Progress is being made toward a goal of increased access to medical care for uninsured people in Wilkes County, according to the 2012 “State of the County’s Health Report.”
More access to health care emerged as the top priority through 2013 in a “health summit” of the Wilkes Healthy Carolinians Council in December 2009, based on opinions of summit participants and data collected in 2009 for the most recent community health assessment for Wilkes.
The other three were, in order of priority, substance abuse prevention, fitness and nutrition for disease prevention and access to mental health services
The health report said the number of uninsured patients receiving services in Wilkes increased from 4,800 in 2009 to 6,230 in 2012 (a 29.7 percent increase), partly through efforts of an access to care task force established as part of the health summit.
Representatives of the Wilkes County Health Department, Wilkes Regional Medical Center, Health Foundation and other community agencies have started collecting data for the 2013 Community Health Assessment/Community Health Needs Assessment. Priorities for the next three years will be based on this assessment.
Access to care
In 2009, 4,800 (40 percent) of about 12,000 uninsured patients in Wilkes were being served through Access to Care/Care Connection services. The 6,230 being served now represent 51 percent of 12,000. The task force’s goal is to increase this to 60 percent by 2014.
Armando Limon, a Wilkes County Health Department social worker and Access to Care Task Force chairman, said he gets 40 to 50 calls per month from people without insurance seeking health care.
Limon said he directs them to the nonprofit Mountain View, West Wilkes and Boomer medical centers or the Wilkes County Health Department.
If certain income requirements are met, the rural medical centers only require a co-payment of $15 to $25 per uninsured patient.
Medical Access Plan (MAP) funds awarded to the three centers by the N.C. Department of Health and Human Services cover about $60 more of the per patient cost.
MAP funding, sometimes all spent before the end of the fiscal year, and patient co-payment still leave at least $25 of the cost of seeing an uninsured patient unpaid.
Simultaneously, say officials, the number of uninsured or under-insured people in Wilkes has risen as Medicare and private insurance reimbursements have decreased.
The health department receives funds from county government and the N.C. Office of Rural Health for patients without insurance, said Limon.
Limon said some physician specialists and WRMC in Wilkes have agreed to see certain numbers of uninsured patents.
Limon said uninsured patients are provided with reduced prescription medication through the Care Connection Pharmacy, as well as with free dental care through the Wilkes Public Health Dental Clinic in two clinics twice a year. Over $15,000 in free dental care has been provided so far.
Prescription pain medication
The 2009 unintentional poisoning death rate, primarily from prescription pain medication overdose, was 46.6 per 100,000 in Wilkes, far more than the statewide rate of 11 per 100,000.
After the start of Project Lazarus and the Chronic Pain Initiative, the overdose death rate was 69 percent lower in 2011. This by far exceeded the substance abuse prevention task force’s goal of reducing the number of Wilkes deaths due to unintentional poisoning by 20 percent by 2014.
The average age of Wilkes people who died from prescription pain medication overdose was late 30s. Most also had significant health problems, including respiratory, circulatory and metabolic disorders.
Most of them used prescription pain medication for both medical and nonmedical reasons and exceeded their physiologic tolerance, either directly or in combination with other legal or illegal substances.
“As a result of heightened community awareness, activation and community-building activities, many organizations are now engaged in responding to the overdose epidemic in Wilkes County. A central community organizer (Fred Brason) holds positions as part of Project Lazarus, the Chronic Pain Initiative and the Substance Abuse Task Force and is responsible for coordinating overdose prevention efforts and minimizing duplication,” the report stated.
The goal for fitness and nutrition for disease prevention is to reduce obesity rates among middle school children over the 85th percentile in weight by 5 percent by 2014. Jared Belk of the Wilkes Health Department is chairman of this task force.
The report said 50.5 percent of Wilkes middle school students were at a healthy weight in 2009. Of 24 percent of middle school students tested in the fall of 2011, 44.6 percent were at a healthy weight. This is the most recent data available.
The Wilkes schools started the In-school Prevention of Obesity and Disease program in 2010-11, but it ended after 2010-11 due to state funding cuts. Body mass index data for Wilkes students in grades K-8 is still being collected and physical fitness tested and schools will send this data home to parents, the report stated.
Additional community parks and upgrades to playgrounds at Millers Creek, Mountain View, Roaring River, and C.C. Wright elementary schools were completed in 2012 in a partnership between the Wilkes schools and the health department.
This work is funded with a $151,400 grant from the Kate B. Reynolds Charitable Trust. Boomer-Ferguson, Traphill, Ronda-Clingman and Mount Pleasant were the first four schools to receive funding. The final phase began this school year, with Mulberry, C.B. Eller, North Wilkesboro, Wilkesboro and Moravian Falls elementary schools receiving funds for their community parks.
The report said that out of a $7.4 million federal Community Transformation Grant awarded to the state, the area Public Health Incubator is getting $400,000 annually for five years to create policies that address healthy eating, exercise, tobacco free living and chronic disease management.
The report said officials in Wilkes plan to help interested farmers markets and fresh produce vendors be able to accept food stamps as payments.
The access to mental health services task force set a goal of reducing the number of deaths from suicides by 10 percent. The number of deaths due to suicide in Wilkes went from 14 in 2009 to 12 in 2010, which was a 16 percent reduction.
With Wilkes Health Department Director Ann Absher as chairman, the task force is focused on prevention and access to services.
The task force established a speakers’ bureau for consumer awareness events and completed a consumer/provider brochure to be distributed electronically and in public places. It is also addressing long hospital emergency room visits, options to prevent unnecessary involuntary commitments and other strategies.
The report said availability of services and assistance for needy families were decreased by a statewide reduction in funding for public health and other human service agencies and service. It said low socioeconomic status is directly related to poorer health outcomes.
The Wilkes Health Department’s American Diabetes Association (ADA) Certified Diabetes Education Program has moved from Wilkes Regional Medical Center to a location with more space at 234 Jefferson Street, North Wilkesboro.