need for lasting careers in the rural health care. The mobile unit includes members of the health workforce, simulation experiences, and connections to several student support services and programs.

AFMC’s outreach quality team also works on several quality improvement initiatives for physician practices, hospitals, health care providers, and acute care hospitals to teach best practices and ensure that health care professionals are offering the best quality care. AFMC’s resource library also includes handouts, fliers, and reference materials for physicians and the general public designed to provide information about a broad range of health care topics, including cardiac health, Medicaid beneficiary information, breastfeeding promotion, suicide, and substance abuse.

Mental and Behavioral Health Services

The need for mental and behavioral health services in Arkansas has been steadily increasing since 2014 and has increased rapidly since the COVID-19 pandemic. The Kaiser Family Foundation reports that 32.6% of adults in Arkansas are experiencing symptoms of anxiety and/or depressive disorder. This is higher than the national average of 32.3%. The suicide rate in Arkansas is also higher than the national average.

Only 33.7% of the need for mental health professionals is currently met in Arkansas. Of adults who reported a major depressive episode, 38.4% did not receive mental health treatment, which is higher than the national average of 28.2%.

“Because of the continued rise in mental and behavioral health issues in the state, organizations, foundations, insurers, and the State have increased and expanded these services and resources in rural Arkansas and across the entire state,” Ms. Bridewell says. “Despite these increased services, we still have a lot of work to do.”

Telehealth Expansion

Much like mental and behavioral health services, the pandemic caused a widespread increase in the use of telehealth services in the health care community. While the patients’ and providers’ overall acceptance and use of telehealth has increased in recent years, there are individuals who cannot cultivate the benefits of telehealth due to a lack of robust broadband connection.

Thankfully, the State of Arkansas has taken charge of initiatives to increase broadband access, especially in rural parts of the state. Although telehealth services are slowly becoming available throughout the state, Ms. Bridewell says that providers and patients still need to know how to use it for it to be effective. “There must be more assistance and education for patients and health care providers to further increase their usage of these services,” she says.

Training and Education

“Rural and residency training is becoming more recognized. Funding is slowly becoming more available to assist with the physician shortage,” Ms. Bridewell says. “However, there is still a need to ensure that medical staff are fully equipped and qualified to provide the best care possible. There must be a way for these programs to be financially viable for rural organizations willing to provide health care professional training.”

ARHP provides continuing education units, training, and certification for the existing health care workforce to continue providing quality, locally available health care. ARHP will also soon become an approved trainer for community health workers for the state of Arkansas. ARHP actively trains students, community members, and key stakeholders to serve as community health workers to meet the needs of rural residents.

ARHP is also involved in a planning project to engage regional and state education and health care partners to establish a rural residency training program in family medicine by 2024. College students and residents can also intern at ARHP and member health care organizations to gain knowledge and experience of working in the rural health landscape.

AFMC also provides training and education to Medicaid beneficiaries to ensure they understand their rights and responsibilities as patients. AFMC’s Arkansas Medicaid Handbook provides a detailed breakdown of the Arkansas Medicaid programs and eligibility requirements.

How can providers support patients in rural areas?

Regardless of where they practice, Ms. Bridewell says that all providers and health care professionals can take steps to address gaps in health care access and offer support and assistance to their patients.

  • Embrace telehealth and virtual care for patients when needed.
  • Take time to understand the unique cultural and social aspects of rural communities. They are different and need to be understood in order to inform best practices.
  • Collaborate with other health care professionals and utilize the expertise of more seasoned providers when needed, especially when practicing in isolated rural communities.
  • Integrate mental and behavioral health services into primary care settings for patients.
  • Provide patients with access to patient education and patient navigation services.
  • Stay up-to-date on best practices.

Celebrate National Rural Health Day

Thursday, November 16, 2023, is National Rural Health Day, an opportunity to recognize and honor the efforts of rural health care providers, communities, and other key leaders and stakeholders dedicated to addressing the unique health care challenges of rural America. The National Organization of State Offices of Rural Health (NOSORH) promotes National Rural Health Day to celebrate the power of rural.

Health care professionals can explore ways to celebrate and learn more about how to get involved in supporting rural providers. Last year, NOSORH recognized ARHP as the Arkansas Rural Health Champion. ARHP participates in national calls and seminars with NOSORH and promotes awareness on social media for National Rural Health Day. ARHP works with the Rural Health Association of Arkansas to promote available virtual events hosted by national rural health organizations.

Join the celebration, learn about upcoming events, and use the promotional toolkit to show your support and raise awareness for the health care challenges that rural Arkansans face.

While Arkansas has made strides toward accessible health care for all, there is still a long way to go. Rural health is public health, and we cannot ignore the needs of any patient. Through staying up-to-date on best practices, raising awareness, and partnering with local rural health organizations, we can close the gap and provide quality care to everyone, regardless of where they live.

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Eldrina Easterly

Mobile: 501-553-7607

Chris Hughes

Office: 501-212-8742
Mobile: 501-553-7651

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