Pend Oreille County Rural Health Project

Destry Taylor

UCONJ 501

Summer 2010

Pend Oreille (pronounced pond-ə-RAY) County is located in the northeastern-most corner of Washington State.

Pend Oreille County Overview

Small Town and Isolated Rural community

Population - 12,859

Total Area - 1,425 sq. miles

The county seat and largest city is Newport.

Major industries include light manufacturing, value-added wood products and recreational products

Known for its beautiful scenery and recreational opportunities for tourists

Pend Oreille County Overview - Demographics

Gender Female - 50.1% Male - 49.9%

Age Under 18 – 20.9% Over 65 – 16.5%

Race/Ethnicity White - 90.8% American Indian/Alaskan Native – 3.0% Hispanic/Latino – 2.7% Multi-racial – 2.4% Asian/Pacific Islander – 0.6% Black/African American – 0.3%

Source 2000 U.S. Census Data

Pend Oreille County Overview - Economy

Poverty Rate (2008): Pend Oreille Co. 18.8% WA State 11.3%

Median Household Income (2007): Pend Oreille Co. $35,788 WA State $55,771

Unemployment rate (first quarter of 2010): Pend Oreille Co. 16.3% WA State 10.2%

Total Employment Growth (first quarter of 2010): Pend Oreille Co. -4.7% WA State -1.8%

Source: U.S. Department of Labor

Pend Oreille County - Health Care Access

# Clients% of

Population

Uninsured (under 65) 1,627 12.66

Medicaid (all ages) 3,358 26.11

Total Medicare 2,348 18.27

Disabled 509 3.96

Elders – 65 and older 1,839 14.31

Pend Oreille County - Health Care Infrastructure

Over 75% of the county is more than 30 minutes away from both Acute and Obstetric (OB) care

TIME TO ACUTE CARE TIME TO OB CARE

Pend Oreille County - Health Care Infrastructure

Designated a Health Professional Shortage Area for both Primary Care and Mental Health

Served by a single Level IV trauma hospital in Newport

Nearest pediatric trauma center of any designation is in Spokane which is 48 miles south of Newport

Two clinics - One Community Health Clinic in the

north-central town of Ione Two rural health clinics in Newport

Health Disparities - Pend Oreille County vs. Washington State

HEALTH INDICATOR PEND OREILLE

CO.

WASHINGTON ST.

OVERWEIGHT & OBESITY    Percentage of adults reporting a BMI of 30 or higher 27% 22%

TOBACCO USE    

Percentage of adults that smoke 23.3% 15.3%

Percentage of 10th graders that smoke 16.4% 14.4%

SUBSTANCE ABUSE    

Percentage of adults reporting binge drinking 16.0% 14.0%

IMMUNIZATION    

Percentage of adults >65 that received a flu shot in the past 12 months

60% 69%

INJURY & VIOLENCE    

Incidence of unintentional death per 100,00 people

69.1 39.1

What are the leading health concerns in Pend Oreille County?

Chronic diseases that many Americans face: diabetes cardiovascular disease

Health concerns that many other rural communities face: Increase smoking rates Higher suicide rates Higher intentional and unintentional injury rates

- but unlike residents of urban communities they have fewer resources with which to manage their illnesses.

High Priority Health Issues in Pend Oreille County

Two examples of very different health issues:

Diabetes is an important chronic health concern facing many Americans including the residents of Pend Oreille County

Fall-related injury and death is a health concern that is specific to residents of Pend Oreille County

A High Priority Health Issue in Pend Oreille – Diabetes

In Pend Oreille and Washington State, one in 14 adults have diabetes (2010).

Source: Washington Department of Health (2010)).

A High Priority Health Issue in Pend Oreille – Fall-Related Injuries and Deaths

Pend Oreille has 1.5x the incidence of both fall-related hospitalizations and fall-related deaths relative to WA State (2003-2007).

Pend Oreille – ages 85+

Pend Oreille – Total

Washington State – ages

85+

Washington State - Total

Fatal Falls per 100,000 people

776.5 14.8 262.6 9.5

Non-fatal Falls per 100,000 people

8,282.9 439.1 4,626.9 289.9

Source: Washington Department of Health (2009).

A Model for Community Level Interventions – Prevention of Fall-related Injuries and Deaths

Many communities across the U.S. are attempting to address the issue of fall-related injury and death especially in elders

The interventions that have been proven to be effective by the Centers for Disease Control (2009) comprise the following:

Home assessment by professionally and/or community-trained individuals

Client education on fall prevention strategies Clinical assessment of patient medications, physical

health and mental functioning Home repair and safety device installation

The Fall Prevention Program in Tucson, Arizona An Effective Fall Prevention Programs Identified by the CDC

Collaborative program between the University of Arizona (UA) and local/state government Home Assessment – conducted by fire department

personnel, every client receives a Safety Bag containing:

smoke alarms, nightlights, flashlights, batteries, counter mat, pot holders, timers, double-sided carpet tape, installation of grab bars, bathtub appliqués, oven sticks, light bulbs, reflective tape, and a non-skid rug

Home Repair – if necessary clients are referred to a subsidized home repair program

Clinical Assessment – student nurses from UA or a public health nurse conduct a fall risk assessment and provide clients with education and resources on fall prevention

Follow-up – the nurse (or student nurse) makes referral to appropriate community organization for follow-up

The Implementation of a Fall Prevention Program in Pend Oreille County – Assessment

Home Assessor Options Trained local volunteers High School Students interested in a career in Health sciences AmeriCorps participants (preferably those hired from the Pend Oreille County community)

Clinical Assessor Options WSU nurse students Pend Oreille Co.

Grant-funded public health nurses

The Implementation of a Fall Prevention Program in Pend Oreille County – Home Repair and Safety Device Installation

Secure a grant to pay currently unemployed residents to do home repairs and install safety devices in the homes of elders who have had their initial assessment

Also a program could be implemented in the high school or community college to train interested individuals

The Implementation of a Fall Prevention Program in Pend Oreille County – Follow-up

Follow-up could be conducted by student nurse, trained community members or social workers

A program could be initiated to train elders on fall prevention education providing individuals with a social outlet and out-of-home physical activities.

TIME OUTSo What Does the Pend Oreille County Community Identify as Its High Priority Health Issues?

How do we know that the residents of Pend Oreille County want to make changes in the area of fall prevention or any of the other health concerns we have identified?

Looking beyond the data – how do we engage the community in identifying health priorities and implementing change? Town Hall Meetings Surveys Asking Health Care Providers

Newport, WA

Using the Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) community engagement tool

PACE-EH was developed as a tool for community assessment and health intervention

Main features (from Public Health Grand Rounds): requires that scientific data is collected and made

available during all decision-making sessions. involve as many of the community leaders as possible to

create public health partnerships that work to share institutional strengths. (As we well know, work is much more effective when done in collaboration with organizations and individuals in their communities)

http://www.publichealthgrandrounds.unc.edu/places/handout_PACEHuse.pdf

Using the Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) community engagement tool

Source: http://www.publichealthgrandrounds.unc.edu/places/handout_PACEHuse.pdf

NEXT STEPQuestions for Community Stakeholders and Leaders

Do you feel the health resources (such as health workers or clinics) exist to address these concerns? How could it be improved?

What non-health interventions (such as job opportunities or better housing) do you feel would aid in improving

these health concerns?

Do you feel community members would be in willing to work to make changes in these areas?

Do you want outside support in making health changes? If yes, what kind?

NEXT STEPSQuestions for Community Stakeholders and Leaders

Do you feel the health infrastructure exists to address these concerns? How could it be improved?

What types of non-health interventions do you feel would aid in improving these health concerns?

Do you feel community members would be in willing to work to make changes in these areas?

Do you want outside support in making health changes? If yes, what kind?

Sand Point, WA

References

1. County Health Rankings. (2010). Snapshot 2010: Pend Oreille. Retrieved from http://www.countyhealthrankings.org/washington/pend-oreille

2. Department of Health and Human Services. “Community Health Status Indicators” Retrieved from http

://communityhealth.hhs.gov/Demographics.aspx?GeogCD=53051&PeerStrat=42&state=Washington&county=Pend%20Oreille

3. Department of Health and Human Services. “Find Shortage Areas: HPSA by State & County” Retrieved from http://hpsafind.hrsa.gov/HPSASearch.aspx

4. Google Maps. (2010). Retrieved from http://maps.google.com/

5. Indiana Business Research Center. (2010). STATS Indiana – Overview of Pend Oreille County. Retrieved from

http://www.stats.indiana.edu/uspr/a/usprofiles/53/us_over_sub_pr53051.html

6. Parra, E.K., & Stevens J.A. (2000). U.S. fall prevention programs for Seniors: Selected Programs Using Home Assessment and Home Modification. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/ncipc/falls/default.htm

7. Public Health Grand Rounds. (2007). Protocol for Assessing Community Excellence in Environmental Health. Retrieved from http://www.publichealthgrandrounds.unc.edu/places/ handout_PACEHuse.pdf

8. U.S. Bureau of the Census. (2010). Pend Oreille County Quick Facts. Retrieved from http://quickfacts.census.gov/qfd/states/53/53051.html

References

9. U.S. Department of Labor Bureau of Labor Statistics. (2010). Local Area Unemployment Statistics. Retrieved from http://www.bls.gov/lau/laucntycur14.txt

10. Washington State Department of Health. (2006). Access of Hospital-Based Perinatal and Neonatal Care, 2006. Retrieved from

http://ww4.doh.wa.gov/gis/pdf.neon)tt.pdf

11. Washington State Department of Health. (2006). Access to the Nearest Acute Care Hospital in Washington, 2006. Retrieved fromhttp://ww4.doh.wa.gov/gis/pdf/acute_tt.pdf

12. Washington State Department of Health – Diabetes Control and Prevention Program. (2010). Chronic disease profile: Pend Oreille County. Retrieved from http://www.doh.wa.gov/cfh/diabetes/publications/2010-profiles/Pend-Oreille-

10.pdf

13. Washington State Department of Health – Injury & Violence Prevention Program. (2009). Washington State Injury Data Tables. Retrieved from http://www.doh.wa.gov/hsqa/emstrauma/injury/data_tables/default.htm