COVID pandemic reveals rural Kansas health care challenges, including advanced care and broadband access
As rural health care continues to be impacted by the coronavirus pandemic, Kansas doctors are studying how best to improve vaccination rates in communities.
That is one example of how doctors and health officials at The University of Kansas Health System are seeking to help rural areas.
"The way COVID rolled out across Kansas, it was mostly in the metropolitan areas to being with," said Robert Moser, dean of the KU School of Medicine in Salina. "But once it began to hit into our communities where we had the meatpacking plants, and others across southwest Kansas, it really did explode.
"Leading into that huge surge in November, the biggest challenge was just finding places where these patients could go that needed more advanced care."
Moser was one of several KU officials participating in a July 28 discussion of the impact COVID-19 is having on rural communities.
The health system's Care Collaborative, which advises and supports health care providers and facilities in smaller Kansas communities, expanded an existing technology to help rural facilities find beds for patients who needed a higher level of care.
At the height of the fall and winter surge, it could take as many as 10 phone calls to find a bed for a patient who needed a transfer, said Jodi Schmidt, executive director of the Care Collaborative.
"The bed-finder capability worked so well the KDHE adopted it for statewide implementation," Schmidt said. "It allowed our rural providers to focus locally on what was going on with their patient in front of them, not having to spend all of that time on the back end trying to find an available COVID bed for those patients who needed that next level of care."
Amid the new wave of COVID-19, The University of Kansas Health System in Kansas has stopped taking transfers.
New surge hits rural Kansas
Many rural areas are struggling to contain the new surge brought on by the highly contagious delta variant. White House and Centers for Disease Control and Prevention data released Friday show Bourbon, Linn, Atchison, Labette and Stanton counties with the worst case rates over the past seven days.
Some areas of rural Kansas have been hit especially hard by the pandemic. Norton, Ellsworth, Seward, Pawnee and Ford counties have the five worst per-capita rates of cumulative cases since the start of the pandemic. The most COVID-19 deaths per capita have been in Gove, Comanche, Ness, Sheridan and Nemaha counties.
"I was very proud of the way that our county health officers across the state and our rural providers and their care teams really ramped up their response to dealing with what they had to in their communities with limited resources," Moser said. "They were very aggressive about being some of the first programs to utilize the monoclonal antibody.
"We took the infusion recommendations from here and adapted them to the rural centers, and they quickly took it upon themselves to make that available to their patients."
"I know they're tired. I know they're probably frustrated with what they're seeing with the low vaccination rates, but they continue to do a great job out there. And we're seeing some communities doing a great job with that and we hope to share those best practices."
The Care Collaborative is also studying what works in rural vaccination campaigns, and "what can we share to help them improve vaccination rates in their communities," Schmidt says.
Kansas Department of Health and Environment data shows rural communities tend to have lower vaccination rates. Stevens County has the worst rate of fully vaccinated population, at about 23%.
But not all rural counties are underperforming. Marshall County, for example, has the highest vaccination rate in the state at about 50%.
"Hang in there," said Steve Stites, the chief medical officer at KU. "It is very easy to be frustrated that folks have not been vaccinated and because of that we're having another wave and we all have to go back to social distancing."
"We can be very frustrated, as a vaccinated person, with those who were not vaccinated," he continued. "But we are all in it together at the end of the day. Instead of being angry, let’s be persuasive. Let’s talk and have a good, honest conversation."
Telehealth services and rural broadband
Even before the pandemic, the medical school in Salina was considering adding telemedicine as part of the curriculum.
"I think telehealth is going to play an important role in providing access to health care, including specialty care," Moser said.
The expansion of virtual doctors visits highlighted another problem facing rural areas.
"The move to telehealth as a result of the pandemic exacerbated the broadband gaps across our state," Schmidt said. "So we moved really quickly, working with the Department of Commerce, and achieved a $3 million federal grant to bring additional support to our communities to connect rural health clinics with their patients, to connect rural hospitals with their testing and vaccination sites, to connect with EMS and long-term care."
Future of rural medicine and financial challenges
Moser said there has been a drop in the number of students from rural Kansas applying to medical school.
"The biggest challenge is we need to feed the pipeline," he said. "We've got to get more students interested in health care as a career, and obviously we know from the data over 40 years of study that if you grow up rural, you're more likely to go back rural, you're more likely to practice primary care."
Michael Kennedy, who recently retired as the associate dean of KU Rural Medical Education, spent a decade in private practice in Burlington.
"Trying to keep student interest up when it comes to wanting to practice rural medicine" is a challenge, he said. "You have to fight things like professional isolationism, you have to fight some of the common myths that are out there that it's not as challenging or it's not as rewarding as an academic medical practice, which is total bunk."
Kennedy said the top challenge for rural medicine is keeping local health systems financially viable. He is particularly concerned about access to maternity care, because it "has not proven to be a profit center for a lot of rural hospitals."
"What are we going to do so that women don't have to drive an hour and a half to two hours once they go into labor to deliver a baby?" he asked.
The Care Collaborative can provide resources to help rural practices keep up and adapt to payment changes, reporting requirements and other medical system updates.
"Rural hospitals have been challenged over the last decade," Schmidt said. "COVID did provide some short-term funding to help them manage the pandemic successfully, but those funds are not going to be able to sustain them long-term. And that's why it becomes so important for those local hospitals to continue to meet the needs of their local patients so they keep as many patients as close to home as possible."
"Over the last decade, more than 100 rural hospitals have closed, and we have had a few here in Kansas as well," she continued. "Unfortunately, the most recent data suggests that we are among the top three in the nation in terms of hospitals considered at risk. We're fortunate that Kansas taxpayers have stepped up to support their local hospitals as best they can, but it isn't always enough."