Finding health care solutions for medically underserved rural areas

In the United States there are 14 million people living in medically underserved areas where access to health care continues to be a chronic problem with no clear solutions. Many residents who live in rural areas don’t have access to doctors, nurses, or pharmacists, and getting medical attention often translates to a several hours drive to the nearest city. College of Pharmacy and Pharmaceutical Sciences (CPPS) Associate Professors of Pharmacotherapy Kimberly McKeirnan and Megan Undeberg are finding ways to bridge this health care gap.

Pharmacotherapy Associate Professor Megan Undeberg grew up in Lind, Washington; population ~560

“There is such a disparity of care for the rural sector,” said Undeberg, who also grew up on a farm in rural Washington before starting her career in pharmacy. “These tiny communities might not have a hospital. It’s so remote—if someone has a heart attack they can’t get to a hospital.”

As part of a project that began in March 2016, CPPS professors have been looking for ways to improve health among older adults in rural underserved areas. One of the main challenges they faced was building that relationship with rural residents, often described as being very independent, and unwilling to seek medical help unless absolutely necessary.

“We could characterize [these patients] as the most at-risk individuals, and they slip through the cracks. They’re very independent and they don’t like asking for help,” said Undeberg. “Some of these folks had significant problems. They would probably all qualify to live in an assisted living facility. It’s that drive to be independent.”

When the two faculty members received additional funding from the Empire Health Foundation to continue the project for another year, they saw it as an opportunity to work with local organizations to build these relationships and reach patients who were in dire need of medical attention. Working with rural pharmacists who have been embedded in the community for decades was vital to accessing these communities.

In the first stages of the project, pharmacists from the college worked with social workers to identify patients and conduct home visits among adults over the age of 50 living in Pend Oreille county, Washington—one of the 18 designated rural medically underserved areas in Washington state.

Pharmacotherapy Associate Professor Kimberly McKeirnan grew up in Palmeroy, Washington; population ~1,400

“These patients live in very rural places,” explained McKeirnan, who also grew up in an agrarian part of Washington state, two hours outside of Spokane. “When we went for one visit, the road was washed out and we had to reschedule. [Residents] couldn’t even get out of their home because of the flooding.”

Fourteen patients took part in the home visits by WSU faculty members. All of those included had been previously diagnosed with at least two chronic medical conditions, at least one of which had to be diabetes or hypertension—with at least one of these conditions not being treated to optimal outcomes. The average age of their patients was 67. The team also worked with Rural Resources a nonprofit which had built up long-term relationships with various patients across northeast Washington. The nonprofit helped to bridge the connection between the pharmacists with patients.

Faculty members spent one hour in the home of each patient, discussing medications, whether they were taking them and if they were doing so correctly, their medical conditions, and lifestyle. Afterwards, they sent their recommendations to the patient’s primary care provider and completed a series of follow-up phone calls over the course of six months.

“We could characterize [these patients] as the most at-risk individuals, and they slip through the cracks. They’re very independent and they don’t like asking for help,”

One example McKeirnan shared was an older woman who lived an hour and a half away from her primary care physician and had a history of high blood pressure and stroke. When she described her symptoms, she complained of headaches which she was taking over-the-counter medications every day to treat.

“Sitting in the kitchen with her, we were going through the shoebox full of meds trying to figure out what was going on,” explained McKeirnan.

Looking at her daily blood pressure log, McKeirnan and her colleagues found the problem; her blood pressure was consistently high. From the patient’s point of view, the numbers were normal for her.

“She wasn’t sure what she was looking for. She knew to check her blood pressure, but she didn’t know what was considered normal,” explained McKeirnan.

That day, her blood pressure was 223/132, when her goal blood pressure should have been less than 130/80. It was so high, they sent her to the hospital, where she stayed for three days. Within six months of the home visit and a review of her medications, her blood pressure was back within goal levels and her headaches had disappeared.

Stories like hers were not uncommon among patients living in rural areas. Another patient experienced dizziness and falls. The pharmacists found that instead of taking Tylenol, he had accidentally picked up Tylenol PM, and was having a bad reaction to the Benadryl in it, causing his dizzy spells.

Overall, the team found 98 unique drug-related problems among their 14 participants, 26% of which were resolved when patients worked with their providers to follow the pharmacists’ recommendations.

With the COVID-19 pandemic spreading across the state, the team has shifted its focus to evaluation and data analysis. Once the health crises is resolved, they look forward to the next phase of their project when they start work with a pharmacist at the Newport critical access hospital in Davenport, Washington.

McKeirnan and Undeberg believe that by working with embedded pharmacists and local nonprofits, they will have a more sustainable solution to providing medical care for these medically underserved, rural areas.