Monday Medical: Collaboration key to health care

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— The Colorado frontier may be tamer than it used to be, but large distances and other challenges stand between rural residents and many health services.

A home health nurse, for example, can spend an entire day of travel and care on one patient living in the far reaches of Routt or Moffat counties. Last year, home health staff with the Northwest Colorado Visiting Nurse Association drove more than 88,000 miles to deliver care to 210 patients.

The Northwest Colorado VNA is among a web of health care facilities, providers, programs and services working to meet the complex health needs of people living in a region with vast geography, harsh climates and small populations.

“Part of the biggest challenge is the need and demand for sophisticated medical services and the small population base available to support those services,” Yampa Valley Medical Center CEO Karl Gills said.

The first National Rural Health Day on Thursday raises awareness of the health care hurdles facing rural America as well as collaborations, citizen initiative and innovation helping communities safeguard residents’ health.

There are twice as many people (about 2,800) for every primary care doctor in small, isolated communities as there are in cities, according to 2005 data compiled by the National Organization of State Offices of Rural Health.

Although resort communities such as Steamboat Springs find it easier to attract doctors and health care professionals, and therefore tend to avert challenges facing many rural communities, they still contend with shortages in specialty care.

The U.S. Health Resource and Services Administration has designated much of Northwest Colorado, including parts of Routt County, as having health professional shortage areas and/or medically underserved populations.

Deficient numbers of primary care doctors, dentists or mental health professionals — as well as factors including poverty, infant mortality and numbers of elderly residents — influence these designations.

This helps communities hone in on areas of need and also qualifies some facilities and programs, such as the VNA’s Community Health Center in Craig, for partial funding and support to help deliver services to low-income and uninsured residents.

The economic downturn further has challenged nonprofit and other health care providers by increasing the number of underinsured or uninsured patients and decreasing funding and other revenue.

“We have not cut any services and have actually managed to increase the number of people we see,” Northwest Colorado VNA CEO Lisa Brown said. “However, we are continually fighting a battle with our budget and working to diversify and increase our revenue to adequately meet the community’s needs.”

YVMC in Steamboat Springs, The Memorial Hospital in Craig and the Northwest Colorado VNA anchor the health care network in Northwest Colorado for people with financial barriers.

A broad range of services for people with a wide range of incomes includes:

■ Primary health and dental clinics

■ Specialists such as pediatricians, OB-GYN and orthopedic doctors, physical and occupational therapists, holistic health practitioners

■ Nonprofit organizations such as Colorado West Regional Mental Health and the Northwest Colorado Dental Coalition

In addition, many community programs provide important support and resources for residents coping with myriad health issues, including disabilities, autism, dementia/Alzheimer’s disease, suicide prevention, poor nutrition, care giving and aging.

Sharing services is critical in delivering care in large regions with sparse resources. Many Steamboat doctors and health professionals, for example, have satellite offices or travel regularly to care for patients in South Routt, Hayden, Craig, Walden, Kremmling or Granby.

Every week, YVMC arranges and pays for Go Alpine to take low-income patients in Routt County to the Community Health Center in Craig. YVMC also partners with the VNA to offer senior health fairs and provide hospice care to patients.

Innovation and community initiative and support also are essential in keeping services accessible to residents and relevant to their changing health care demands.

A full-time cardiology program, a special care neonatal nursery and sophisticated diagnostic imaging services are among YVMC services that other rural hospitals aren’t likely to provide.

The VNA was started in 1964 by nurses and community members who recognized the need for home health.

It has evolved to include multiple facilities and services including prenatal support, school health, hospice, adult day programs as well as wellness, aging and prevention programs helping people improve and better manage their health.

Tamera Manzanares is a community outreach specialist for the Northwest Colorado Visiting Nurse Association.

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