Rural clinics help provide health care in Alabama

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Evelyn Ashton has been going to Phil Campbell Medical Clinic for 20 years.

She's convinced if not for the down home personal care she receives at the clinic, she would not be getting the same kind of health care at another, larger facility.

“It's convenient and that's important. I love that it's just around the corner,” said the Phil Campbell resident. “But as important as that is, they treat me like family. I'm not just a patient to them. They care about me.”

Ashton is among the approximate 16 percent of the national population living in a rural community. More than 60 percent of rural residents live in counties adjacent to urban areas, according to a report released by United Health Center for Health and Reform Modernization. Lauderdale County, according to the study, is among 12 Alabama counties considered “urban” by the Alabama Department of Public Health, as defined by federal guidelines that include population per square mile, yet it contains areas that qualify as distinctly rural.

Franklin County, on the other hand, is wholly classified as distinctly rural.

Proximity to an urban area plays a significant role in the overall health of rural residents, according to the report, which indicates rural Americans face greater difficulty accessing quality health care than people who live in urban areas.

The study notes there are 5 million people who live in isolated and remote locations, while 31 million rural residents live near an urban area. It also found chronic conditions such as cardiovascular disease and diabetes are a bigger problem for rural populations than in urban or suburban areas, particularly in the South and among rural minority communities, where obesity rates and other risk factors are elevated.

Rural communities depend on small clinics and health centers to provide primary health care services, the study notes.

Lexington Mayor Bobby McGuire said there is no question about the important role Lexington Clinic plays in that community, which, although located in Lauderdale County, is wholly defined as rural under federal guidelines.

“Without this clinic, there would be a lot of people who would go without medical service,” McGuire said. “I saw what the town was like when we didn't have (a clinic). People weren't getting the health care they needed. I don't ever want to see that again. It's a blessing having it here.”

In Lauderdale County alone, there are six rural clinics, and a total of 10 in the three-county region that includes Colbert, Franklin and Lauderdale.

“It's good that we have these rural clinics,” said Dr. Karen Landers, Area Health Officer with the Alabama Department of Public Health. “They provide an important link between patients and health care.”

Landers said in a county as large as Lauderdale, there are people in rural areas that have problems with transportation and access to medical coverage because of financial situations.

“Without (the rural clinics) there would be a lack of an important link to the health-care community,” she said. “They provide quality health care that some people might not receive otherwise.”

Waterloo resident Eunice Heard said she would love to have a clinic open again in her town, which is on the western fringe of Lauderdale County.

“We used to have one here, but it's been gone four, five years now,” Heard said. “It was really handy having it here. Now we have to go to Central or into Florence.

“The older we get the more we need a doctor, and without a clinic here, we have to drive a long way.”

Bill Finderfrock, executive director of the National Association of Rural Health Clinics, called rural health clinics “critical providers” in their communities.

“Because of the rural clinics, more people are getting health care, and based on that … it's better,” he said. “We want to improve the quality of health care, and that cuts across geography, whether it is rural or urban areas — the ability to access health care is the important issue.”

Finderfrock said rural clinics funding rely on reimbursements from Medicare, insurances companies and payments from patients. According to the study, a higher proportion of rural residents are covered by Medicare and/or Medicaid than urban residents. In rural areas, 31 percent of the population has Medicare or Medicaid as their primary source of coverage, compared to 25 percent of the population in urban areas. The study also found that rural Americans are slightly more likely to be uninsured than individuals in metropolitan areas and are less likely to have insurance through an employer.

There are about 3,800 rural health clinics in rural communities, mostly in the South and Midwest, according to the study. Primary care providers, including nurse practitioners and physician assistants comprise about two-thirds of all practitioners in rural areas, according the study's findings.

Kari Kirby, who serves as the nurse practitioner for Leighton Family Health Clinic in Colbert County, said though she treats rural residents, her clinic is actually classified as a private health clinic, because she didn't want to go through the stack of paperwork she described as an “inch thick” that's necessary in order be classified as a “rural clinic.”

“You have to be in a specific area of need that would qualify for a rural health clinic (in order to open one),” she said. “The main (requirement) is you have to have a nurse practitioner running it at least 50 percent of the time.”

The way she treats patients doesn't change just because of a classification, Kirby said, and anyone can visit a health clinic. But the way patients are charged varies slightly.

“True rural health clinics … have one set price that they bill to the government, or they base the price that they charge the patient on (the patient's) income if they don't have insurance,” she said. “Then there are privately-owned or hospital-owned clinics, and they have fee schedules that the insurance company sets, and they go by that as to what is charged.”

Fee schedules for nurse practitioners are typically set at about 15 percent less than what physicians make, Kirby added.

Kirby, who has held her current position for 11 years, said she does anything from prescribe cold medicine to giving pap smears. But she does not give prenatal care or deliver babies.

“I'll see patients if they are pregnant if they have a cold or if they have something unrelated to their pregnancy, but if it's related to pregnancy, I'd tell them they needed to see an (obstetrician),” she said.

Jean Hester, a manager and nurse practitioner at the Phil Campbell clinic in Franklin County, shared Kirby's feelings. Russellville Hospital no longer delivers babies, so rural residents there are faced with tough decisions about where to go to give birth.

“A lot of (pregnant women) are going to (Helen) Keller (in Sheffield), ECM (in Florence) and Tupelo (Miss.), and they can go to Jasper,” Hester said. “They have to travel away from the area. We do pregnancy tests at the clinic and if we find out they are pregnant, they are referred to an (obstetrician).”

For many rural residents, saving travel costs whenever possible is important.

Without the Cherokee Family Clinic, a full service health-care facility in that rural Colbert County town, Cherokee residents would face a 20- or 30-minute drive east or west to receive medical care, said Carol Davis, a nurse practitioner who runs the clinic.

“(The clinic) saves them 'trips into town,' as they say,” she said. “And they like minimal trips into town. The cost of gas is a lot for a lot of people, and it's good to have this for people who might not have transportation.”

Davis said rural clinics function similarly to those in urban settings.

“We have labs and we do X-rays. I'm able to diagnose (and) treat (illnesses), prescribe medication and order additional X-rays and labs if it's something that we're not able to do in the office,” she said.

Nurse practitioners operate under the supervision of a physician, who has to work regular weekly hours at the clinic. Though nurse practitioners in some states are allowed to prescribe medications much like physicians can, but in Alabama, certain medications, like narcotics, must be regulated by the supervising physician.

“I love the physician that I have, and we have a good working relationship, and I like having that person that I can go to and talk with, but the downside is that if something happened to her today and she was not able to be there for me, then essentially, my doors are shut until I could find another physician to cover for her,” Davis said. “While I like having that physician there, it is bothersome to know that I always have to have someone there. If something tragic or unforeseen happened, I would be shut down.”

On a daily basis, Davis said she'll treat 20 to 30 people. She said she sees a variety of ages and illnesses.

Littleville Clinic, also in Colbert County, has been in operation for about a year, according to Littleville Mayor Kenneth Copeland.

“And they stay busy all the time,” he said. “We have an older population here and there is no doubt that having the clinic in town makes health care more accessible for our residents. I'm sure if it wasn't here some people wouldn't be getting the attention they need.”

Ashton calls the clinic in her town a lifesaver.

“I live on disability, and I don't have the transportation and can't afford the gas to drive very far to get medical care,” she said. “Half of the time, I'm not able to drive, but the nurses have come and picked me up and took me to the clinic. It's a lifesaver for me. Without the local clinic, I don't know what I would do.”

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Information from: TimesDaily, http://www.timesdaily.com/

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