Facing a sobering assessment of the health disparities experienced by residents of Southwest Virginia – a region that holds some of the highest mortality rates in the country – a coalition of organizations has developed a comprehensive plan for improving regional wellbeing. Called the Blueprint for Health Improvement and Health-Enabled Prosperity, the 42-page report identified the primary challenges confronting three rural health districts and proposed a range of solutions designed to make a tangible difference in people’s health.
The origins of the report date back to 2006 when the region’s political, educational, and healthcare leaders began meeting to explore ways to improve the region’s health. These meetings ultimately resulted in the creation of what are now the Southwest Virginia Health Authority and the Healthy Appalachia Institute at the UVA College at Wise. The groups developed a comprehensive community health needs assessment, which became the first Blueprint adopted in 2009.
Residents of the region experience a disproportionately higher incidence of high blood pressure, obesity, and adverse health conditions associated with smoking. They are more than twice as likely to die prematurely from any cause compared to residents of other regions of the state. The region’s cancer rate, for example, is almost 60% above the state average, and the mortality rate from COVID-19 has been close to 95% higher than Virginia as a whole. Deaths from accidents also are twice as frequent as the rest of the state.
Overlaying this empirical data was research culled directly from actual residents, mostly through community discussions. One in five (20%) participants cited diabetes as the top health problem for the region, followed closely by cancer (18%) and substance overdose (17%). When asked to identify some of the root causes of these health problems, residents identified the combination of “income/poverty,” “substance use,” and “traumatic stress” as well as “access to quality health care” and “geographic distance and other barriers to services.”
The role of telehealth
One of the Blueprint’s three key recommendations was to increase access to telehealth, but doing so has its challenges.
“Three things are needed to access telehealth services: an internet-connected device, adequate and reliable internet service, and an ability to employ this technology,” says Dr. David Driscoll, the director of the Healthy Appalachia Institute in SW Virginia. “Residents of our region are less likely than those elsewhere in the state to have a computer or an internet subscription or know how to use these devices and services.”
As a result, the Blueprint puts an emphasis on implementing telehealth in the region in the near future by providing equipment, connectivity, and training for high-risk patients and providers. And it recommends that the technology not only be made available at home but in a variety of settings where digital navigation support can be provided.
The report recommends setting up telehealth access points in libraries, community centers, EMS units, senior centers, and pharmacies. Assisting with transportation to these public sites also is recommended.
The report calls for increases in school-based health services, including primary and behavioral health care for students and staff – both in person and via telehealth. Telehealth also is to be employed to provide integrated mental health treatment, which includes trauma-informed therapy and medication management, as well as peer recovery support to those working to overcome addiction. Telehealth is also an option in the evaluation and management of child abuse and neglect cases, which are four times higher in the region than statewide.
And finally, according to the Blueprint, greater access to nutrition and diabetes management programs as well as physical activity education can be achieved via telehealth.
“We are currently coordinating six projects implementing one or more of the recommendations in the Blueprint, and four of these projects involve the provision of telehealth services in clinics, public health offices, senior centers and pharmacies,” Driscoll says. “After a period of getting to know the technology and the procedures necessary to use it, community residents and providers have been overwhelmingly supportive of telehealth services.”
Driscoll noted that he recently visited a local Federally Qualified Health Center that has coordinated more than 300 clinical encounters via telehealth in the last three months.
“This is a very rural community, and the ability to receive telehealth substantially reduces geographic distance as a barrier to patients seeking access to specialty health care,” Driscoll says. “We anticipate seeing increased acceptance of telehealth among providers and patients.”
For more information and to view the full Blueprint, visit https://www.healthyappalachia.org/health-blueprint.