“Creating a Culture of Health in Appalachia: Disparities and Bright Spots” sponsored by the Robert Wood Johnson Foundation www.rejf.org, the Appalachian Regional Commission (ARC) www.arc.gov, and administered by the Foundation for a Healthy Kentucky www.healthy-ky.org discusses health disparities in Appalachia.
To discuss behavioral issues, a research team led by PDA Inc. www.pdaconsultants.com in Raleigh North Carolina in collaboration with the University of North Carolina’s Cecil G. Sheps Center for Health Services Research www.shepscenter.unc.edu, and the Wake Forest School of Medicine www.wakehealth.edu, released a report August 2017.
The report found several behavioral health issues in Appalachian Virginia:
- The prevalence of depression among fee-for-service Medicare beneficiaries in Appalachian Virginia is 17.6 percent, compared to 15.4 percent for the U.S as a whole and 13.3 percent for non-Appalachian Virginia.
- Suicide rate in Appalachian Virginia is 39 percent higher than the national rate, and 46 percent higher than the rate in non-Appalachian Virginia
- The percentage of adults reporting excessive drinking in Appalachian Virginia is 15.6 percent lower than in the nation as whole which is 17.7 percent and lower than in non- Appalachian Virginia which is at 16.9 percent
- The poisoning mortality rate in Appalachian Virginia is 55 percent higher than the national rate, and 141 percent higher than the rate in non-Appalachian Virginia
- In Appalachian Virginia, Medicare prescription claims for opioids is at 6.5 percent as compared to 5.3 percent in the U.S as a whole and 4.7 percent in non-Appalachian Virginia
Further discussion on mental issues appeared in an Interim Subcommittee Report recently released for the Joint Commission on Health Care in Virginia. The report titled “Options for Increasing the Use of Telemental Health Services in the Commonwealth”.
The report was presented at the Joint Commission on Health Care August 22, 2017 meeting. The report made a number of recommendations on how to deal with the barriers currently preventing the expansion of telemental health.
The joint commission is very interested in addressing telemental health barriers since many primary care providers are not trained to treat patients with behavioral and substance use disorders plus many are not confident in managing these patients. As a result, primary care providers may wish to refer patients with complex issues to specialists, however there is a lack of specialists in many rural areas.
Also, some providers are not comfortable with technology and establishing rapport with patients, have concerns about clinical workflow, concerns that telehealth services will not be profitable, worry about the lack of clarity regarding policies, concerns exist on the barriers to public and private insurance reimbursement, and many providers realize that many patients may lack access to high speed internet services.
To help alleviate issues restricting help for individuals with mental health problems, the report recommends that an “Appalachia Telemental Health Network Pilot” be initiated to expand and enhance access to quality affordable mental health services in Appalachia, which would allow for efficient, early, and accurate diagnoses, and also reduce travel time and costs.
The Network pilot would be a regional broadband health network using an interoperable, standards-based system to allow for multiple vendor platforms. The network pilot would be able to assess broadband infrastructure throughout the region, develop partnerships with regional providers, clinics, hospitals, public institutes and institutes of higher education, and explore innovation by developing and testing new technologies.
The report recommends that the Commonwealth establish funding for the telemental health network pilot using ARC and Tobacco Region Revitalization Commission grants. The pilot would provide evidence for telehealth policy change, support telehealth training opportunities, assess market dynamics by state, include reimbursement rates, plus create an online referral network and resource center for providers and professionals.
The Network pilot would also create an on-line referral network directory that would enable providers to display their credentials, specialties, and state license information. As part of the network directory, providers would have access to compiled provider information, resources, and advice on using telehealth within their practice, recommend equipment, and announce continuing education opportunities.
For more information on the Interim Report “Options for Increasing the Use of Telemental Health Services in the Commonwealth” reported by the Joint Commission on Health Care at the August 22, 2017 meeting, email Paula Margolis PhD, Senior Policy Analyst at pmargolis@jchc.virginia.gov