UNE Students Share Experiences on their Last Day of the 2018 Piscataquis County Rural Health Immersion

March 21st, 2018 by healthinnovation
The students and faculty pose for a photo after teaching their lessons to students at Greenville School.

The students and faculty pose for a photo after teaching their lessons to students at Greenville School.

Ten UNE health professions students recently participated in a weeklong rural health immersion to Piscataquis County in Maine.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fifth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to the Penquis area.  Last Fall a group of 10 students traveled to Oxford County and Carroll County in New Hampshire for a long weekend immersion; in May of 2017 a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; in March of 2017 medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Throughout the immersion the students are purposefully split into interprofessional teams so that they can learn the roles and how to communicate effectively with other disciplines in order to learn the skills necessary to provide high quality team-based care and improve patient outcomes.  The students experienced a variety of clinical, community, and population health activities in rural and underserved communities in central Maine communities, including Newport, Dover-Foxcroft, and Greenville.  The group was also supposed to visit Eastern Maine Medical Center and Penobscot Community Health Care but due to a Nor’easter the first two days of the trip in Penobscot County were canceled.  Below are reflections from one team after the last day of the trip on Friday, March 16th, 2018.

Mooshead Lake as seen from the Kineo View Lodge

Mooshead Lake as seen from the Kineo View Lodge

Taxia Arabatzis, First year Osteopathic Medicine Student

Dynamic and innovative are some of the words that come to mind when I think about the health care providers we have come across over the past few days in the UNE Maine Rural Health Immersion trip to Piscatquis county. The providers ranged from school nurses to hospital doctors to administrative staff in the clinics and hospitals, and all were very dynamic and innovative. Being in rural areas these providers are limited in almost every way, yet, through strong dedication they are able to make it work.

In rural communities everyone knows everyone, so the local providers are ingrained in the community and they know the needs of the people. Therefore, rural providers are able to directly meet the needs of the people by doing things like delivering extra educational classes at their hospitals, or starting programs to combat substance abuse, or any number of other initiatives to help their community. One thing in particular that I noticed at every facility that we went to was that the staff always mentioned that Fridays were Jeans days for the employees and the money they raised from this was ALWAYS put right back into the direct needs of their community. At one hospital in particular they said the money went towards a food pantry that they could send their patients to if they screened positive for food insecurity (unfortunately a common occurrence in parts of rural Maine). The providers started the food pantry because they felt terrible asking patients about their access to food before the food bank was started since, at that time, they didn’t have a solution to the problem. This is a simple example, but it shows how the providers in rural Maine are truly dynamic and problem solvers. It was clear that the providers we met with understand the needs of their patients in an intimate way that is often hard to find in an urban setting, and that they do everything they can to address their patients needs.

After visiting at the Greenville School the students spent time at Dean Memorial Hospital.

After visiting at the Greenville School the students spent time at Dean Memorial Hospital talking about rural health with the local providers.

Despite the tremendous needs of the rural communities that we visited, they are ahead of the game and innovative in their approach to determining the needs of their community and directly addressing them.  It can be very daunting to look at the health needs of a patient, including physical, social, emotional, and socio-economical health factors and try to address them all. However, in the rural communities health providers are used to this, and they are used to fighting for their patients, who are their neighbors and community members, and that is a lesson that all of modern medicine can learn from.

The last stop of the trip was in Shirley at Lone Wolf Guiding Services where the students learned about dog sledding.

The last stop of the trip was in Shirley at Lone Wolf Guiding Services where the students learned about dog sledding.

Matthew Senno, First year Osteopathic Medicine Student

Meeting with the kids at the Greenville School this morning was such a great experience. I loved interacting with a group of students that is still learning, and it is a great opportunity to improve all of our teaching abilities. It’s always great to spread awareness about brain injuries, and how the brain works in general, especially to children in the 4th grade, who are riding their bikes and playing outside, so have a lot to learn of the proper safety equipment. I was surprised at how much some of the kids knew about the brain already and I was blown away by some of their questions (many of which I didn’t have an answer to). The school nurse was amazing as well. She seemed so dedicated to her job, and to helping all of the kids in the school.

After we left the school, I really enjoyed meeting with Dr. Galen Durose at Dean Memorial Hospital in Greenville. It was interesting to hear how he alone had to run the ED, and how he could be one of the only physicians in the entire hospital. This was eye opening because previously I didn’t fully understand the extent of the lack of providers in such a rural area, and all of the extra work that these health care providers have to do for great patient care, and how willing they are to do it. That seemed to be the overall theme of this trip- that there is a lack of providers, but all of the practicing providers in these areas are willing and happy to work so hard in order to better the health of their patients. This is an encouraging thought for myself as a future physician, knowing that there are currently providers like this that I can look up to, and contact for any advice in my coming years.

One last group photo before heading back to Portland.

One last group photo before heading back to Portland.

UNE Students Share Experiences on their Second Day of the 2018 Piscataquis County Rural Health Immersion

March 20th, 2018 by healthinnovation
Students talk about health policy with Maine State Senator Paul Davis, who represents communities in Piscataquis county

Over breakfast students talk health policy with Maine State Senator Paul Davis, who represents communities in Piscataquis county

Ten UNE health professions students recently participated in a weeklong rural health immersion to Piscataquis County in Maine.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fifth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to the Penquis area.  Last Fall a group of 10 students traveled to Oxford County and Carroll County in New Hampshire for a long weekend immersion; in May of 2017 a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; in March of 2017 medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Throughout the immersion the students are purposefully split into interprofessional teams so that they can learn the roles and how to communicate effectively with other disciplines in order to learn the skills necessary to provide high quality team-based care and improve patient outcomes.  The students experienced a variety of clinical, community, and population health activities in rural and underserved communities in central Maine communities, including Newport, Dover-Foxcroft, and Greenville.  The group was also supposed to visit Eastern Maine Medical Center and Penobscot Community Health Care but due to a Nor’easter the first two days of the trip in Penobscot County were canceled.  Below are reflections from one team after the second day of the trip on Thursday, March 15th, 2018.

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The students meet with Mayo Regional Hopsital CEO, Marie Vienneau to talk about working for a Critical Access Hospital in rural Maine.

Emily Krusec, junior ABSN student

It takes a village. What a cliché – especially when referencing small, rural towns – but in Maine, survival in these types of communities is centered around this overused expression. Being from “away”, as Mainers might say to someone like me who was not born in Maine, I noticed the strong sense of community when moving to the state – this profound characteristic is even more exaggerated in rural Maine. This led me to question why rural areas have such a strong sense of community. During this immersive experience, I learned that it is for survival. Access to healthcare and related resources is not ubiquitous; this is especially a reality in rural areas. To help combat this, many healthcare professionals have adopted the “whatever it takes” mentality in addition to tailoring healthcare programs to the community in order to efficiently utilize the few resources they do have. Rural community healthcare providers must heavily rely on collaboration with others in order to meet the basic quality healthcare needs.

Each interaction, during this immersive experience, touched on community participation in its own way – starting with Piscataquis County Senator Paul Davis who told stories about personal involvement with community members and the impact it had on those individuals. He shared his experience with one woman in his community who lost her driver’s license because of poor vision. For bureaucratic reasons, the DMV was not allowed to give her a license after she had her vision corrected. Senator Davis was able to make a few phone calls and work some magic so this woman was able to get her driver’s license back. In this woman’s case, it solved the most common obstacle of healthcare access in rural Maine: transportation.

The students meet with Gail Bergeron, owner and operator of Foxcroft Pharmacy

The students meet with Gail Bergeron, owner and operator of Foxcroft Pharmacy

Transportation was another common motif that was later emphasized in our meeting with elder town residents who were in the process of establishing a community center in Dover-Foxcroft. Among the seniors was Leslie Fernow, a retired local physician who had a strong passion for her community. In response to the transportation obstacles many of her patients faced, she adopted the “whatever it takes” work ethic by providing home health visits to her patients. Doing so offered many other benefits, including seeing her patient’s in their environment to paint a better picture of their health, along with truly interacting and spending more time with her patients on a personal level. Dr. Fernow also emphasized the importance of community involvement and contributions by healthcare professionals – through fully giving back to patients, neighbors and the community in many ways, this completes the integrated healthcare circle.

This theme continued on in our meeting with the staff at Mayo Regional Hospital. Mayo Hospital is an essential part of the community in Dover; it facilitates community town halls to collect feedback, organizes free classes directed toward health promotion and disease prevention, and they tailor many of their programs to fit the needs of the community – thereby efficiently allocating the limited resources. Mayo providers also discussed the staffing shortage crisis and how rural areas are hit particularly hard. The provider shortage has led to increased collaboration among healthcare professionals and one person having to fill many – sometimes as many as 6 – various roles, just to provide basic quality healthcare. This again reiterates the theme of “whatever it takes”.

Before this trip I believed living in rural areas and having a sense of community were mutually exclusive, but I learned that it was quite the antithesis: the limited resources in a rural community actually brings the community together, making it stronger. So what does it take to provide basic quality healthcare services in rural, underserved areas? It takes health professionals who adopt the “whatever it takes” mentality along with healthcare providers who reach out, collaborate and support one another because that’s all they have. Most importantly, to provide basic quality healthcare in rural communities, it takes the contribution of all members; it takes a village.

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First year osteopathic medicine student, Gigi Green, and junior nursing student, Lauren Yelinek, practice intubating a pediatric patient in Mayo Regional Hospitals Sim Lab with Kathryn Brandt, Director of Primary Care in UNE’s College of Osteopathic Medicine.

 

Evangeline (GiGi) Green, First year Osteopathic Medicine Student

When I woke up this morning I had no idea what to expect from the day. As someone who likes to have control of all aspects of my life this left me feeling extremely apprehensive, but in the end it was a blessing. To give up control and have no expectations allowed me to be fully present with the community and the experiences that we were given during the rural health immersion. I wasn’t taking each experience and comparing it to another one or to some made up benchmark that I had set in my head; to some extent I think this parallels the practice of health in a rural community. The lack of resources that we heard about from the providers that we met with requires creativity and support for one another. At Mayo Regional Hospital in Dover-Foxcroft we were informed of the high turnover rate in rural medical practices due to provider burnout. Part of me couldn’t help but wonder if this burnout stemmed from the expectations that we have as practitioners for a certain level of facility or support that can’tnecessarily be reached in a rural setting.

Nikki Chadwick, VP of Quality and Education at Mayo Regional Hospital, talks to the students about how the staff is striving for superior healthcare quality

Nikki Chadwick, VP of Quality and Education at Mayo Regional Hospital, talks to the students about how the hospital staff is striving for superior healthcare quality

In talking with the providers in Dover-Foxcroft I couldn’t help but be amazed with the level of creativity that they used in their delivery of care as well as their dedication to serving as many roles as they felt the community had a need for them to be in. These people were thriving in their roles, they did not hold on to expectations of the way healthcare needed to be delivered, but rather they ditched those expectations and focused on the needs of their community and how they could best provide the services to meet those needs in an effective manner. This idea of working together with the community is something that continued throughout the rest of the day.

After leaving the hospital we went to the Maine Highlands Senior Center in Dover to meet with elders in the community and to hear their take on health needs. This experience dove back into the concept of community and fostering a stronger community in order to address its needs. The building that we stood in was once the center of the town, it was a place that could be used by all and served many roles and fulfilled many needs. For many years it had been neglected and had not been used for some time, but members of the community came together to restore the building and bring it back to what it once was- a community gathering spot- but with additional services to address the emerging needs of the community. What stuck with me is that community means different things in different places. When in a town that has challenges a strong sense of community becomes even more meaningful. Dr. Leslie Fernow talked to us about the unfortunate societal trend of decentralizing a community and moving away from the traditional community-oriented lifestyle. In her opinion, which I agree with, this is not what we should be striving to achieve. Instead, we should be fostering stronger community and bringing people together, which will be achieved through the Maine Highlands Senior Center. Giving people a place to go and a sense of belonging allows you to pool your resources and work together to achieve greater health.

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Students meet with community elders at the Maine Highlands Senior Center in Dover-Foxcroft. They later broke out into small groups to talk to the elder guests about what its like to live and work in a rural community like Dover.

 

Alicia Bergquist, Junior ABSN Student

“We’re both seventy-five, and neither of us are on any medications.” Over the next thirty minutes Joe and Beth, locals to Piscataquis and Penobscot Counties, became my idols for what it could mean to age healthily in a small rural community. Having moved to Dexter, Maine twenty-five years ago with their daughter to, “escape the rat race” of New Jersey, the couple almost immediately were made integral members of the community. With a population of less than 4,000 the citizens of Dexter were eager to take advantage of Joe’s background in middle and high school education and Beth’s speech pathology practice. Since retiring, Beth has started the first chapter in the Penquis Region for the National Alliance of Mental Illness (NAMI), and is forming one of the first geriatric mental health support groups in the area. Once Joe retired from teaching, he got right to building a small house for the two of them on their eighty-six acre plot of land. “How do you two stay so healthy?” I asked, suspecting I may have a good idea already. “Staying active in our community, and a whole food, plant-based diet!” Beth affirmed. They are lucky enough to have had the same family physician since they came to Dexter – in contrast to another community member who had expressed great anxiety over the announcement that her primary care physician was leaving her practice – and emphasized their appreciation for their provider always taking as much time as necessary with their every appointment. Hearing about how involved they were in the towns of Dexter and Dover-Foxcroft, and seeing the positive results reflected in their springy steps, easy laughter, and kind words for each other, their town, and their experiences reinforced the growing sense I was getting for just how supportive and fulfilling a small rural community can really be.

I had been introduced to Joe and Beth at the soon-to-be gorgeous Town Commons in downtown Dover-Foxcroft. The historic building is nearly finished after extensive renovations, and the lively couple were two out of the seven elder community members we had the privilege to spend some time with in what will soon be established as a senior center for the community. As we received a tour of the building, the beautiful stage and event space, and the senior center, my mind was flooded with possibilities of what could soon be happening there. The thought of residents of all ages coming together to celebrate, learn, and just get to know one another appealed to my romantic notions of old-fashioned small town rural America. As we become more isolated behind our phone and computer screens, we become more and more detached from our neighbors and local opportunities for leadership. As populations concentrate in urban centers, resources begin to disappear from rural communities on the margins, and even the simplest things like access to fresh fruits and vegetables can become insurmountable. We hear complaints about America changing for the worst, and it can feel like our environments are becoming more dangerous, hostile, and prohibitive to success. After spending the first part of the day at Mayo Regional Hospital in Dover-Foxcroft, where we learned how the scope of practice for rural providers can be expansive, often with a much heavier focus on community health, meeting with community members made me realize the pathway to community involvement and collaboration is still accessible.

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The stairwell at Mayo Regional is painted with a wonderful mural in order to encourage people to take the stairs instead of the elevator.

Of course there are many challenges to rural health, which we also discussed throughout the course of the trip. Maine’s aging population is one of the largest obstacles; Piscataquis County has the oldest population in the oldest state in the country. “We used to see kids running all over the grocery store…we almost never see any children any more”, mused Beth and Joe. Poverty and food insecurity are very real problems in these communities, and people really depend on each other to make ends meet. When I asked Beth and Joe if it was easy to maintain an organic vegetarian diet in their town, Beth just laughed, and sang her praises for the online food delivery service they use. While small farms are reemerging as providers of tons of produce, meat, and dairy in these areas, cost is still a preventing factor for many families. Lack of transportation can make access to health care, employment, and other needs nearly impossible making the, “under one roof” model of Mayo Hospital and the Maine Highlands Senior Center invaluable. Burnout for health care providers leads to high turnover and a recruitment deficit, and as large numbers of staff members reach retirement there are fewer candidates to replace them. Most of us may react to challenges like these by skipping town to seek more opportunity; the residents of these small towns, however, are committed to their community. The pride, loyalty, and optimism in the face of the facts demonstrated by all the people we met with today is overwhelming. When I left Mayo Regional Hospital and the Maine Highlands Senior Center, I felt motivated by everyone’s tireless devotion to their towns and stalwart faith in their missions to improve the lives around them. We heard several times: the people here are what makes this community work worthwhile. I left Dover-Foxcroft thinking, I may just find myself getting to know these very people much better.

 

The group of ten UNE healthcare students meet with Mayo Regional Hospital CEO, Marie Vienneau

The view from the Kineo View Lodge in Greenville where the group stayed on Thursday night. Just to the right was a beautiful view of Moosehead Lake.

UNE Students Share Experiences on their First Day of the 2018 Piscataquis County Rural Health Immersion

March 19th, 2018 by healthinnovation
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Ten healthcare students from the University of New England recently participated in a rural health immersion to Piscataquis County.

 

Ten UNE health professions students recently participated in a weeklong rural health immersion to Piscataquis County in Maine.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fifth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to the Penquis area.  Last Fall a group of 10 students traveled to Oxford County and Carroll County in New Hampshire for a long weekend immersion; in May of 2017 a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; in March of 2017 medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Throughout the immersion the students are purposefully split into interprofessional teams so that they can learn the roles and how to communicate effectively with other disciplines in order to learn the skills necessary to provide high quality team-based care and improve patient outcomes.  The students experienced a variety of clinical, community, and population health activities in rural and underserved communities in central Maine communities, including Newport, Dover-Foxcroft, and Greenville.  The group was also supposed to visit Eastern Maine Medical Center and Penobscot Community Health Care but due to a Nor’easter the first two days of the trip in Penobscot County were canceled.  Below are reflections from one team after the first day of the trip on Wednesday, March 14th, 2018.

 

Colleen Moore, Junior ABSN student

For the typical student of health care, an immersive experience in a rural setting is unimaginable, if attainable to any extent. On a cloudy, slightly snowy day in Newport, Maine, however improbable the circumstance, ten students were granted the opportunity to begin a tour of rural healthcare across the Penobscot and Piscataquis counties of Maine. The trip already having been truncated due to a massive snow storm, the plans for visiting Eastern Maine Medical Center and Penobscot Community Health Care were regretfully cancelled, leaving the fresh osteopathic, pharmacy, and nursing students with little rural exposure after the first day. With some quick thinking by the trip leader, we were graciously received by Robin Winslow, the CEO, of Hometown Health Center, a Federally Qualified Health Center (FQHC) devoted to serving rural Maine in different locations across five counties.

In a well-lit, comfortable, clean clinic, with the walls adorned with stickers from the movies Cars and Frozen, Robin educated our group about the role of Federally Qualified Health Centers in rural settings, and how her clinics operated within those strict parameters. We learned about the lack of providers coming to rural health clinics due to competing incentives from hospitals, and the struggle for the future of quality rural healthcare due to the aging population of Maine’s healthcare professionals and the impact of opioid addiction.

The most striking aspect of rural healthcare for me that Robin presented was the complex role that each health care professional played in her clinic. In a rural setting, a patient faces many challenges in receiving quality, individualized health care. In an urban setting, quality care usually entails referring a patient to a specialist. In a rural setting, certain barriers, such as transportation, lack of providers, lack of funding, limited resources, and distance between health care facilities present challenges. To address these challenges, Robin talked about the benefits of providing integrated medical, dental, and mental health care all in one facility. In order to provide the best care possible for Hometown Health Care, Robin told us about the nurses, the doctors, and the one pharmacist, and how each contributes to the clinic in by playing many roles that go beyond merely examining their 7,300 patients.

Throughout our discussion, the staff members of Hometown Health Center awed me with their level of interdisciplinary cohesion, and how each healthcare professional worked with compassion to deliver excellent health care in a setting with limited resources. I was left with an impression of Robin’s emphatic resilience, and her dedication to providing affordable, quality care for a community she genuinely cared for, by expanding the roles each of the healthcare providers played.

The success of Robin’s clinic seemed not to come from being financially well-supported, well-staffed, or having especially attracted top-ranked professionals, but from the uniquely dedicated and compassion that each professional brings to the clinic. Each member of the clinic was personally invested in meeting whatever role was needed by the patients, and indeed each staff member wore many hats regardless of the role expectations of that professional’s background. Any clinic can grow and learn from the dedicated interdisciplinary efforts of Hometown Health Center.

 

Alivia Spicer, First Year Osteopathic Medical Student

Finally, after having our trip delayed by 1.5 days due to a Nor’easter, myself and nine other pharmacy, nursing, and medical students were on our way north for the March 2018 Rural Health Immersion Program. Our first stop in the journey north was at the Hometown Health Center (HHC) in Newport, ME. HHC is a federally qualified health center (FQHC) and is a non-profit organization, serving roughly 7300 patients in four locations.

We dropped off boxes of medical supplies at HHC that we had picked up in Portland before departing for the rural health immersion and we were able to get a tour of the facility and meet with Robin, the CEO. Within minutes of listening to Robin discuss the history of the four practices she operated located in Pittsfield, Dover-Foxcroft, Dexter, and Newport; it became very apparent to me of the need for more healthcare providers in rural areas. She stated that out of four locations, they had only four nurses and seven providers (one being a medical doctor and the rest being mid-level providers). She stated that as a non-profit organization, they struggle with recruiting and keeping physicians due to the hard to compete with nearby hospitals that offer better pay and better benefits.

Throughout the entire talk, I could see how driven and compassionate Robin was in providing healthcare to patients in rural Maine with limited resources to the best of her ability. Whether that meant rallying staff together to contribute money to pay for a cab ride for a patient to the hospital or if it meant guaranteeing to see that patient the same day they called for an appointment, you could tell that the providers working there do it out of the goodness of their heart with their patient’s health and well-being as their number one priority.

Having grown up in rural Maine myself, I have seen the need for more healthcare providers and the lack of access to healthcare first-hand. However, todays visit at HHC made me realize that we as future nurses, pharmacists, and physicians will be playing a significant role in the direction and future of medicine. It starts now.

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Jen Van Deusen, Director of Curriculum in UNE’s College of Osteopathic Medicine, discusses the goals of the trip after dinner on the first night.

Jenny Lau, Second Year Pharmacy Student

March 14, 2018 marks Day 1 of the 2018 Central Maine Rural Health Immersion. Our first stop was at Hometown Health Center (HHC) in Newport, one of their four offices in Maine. Upon delivering several boxes of medical supplies, the CEO (Robin Winslow) graciously welcomed us and introduced HHC to us. As I reflect back on what she said, what I found most memorable is when she mentioned there is only a total of 7 providers in all 4 locations and they get about 23,000 patient visits annually. The majority of these providers are mid-level providers and there is only one physician. As she expressed her concern of physician shortages and provider shortages in general due to the aging healthcare workforce and inevitable retirements, I can’t help but to question why there aren’t any promising solutions to this crisis. How is it possible to have such disparities in healthcare? As students, what can we do now to help with the reform?

On a brighter note, this brief experience showed me a different side of a conventional workplace environment. I was surprise to see how well the staffs worked together as a team towards the same goal. I didn’t sense there was a chain of command in place; the nurse practitioner spoke freely in the presence of the CEO. I believe these particular healthcare members face additional stress and challenges as they account for their patient’s transportation and the financial burden of medical expenses for their patients. Despite these unique challenges, the staff were seemed very happy at work. Unlike in urban communities with adequate healthcare access, it was apparent here that the staffs here are valued and not easily replaced.

I look forward to the rest of this immersion and continue to learn with an open heart.

 

Lauren Yelinek, Junior ABSN Student

We left for Dover-Foxcroft at 3:00pm on Wednesday March 14th 2018, a day and a half later than we had planned. It is March in Maine, and it is clear that Mother Nature does not care about our Rural Health Immersion itinerary. As I watched the piles of snow on the side of the road climb higher as we rolled north, it occurred to me that we might not be the only ones whose plans may have been changed due to the third Nor’easter in three weeks. As we would come to find out at an impromptu visit to Hometown Health Center in Newport, transportation is one of the most considerable challenges to accessing quality healthcare for communities in central Maine.

Hometown Health Center (HHC) is a Federally Qualified Health Center (FQHC), a non-profit organization funded by and beholden to federal grants. While this means tight regulations and careful documentation by administration, it also means that rural communities in central Maine have access to quality healthcare providers and programs that they might not otherwise have, such as the Prescription Assistance Program that allocated over $1 million worth of prescription drugs to the 7300-person patient pool at HHC. Robin, the CEO, repeatedly referred to the efforts of the HHC as “the mission”, which underscored that the work done here is more than a note on a chart or a tally mark for a grant application. She mentioned that the staff participated in dress-down Fridays to contribute to a petty cash fund for patient needs, and that some of these funds recently went toward a patient’s medical procedure. The sadness in Robin’s voice when she described the difficulty of finding a cab to transport this patient to their procedure made me feel ashamed for being frustrated with our delay hours earlier.

Robin was clearly more than a CEO; she cared deeply about consistently and effectively being able to reach those in the community who needed care the most. This was evident in her explanation of current providers within the HHC system, and her concern for the future. The need for more providers at HHC – particularly, physicians – is met with economic and geographic constraints. As a FQHC, HHC cannot match the provider pay and benefits offered by traditional, for-profit healthcare organizations.

As we exited HHC, we walked past brightly-colored Sliding Scale signage and community resource pamphlets, and I sat down in the UNE van that had delivered me here, with accessibility on my mind. We had still arrived at HHC, despite the storm. But how many patients had missed an appointment? How many community members don’t see providers because they can’t get there in the first place? How many young professionals think that Newport, ME, is just too far, “too rural”? How many can’t afford to work at an FQHC, for a “mission”? Accessibility is not just a patient issue, it is a systemic healthcare issue that impacts those receiving and providing care, particularly in rural communities. I told myself not to forget this as we drove north toward Dover-Foxcroft, passing several homes that had snow piles nearly blocking their front doors.

UNE Forms a Pipeline to Western Maine to Address Healthcare Shortages

November 10th, 2017 by healthinnovation
A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

Ten healthcare students from UNE’s College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physican Assistant and Bachelor of Science in Nursing (BSN) programs recently attended a long weekend rural health immersion in Oxford County of Western Maine and Carroll County of Northern New Hampshire. The experience, which is coordinated and funded by UNE’s Center for Excellence in Health Innovation and the Maine Area Health Education Center (AHEC), is a pipeline activity created to reduce healthcare provider shortages in rural Maine and to strengthen UNE’s relationships with healthcare centers around Maine. The October immersion experience was the fourth time that a rural health immersion has been offered to UNE students but the first time that a group had gone to Oxford County; last May a weeklong immersion was held in Maine’s midcoast region of Knox and Waldo Counties; last March a weeklong immersion was held in Franklin County; and in May of 2016 the first weeklong immersion was held in Maine’s northern most county, Aroostook County.

“So far, we’ve had over 50 students participate in the immersion experience, and the data that we’ve collected from them suggests that these students are more interested in practicing in a rural or medically underserved area after participating in the immersion” says Karen O’Rourke, Director of the Maine AHEC, located within UNE’s Center for Excellence in Health Innovation. “This corresponds to the literature which shows that early and often exposure to rural health is the most effective strategy to increasing rural provider retention. This is is precisely why we’ve created the rural health immersion, to provide opportunities for our students to get exposed to Maine’s more rural communities, so that they are more likely to become a rural healthcare provider after graduating.”

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

Attracting healthcare professionals to rural and underserved communities has been a national priority for several years and a particular issue for Maine partly due to the fact that, according to the 2010 Census Data, Maine was the most rural state in the United States. Rural terrain can lead to long commutes for patients seeking basic healthcare services and can exacerbate provider shortages, leading to poorer health outcomes. This is a particular problem in Maine where nearly 1/3 of all of Maine’s providers work in Cumberland County, leaving many of Maine’s larger and more rural communities underserved. In order to help alleviate healthcare workforce shortages in Maine’s more rural counties, the Maine AHEC has strategically located three AHEC centers around Maine in Aroostook, Franklin, and Penobscot counties. “Oxford County is one of the Maine’s counties with the fewest healthcare providers in the State, with only about 2% of the providers living in that area. We were able to utilize our western Maine AHEC center, which covers Oxford County, to help connect with area hospitals for this immersion.”, says O’Rourke.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Maine and New Hampshire provide a contrasting picture of health and well being, despite neighboring one another. According to the United Health Foundation, New Hampshire ranked 6th in overall health rankings, whereas Maine did not fair as well, ranking 22nd. “These health disparities became apparent to the students rather quickly” said Ian Imbert, MPH, the project coordinator of a prestigious four year Josiah Macy Jr. Foundation grant in UNE’s Center for Excellence in Health Innovation, which aims to enhance team-based care and improve patient outcomes. “The immersion experience provided them an opportunity to see first-hand the effects of healthcare access and funding for prevention programs. In Maine, the decision not to expand Medicaid has created access barriers that have effected the health of our communities, whereas the expansion of Medicaid in New Hampshire has created additional funding to provide much needed services to its underserved populations.” Indeed, the Robert Wood Johnson Foundation’s 2016 county health rankings, for example, show that Carroll County in New Hampshire ranked 4 out of 10 in health outcomes, while Oxford County in Maine did not fair as well, finishing close to the bottom, 14th out of 16.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

It’s predicted that some of the health challenges that Maine’s more disparate Counties face would be improved if there were more providers who lived and worked in those areas. According to the Robert Graham Center and the Nursing Workforce Forecast, Maine will need an additional 120 primary care physicians and 3,200 nurses in the next decade in order to maintain current rates of healthcare utilization. Moreover, the Maine Department of Labor projects a shortage of 170 dentists. Research shows that students are more likely to practice rural medicine if they have a personal connection to a rural area, so, the rural health immersions aim to provide opportunities for students to connect to rural Maine and hopefully alleviate healthcare provider shortages.

The students who participated in the Western Maine rural health immersion came from a broad array of backgrounds, some growing up throughout the country in areas like Maryland and Pennsylvania while about a third of the students had grown up in New England or had spent time previously in rural Maine, either through extended family or while vacationing. Most students had some experience working with underserved populations in the past but for a few it was their first opportunity to experience rural underserved healthcare. One student from UNE’s College of Dental Medicine, Nicole Caron, from Massachusetts, reflected after the final day of the immersion, “This trip introduced me to a bunch of different rural communities that all had one thing in common, extraordinary healthcare providers who work every day to improve the health of their patients and their communities, despite the obstacles they may face in rural areas. I have been inspired and I hope that I am able to practice dentistry just like the professionals that we interacted with this weekend.”

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

During the immersion, the students experienced a variety of activities in underserved areas in Oxford and Carroll Counties, such as meeting with providers of Memorial Hospital in Conway, NH, and Bridgton Hospital in Bridgton, ME, for a tour of the hospital facilities; a tour and discussion with providers at Sacopee Valley Health Center, a Federally Qualified Health Center in Porter, ME and at White Mountain Community Health Center, a rural community health center in Conway, NH; a trip to Conway Oral Health in Conway, NH to talk about dentition in rural communities; and a tour of Hannafords pharmacy in Bridgton, ME. “This was the first time that an immersion cradled two states”, said Imbert “which allowed the students to think about health policy, and the effect it can have on populations..”

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

The students attended the Fryeburg Fair, Maine’s largest agricultural festival, where they helped staff the first aid centers. The students created care kits, consisiting of basic, yet essential health care products, like toothpaste, toothbrush, soap, band aids, and more, to hand out to people at the fair. They also worked along paramedics to take blood pressures and provide basic health education on oral health, exercise, and nutrition. “This event gave me the opportunity to meet and talk with people who live in rural communities in Maine”, said Minh Tam Hua, a second year pharmacy student. “I feel that we as health professional students should create more health screenings in rural areas to educate the community about many of the diseases that we saw. If we all stand together and contribute our part, we will be able to help reduce the number of chronic diseases that are taking place in these rural areas.”

Students conducted a Worksite Health ScoreCard at the fair to assess it's performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Students conducted a Worksite Health ScoreCard at the fair to assess it’s performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Jen Van Deusen, MEd, Director of Curriculum in UNE’s College of Osteopathic Medicine, has participated in all four immersions and once again helped to lead the western Maine immersion. “It’s amazing to see the students perceptions of rural health change throughout the trip. And when they return to the classroom I see how excited they are to share what they’ve learned with their peers, creating a ripple effect.”

The full team of students who attended the Midcoast Maine immersion included two medical students from UNE’s College of Ostepathic Medicine Taylor Ouellette and Rodger Carter; two pharmacy students from UNE’s College of Pharmacy Kelly Banks and Minh Tam Hua; two students from UNE’s Nursing Department Katherine Clark and Lesley Lafland; three students from UNE’s College of Dental Medicine Nicole Caron, Brittany Malia, and Kimberlee Sell; and one student from UNE’s Physician Assistant Department Rachel Moore. You can read more on each students experience here.

The group roasts marshmallows on their last night together in Oxford County.

The group roasts marshmallows on their last night together in Oxford County.

The trip was graciously supported by Maine’s Area Health Education Center (AHEC), the Josiah Macy Jr. Foundation, and UNE’s Center for Excellence in Health Innovation. The Maine AHEC has continued to prioritize experiential learning in rural communities for graduate healthcare students and their commitment to the rural health immersion proved to be invaluable for the success of the trip. The Josiah Macy Jr. Foundation grant that also helped fund the experience is a four-year grant awarded to UNE in 2015 from the Josiah Macy Jr. Foundation and aims to improve health care and education in rural areas. Dora Anne Mills, MD, MPH, FAAP, Director of UNE’s Center for Excellence in Health Innovation, helped create the immersion experience.

 

FMI: Contact Ian Imbert, MPH, (207-221-4625 or iimbert@une.edu)

 

University of New England Works with State and Community Partners for Public Health Emergency Preparedness Exercises

November 8th, 2017 by healthinnovation
UNE osteopathic medicine student adminsters a flu vaccine at the October 20th Alternate Care Site emergency preparedness exercise located at UNE's Biddeford campus center gymnasium.

UNE osteopathic medicine student Justin Doroshenko adminsters a flu vaccine at the October 20th Alternate Care Site (ACS) emergency preparedness exercise located at UNE’s Biddeford campus center gymnasium.  This was the first time that an ACS exercise had been conducted in Maine.

The University of New England recently hosted two public health emergency preparedness training exercises in collaboration with state and community partners, offering free influenza vaccinations to the UNE community and public as part of the events. This is the second year in a row that UNE has partnered with local and state public health agencies to conduct a public health emergency preparedness exercise in order to be better prepared in the event of a real public health emergency. “For several years UNE has registered to be part of a volunteer network of Points of Distribution, or PODs, that will serve as centers for administering medicines, vaccines, and/or necessary supplies for the public in the event of a large-scale emergency”, explained Dora Anne Mills, M.D., M.P.H., FAAP, vice president for Clinical Affairs and director of UNE’s Center for Health Innovation. “To fully prepare for such an event, UNE faculty, staff, and students work in collaboration with state and community partners to simulate such an event, and offer free influenza vaccines to the public as part of the exercise.”

On October 20th, 2017, the UNE Biddeford Campus Center gymnasium was converted into an Alternate Care Site (ACS), a temporary medical system that is established to provide low-acuity care during a public health emergency. UNE students from four of UNE’s six colleges participated in the exercise to learn some of the principles of emergency preparedness planning from State officials.  A large turnout of people looking to receive their flu vaccine allowed medical and pharmacy students to administer vaccines to more than 225 UNE students, faculty, and staff.  Jessica Rehrig, a second year osteopathic medical student in UNE’s College of Osteopathic Medicine said “It is reassuring, both as a student physician and a member of the community, to know that adequate policies and procedures are in place to accommodate patients in the event of a medical surge or state-wide emergency.”

ACS exercise overview smaller copy

The UNE campus center gymnasium was converted into a temporary medical system to provide flu vaccines to the public. Several local and state public health agencies participated in the exercise, including the Maine DOT who delivered the durable medical supplies shown here to Biddeford from a warehouse in Augusta.

The October 20th ACS exercise represents a milestone as the first deployment of a multi agency scenario for the newly established York County Medical Reserve Corps (MRC), a partnership between the greater York County community and UNE.  It was also the first time Maine had implemented a test of the ACS system. “Maine CDC Public Health Emergency Preparedness Program (PHEP) purchased these modules as a way to provide emergency medical assistance in the event of a real response situation. These modules are designed to assist in the immediate response effort, as in help until help arrives, when Federal Medical Systems cache can be deployed”, says Patrick Furey, Maine CDC Public Health Emergency Preparedness Exercise and Training Coordinator. “It was great working with UNE faculty, staff, and students, area Walgreens Pharmacy staff and management, as well as Maine’s Medical Reserve Corps (MRC) volunteers at this exercise.”

One week later, on October 27th, 2017, the newly renovated Innovation Hall at UNE’s Portland Campus was converted to a Point of Dispensing (POD) site where influenza vaccine was once again administered to community members.  Medical, pharmacy, nursing, and public health students helped staff the exercise.  Valerie Bedard, a senior nursing student in UNE’s Westbrook College of Health Professions said “As a student here, it is wonderful to see that UNE is proactively thinking about how it will take care of the community in the event of an emergency. I really enjoyed learning from, with, and about my medical and pharmacy student peers as well as from the local and state public health community.”

A Point of Dispensing (POD) exercise was conducted on October 27th in UNE's newly renovated Innovation Hall.

A Point of Dispensing (POD) exercise was conducted on October 27th 2017 in UNE’s newly renovated Innovation Hall.

Caity Hager, from Maine’s Cities Readiness Initiative based out of the City of Portland, helped coordinate last years POD exercise on the UNE Biddeford campus and was able to use some of the lessons learned from last year to improve upon this years exercise. “Partnering with UNE to conduct similar exercises two years in a row allows the Maine Cities Readiness Initiative to improve and strengthen our plans to respond to this type of emergency”, said Hager. “We have been improving and refining procedures based on feedback from last year’s exercise and it is important for our program to have the opportunity to exercise the changes and evaluate the improvements to our plans.”

Caity Hager from Maine's Cities Readiness Initiative provides a "Just-in-time" orienation training for the staff members who volunteered to operate the exercise.

Caity Hager from Maine’s Cities Readiness Initiative provides a “Just-in-time” orientation training for the staff members who volunteered to help operate the exercise.

In total, more than 350 people receive an influenza vaccine at these exercises. A partnership with Walgreens and UNE’s Health Services ensured that there was enough vaccine supply to dispense to the public at the exercises. Several employees from Walgreens, including seven licensed pharmacists, donated there time to help staff crucial clinical and non-clinical roles at both exercises.  Heather Stewart, an alumnus of UNE’s College of Pharmacy Class of 2014, and current Walgreens pharmacist, says that her time at UNE as a student helped instill the importance of influenza surveillance as a tool to keep the public healthy.  “Influenza is a vaccine preventable virus that has significant public health consequences including decreased productivity, and increased morbidity, mortality, and healthcare expenditures.  Events such as the ACS and POD exercises not only prepare our First Responders for a large scale emergency but they also increase ease of access by creating another public health environment for patients to obtain their influenza immunization.”, said Stewart.

Heather Stewart, PharmD, provides a workshop on proper flu vaccine administration techniques to UNE healthcare students.

Heather Stewart, PharmD, provides a workshop on proper flu vaccine administration techniques to UNE healthcare students.

These exercises are done in collaboration with a number of partners, including: Maine CDC, York and Cumberland District Public Health Councils, Emergency Management Agencys, the City of Portland’s Maine Cities Readiness Initiative, area Walgreens pharmacists and management, and Maine Responds (Maine’s emergency health volunteer system). “As part of this initiative, UNE’s Center for Health Innovation works collaboratively with our health professions programs as well as state and community partners to provide learning experiences for our students. A number of medical, public health, nursing, pharmacy, and other students attend sessions run by emergency preparedness experts and assist in administering vaccines,” said Mills. “As a result, southern Maine will be better prepared for an emergency today, and tomorrow’s health professionals will also be better prepared.”

To learn more about the Center for Excellence in Health Innovation, visit: www.une.edu/academics/centers-institutes/center-excellence-health-innovation

UNE Holds Workshop on Opioid Use Disorder and Medication Assisted Treatment

November 8th, 2017 by healthinnovation
Expert speakers discuss opioid use disorder and medication assisted treatment at the October 28th workshop located on UNE's Portland campus.

Expert speakers discuss opioid use disorder and medication assisted treatment at the October 28th workshop located on UNE’s Portland campus.

On Saturday, October 28, 2017, the University of New England Center for Excellence in Health Innovation hosted an opioid use disorder (OUD) and medication assisted treatment (MAT) Workshop at UNE’s newly renovated Innovation Hall.

More than 150 people registered, and attendees included UNE students from the College of Osteopathic Medicine, College of Pharmacy, Westbrook College of Health Professions and College of Dental Medicine, as well as UNE faculty and clinicians from the community. Experts led presentations and discussions on MAT; screening, brief intervention, and referral to treatment (SBIRT); prescribing laws; public health impact; and stigma.

“As we face a deadly epidemic of opioid addiction, workshops like this are critical to assuring the clinicians of tomorrow as well as today are able to work together with clinicians from other professions and patients to successfully screen people for addiction, help people get into treatment, and keep them in recovery,” said Dora Anne Mills, M.D., M.P.H., director of the Center for Excellence in Health Innovation.

In 2016, 313 Mainers died of an opioid-related overdose, which represents 83 percent of all drug-related deaths in the State. Currently, the demand for MAT in the state still outpaces the supply, especially among those who lack health insurance or live in health professional shortage areas. To address the critical need for health professions education around OUD and MAT, the Center for Excellence in Health Innovation received $80,000 in supplemental funding from its federal Health Resources Services Administration (HRSA) Primary Care Training and Enhancement (PCTE) grant to further increase education around MAT in primary care. The Center for Excellence in Health Innovation plans to hold lunch and learn programs and future events for faculty and students who are looking to learn more about OUD and specifically MAT.

FMI contact Melanie Caldwell, mcaldwell4@une.edu or visit http://www.une.edu/academics/centers-institutes/center-excellence-health-innovation/grants-initiatives/primary-care-training-and-enhancement-grant

UNE Faculty and Staff Present at Collaborating Across Borders VI Conference in Banff, Canada

November 8th, 2017 by healthinnovation
UNE faculty from the Westbrook College of Health Professions present in Banff Alberta at the Collaborating Across Border (CAB) conference (From L-R, Nancy Jo Ross, Sally McCormack Tutt, Kelli Fox, Elizabeth Crampsey, and Kris Hall)

UNE faculty from the Westbrook College of Health Professions present in Banff Alberta at the international Collaborating Across Border (CAB) conference (From L-R, Nancy Jo Ross, Sally McCormack Tutt, Kelli Fox, Elizabeth Crampsey, and Kris Hall)

The University of New England was well represented at the Collaborating Across Borders VI conference in Banff, Canada. Ruth Dufresne, S.M., research associate and evaluator in the Center for Excellence in Health Innovation, gave a presentation focused on evaluation of the Josiah Macy Jr. Foundation and the Health Resource Services Administration (HRSA) funded Primary Care Training an Enhancement (PCTE) Project. She presented on behalf of the PCTE Team which includes Dora Mills, M.D., M.P.H., F.A.A.P., Jennifer Gunderman, M.P.H., Melanie Caldwell, M.S., Ian Imbert, M.P.H., and Toho Soma, M.P.H., as well as clinical partners at Penobscot Community Health Care (PCHC).

Elizabeth Crampsey M.S., OTR/L, BCPR, Kelli S. Fox LCSW, CCS, LADC, Kris Hall M.F.A., Sally McCormack Tutt PT, D.P.T., M.P.H., and Nancy Jo Ross Ph.D., RN, gave an interactive presentation titled, “Parallel Processes in Interprofessional Education (IPE): From Campus to Community.” They described an interprofessional educational (IPE) experience the team has been teaching for the past three summers in collaboration with clinicians from Maine Medical Center. They led participants through activities that simulated student activities in the course. Other UNE faculty contributors include Jan Froehlich M.S., OTR/L, Valerie Jones LMSW, Kira Rodriguez, M.H.S., and Heather McNeil.

Faculty worked to parallel/align the on-campus curriculum with professionals in the field to illustrate the real-world challenges faced by interprofessional teams in clinical practice. The course consisted of two classroom sessions and an assignment for the student groups to work on during the week between the classroom sessions. Students were assigned to interprofessional groups and were guided through activities that provided them the opportunity to learn about two key interprofessional core competencies: teamwork and professional communication. The classroom sessions were evaluated by faculty student feedback. The student feedback was analyzed to determine changes in their comfort level with IPE upon completion of the entire series of activities. The results of this analysis were also presented at the conference.

FMI: Contact Kris Hall of UNE’s IPEC at ipec@une.edu or at (207) 221-4491

UNE Students Share Experiences on their Second Day of the Fall Long Weekend Western Maine Rural Health Immersion

October 11th, 2017 by healthinnovation
Minh Tam Hua, second year pharmacy student, and Rodger Carter, first year osteopathic medicine student provide a blood pressure screening to a volunteer at the Fryeburg Fair on Saturday, October 7th.

Minh Tam Hua, second year pharmacy student, and Rodger Carter, first year osteopathic medicine student provide a blood pressure screening to a volunteer at the Fryeburg Fair on Saturday, October 7th.

Ten UNE health professions students recently participated in a long weekend rural health immersion to Oxford County in western Maine and to Carroll County in northern New Hampshire.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fourth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to Oxford County.  Last May a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; last March medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Of the four immersions that have been held so far, this was the most diverse group of students, five different health professions were represented from UNE from the College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physician Assistant and Bachelor of Science in Nursing (BSN) programs.  Throughout the trip the students were split into interprofessional teams so that they could learn about the roles of the other professions and how to communicate effectively across disciplines in order to provide team-based care and improve patient outcomes, a primary learning outcome of the four year Josiah Macy Jr. Foundation grant that helps fund the immersion experiences.   The students experienced a variety of clinical, community, and population health activities in underserved areas in western Maine and northern New Hampshire.  Below are reflections from one team after the second day on Saturday, October 7th, 2017.

Brittany Malia, second year dental medicine student

The rural health immersion trip has been an amazing experience! Today was our second day and in the morning we volunteered at the Fryeburg Fair to help staff the First Aid centers. At the fair, we handed out care kits and provided blood pressure screenings. I enjoyed interacting with members of the community at the fair and talking to them about the communities that they live in.

After the fair, we toured a local community Pharmacy at a Hannafords supermarket. The pharmacist showed the entire group how a prescription is filled from start to finish, which I thought was enlightening since I will be prescribing once I become a dentist. This was just one of the many places that we have been able to see throughout the weekend; yesterday we also toured two critical access hospitals, two community health centers, and an oral health clinic. The rural health immersion trip has been a wonderful opportunity to learn about the roles of other health professions, and how we can successfully work together as a team in order to provide the highest quality care to our patients.

Later in the evening we returned back to our house on the water to play board games and have s’mores in front of an open fire. During this trip, I have met many wonderful students from other health professions that I otherwise wouldn’t have had the opportunity to meet. I highly recommend this trip to anyone considering attending!

 

 

UNE students pose for a photo in front of one of the first aid stations at the Fryeburg Fair, where the students helped hand out free Care Kits and provided health screenings to anyone interested.

UNE students pose for a photo in front of one of the first aid stations at the Fryeburg Fair, where the students helped hand out free Care Kits and provided health screenings to anyone interested.

Minh Tam Hua, second year pharmacy student

Today during the Fall Long Weekend Rural Health Immersion, I got the opportunity to volunteer taking blood pressure and passing out Care Kits to the people at the Fryeburg Fair, which is known to be the largest agricultural fair in Maine. We were divided into groups, where each groups consisted of a medical student, a nursing student, a dental student, and a pharmacy student. This was my first time working with other students from other health professionals so I got the chance to learn more about their profession and what their roles were.

This event gave me the opportunity to meet and talk with people from the rural communities in Maine. My group and I took blood pressure of total 12 people and only one person turned out to have a “normal” blood pressure reading. The other 11 people’s blood pressures ranked in the hypertensive range. From class I know that the normal blood pressure reading in a healthy individual is around 120/80 and anything higher than that will be a risk factor for developing certain diseases. I was shocked that it was that many people who were at risk of getting Hypertension. As future health care providers, my group and I would recommend that the people whose blood pressures were in the hypertensive range be referred to the paramedics on staff. To our surprise, most of them weren’t concerned that their blood pressures were high. I feel that most of the people that we met during this fair didn’t want to hear about many of the health risk factors, such as unhealthy diet, lack of exercise, smoking and high blood pressure readings and how they can all lead to serious health issues in the future.

Based on this personal experience, I feel that we as health professionals should create more events in Rural communities where we provide free screenings and educate the community about the danger of the chronic diseases, such as Hypertension, Diabetes, Hyperlipidemia, Stroke, and Heart diseases. I think that, as students, we can make an impact on the health of these people. From a health professional point of view, and from what we’ve learned during this immersion so far, I believe that it’s important and better to prevent a disease early on than treating it later on. I feel that if we all stand together and contribute our part, we will be able to help reduce the number of chronic diseases that are taking place not only in these rural areas but also throughout the US.

Students conducted a Worksite Health ScoreCard at the fair to assess it's performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Students conducted a Worksite Health ScoreCard assessment at the fair to assess it’s performance in several categories like Animal areas, Nutrition, Tobacco, and more.

 

Kimberlee Sell, second year dental student

On the second day of the immersion we attended the Fryeburg Fair which can attract between 30,000-40,000 people in a single day. We split into three teams, two teams worked at the first aid stations and one team would check the “Health Score” of the fair using an altered health assessment tool created by the CDC. While at the first aid stations we offered free blood pressure screenings and we gave out Care Kits consisting of things like toothpaste, soap, and band-aids. While the care kits seemed insignificant to me, it felt good to see how excited people were to get some basic health supplies for free, especially the toothpaste.

My first two shifts at the fair were spent giving blood pressure screenings. There was a good number of people who were very excited to see what their blood pressure was. I did notice a lot of people had a blood pressure that read into the hypertensive range. We would talk to them about visiting their primary care provider and hand them off to the NP or paramedic on staff with us. The people I talked to didn’t seem eager to visit their provider when we talked with them about it, perhaps because they had to travel long distances or couldn’t afford the co-pays at their doctors office.

The third station was checking the health of the Fair regarding Tobacco and Nutrition policies. The only ‘no smoking’ signs were located by the first aid stations. We noticed many people smoking in the middle of crowds of people. We thought the fair could improve it’s tobacco policy in order to make it a more healthy environment for guests; one recommendation would be to have designated smoking areas away from crowds of people. We also noticed that the healthy food choices were few and far between. We did see a steak salad and a smoothie bar. Overall, it was a fried paradise- anything you could think of was fried, oreos, ice-cream, dough, and more. Because of this we also thought the fair could improve its nutrition score by providing more healthy food options.

 

DSC_1071 smaller photo fire

Later in the evening the students returned to the house to enjoy s’mores over an open fire and reflect on the days activities.

UNE’s Fall Long Weekend Rural Health Immersion Kicks off

October 10th, 2017 by healthinnovation
DSC_1077 smaller file group pic

Ten UNE healthcare students recently participated in a long weekend rural health immersion to western Maine and northern New Hampshire. (From L – R Row 1 Taylor Ouellette OMS I, Brittany Malia CDM II, Kimberlee Sell CDM II, Minh Tam Hua CoP II, Kelly Banks CoP II, Katie Clark BSN IV, Nicole Caron CDM II; Row 2 Ian Imbert MPH, Rodger Carter OMS I, Lesley Lafland BSN IV, Rachel Moore PA I)

Ten UNE health professions students recently participated in a long weekend rural health immersion to Oxford County in western Maine and to Carroll County in northern New Hampshire.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fourth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to Oxford County.  Last May a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; last March medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Of the four immersions that have been held so far, this was the most diverse group of students, five different health professions were represented from UNE from the College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physician Assistant and Bachelor of Science in Nursing (BSN) programs.  Throughout the trip the students were split into interprofessional teams so that they could learn about the roles of the other professions and how to communicate effectively across disciplines in order to provide team-based care and improve patient outcomes, a primary learning outcome of the four year Josiah Macy Jr. Foundation grant that helps fund the immersion experiences.   The students experienced a variety of clinical, community, and population health activities in underserved areas in western Maine and northern New Hampshire.  Below are reflections from one team after the first day on Friday, October 6th, 2017.

 

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD, to discuss providing care to underserved populations.

Rachel Moore, first year physician assistant student

Reflecting on the first day of the Rural Health immersion, it is hard to fully sum up everything I experienced and learned. From the very first stop at Saccopee Valley Health Center (SVHC), I was in awe of all the things I took for granted as a practitioner. We quickly learned that many patients in this community are severely limited by transportation, which limits their ability to go to Portland for referrals or any further care that SVHC was not able to offer. Not only that, but even basic oral hygiene did not really exist; and their dentist discussed how for a while 75% of his appointments were full mouth extractions because his patients teeth were beyond the point of repair. From one clinic to the next we witnessed the struggles everyone faced with opioid addictions and patients who are at or below the poverty line and unable to pay for their care. At Bridgton Hospital, we were informed that nearly half of the babies are born addicted to tobacco, alcohol, or other drugs. It would be understandable if someone were to look at the challenges their health practitioners are facing and feel they are insurmountable.

And yet, despite the seemingly insurmountable challenges, at each clinic we saw health care practitioners full of passion, creativity, and love for their community. Each of the people we met with were full of excitement to serve the rural populations and were willing to do whatever it took to do right by them. Throughout the day we say endless examples of this, including a dentist fresh out of school who built the entire dental program at SVHC from scratch and started outreach to the community to teach proper teeth dentition to children in schools; an NP who had achieved countless additional certifications, including one in Psych to help serve the specific needs of her community; the Bridgeton Hospital’s free shuttle for their patients so they can get the care they need; the cross competency trainings of nurses in all the departments so that they can change departments at a moment’s notice to serve where they are most needed.

There is a vast network of community in these health systems and everyone seems to know everyone and offer their support to help serve their patients. It’s true that the rural communities that we’ve visited so far have been underserved but nevertheless it is so clear that the providers that we’ve met give every ounce of their energy to improving the health of their communities.

 

 

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

 

Taylor Ouellette, first year osteopathic medicine student

What resonated with me most about today’s site visits was the passion of the providers that spoke to us about their practices. Providers of various backgrounds showed us around each site, and the different backgrounds of these providers added to our visits and served to show us the unique personality of each place. When these individuals showed us around the facility and interacted with other providers and staff at the site, we could tell by looking at their facial expression and listening to their presentation how excited and proud of their office, hospital or clinic they were even though these sites are not the may not have the most state of the art equipment to practice medicine and see patients. In fact, one provider at a small community health center communicated to us that although the practice was lacking in funding and resources, there was another similar sized health center in the state that was worse off than the site she worked at, as if to say “it could be worse”.

Hearing this providers optimism about her practice showed the positive and steadfast attitude these rural healthcare providers have about the work that they do every day. These providers that we are meeting with know how significant of an impact they are making on the local community and how vital they are to the wellbeing of the community as a whole. Yet, they were humble about this fact as they were talking to us. Listening to the providers tell stories about patients in the community they care for was very inspirational and uplifting despite the challenging circumstances of many of the people these providers treat. Their passion was contagious.

I was also very impressed by the fact that these providers develop the skills to think on their feet and get creative with the limited resources they have to treat patients who face many barriers to accessing quality healthcare. Furthermore, these providers are remarkable in the sense that their scope of practice is forced to become so broad as they have to become competent in a variety of topics due to the range of issues they deal with on a daily basis in a rural setting. I’m looking forward to what tomorrow has in store for us!

 

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

 

Kelly Banks, second year pharmacy student

The first stop of the day was at Sacopee Valley Health Center with Dr. Jeff Ray. Before arriving the perception of a rural area was the potential for lack of resources. What was fascinating about Dr. Ray and his facility was how much more ahead of the medical game than most facilities are in a non-rural area. When asked about E-prescribing and electronic records he indicated his facility has been working with that type of system long before it was mandatory. When asked about the opioid crisis he indicated they offer plenty of access for patients to speak with someone at the facility, hold meetings, and try their best to regulate the date at which the prescriptions can be filled. An issue he did bring up with the opioid crisis is that the pharmacy will sometimes fill prescriptions earlier than indicated which he was hopeful will eventually change.

The second stop was at Memorial Hospital in which the pharmacy students got the option to speak with the pharmacist. He had worked in community pharmacy for a number of years before working in the hospital setting. What I took away from the visit with him was the sense of community he has by working in a smaller hospital pharmacy. Two pharmacists will run the whole hospital while a larger hospital has one pharmacist per level. He explained that everyone seems like family, all of their families grow up together, and it gave him a better “quality of life”.

The third stop was White Mountain Community Center. What seemed to amaze everyone about this facility was that there was a food pantry in the middle of the practice that was run by volunteers in the community. They have a physician on site only a couple times a week so the NPs on staff run the show. Another important point to this stop was that the NPs would get extra certifications in order to serve the community needs better. This facility also had a teen clinic run by volunteers in the area where kids could get birth control, condoms, and someone to talk to if needed. There are not many teen clinics around so they are crucial to helping the area.

The last stop was Bridgton Hospital which was the most enthusiastic work setting of all. The atmosphere in the hospital was that the patient comes first while making use of their small facility. It was interesting how, in the case of a sudden patient surge, the different departments of the hospital can expand to become a part of other departments by just opening up a few doors. This helps with work flow depending on staffing and time of day.

The Rural Health Immersion allowed for us to get an idea of what health professionals deal with on a daily basis. Whether the facilities were teaching how to brush teeth through community outreach at the schools or helping the nearly 50% of babies born on drug dependence, the facilities adapt to serving their community as it needs it most. The first day showed me how much of a difference each health care professional can make on the rural community one day and one patient at a time, especially when they work well together as a team. This Rural Health Immersion has really opened my eyes to how difficult but rewarding working in a rural health community can be with the right attitude.

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

Later in the day the students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DDS.

Lesley Lafland, fourth year nursing student

I enjoyed the Rural Health Immersion to Oxford County, it was truly an eye opener as it provide a glimpse into rural health. My two favorite stops today were Saccopee Valley Health Center and Bridgton Hospital. I grew up in what I thought was a rural setting in Aroostook County but, looking back, I always had readily accessible health care.   After todays experiences, I realized that I actually had it a lot better than most people in rural settings. I had a hospital in my hometown and transportation to get to my appointments whereas the patients in the greater Porter community have to travel over an hour to get to the hospital or to specialists. I’m considering becoming an infusion nurse and noticed that they don’t have anyone doing infusions there, largely due to the fact that there is no way to monitor the patients and make sure they are communicating with their oncologist and following their treatment plan.

Bridgton Hospital was great to visit and learn that even though it’s in a rural area and is a critical access hospital they have an infusion room so that cancer patients don’t have to travel over an hour to Central Maine Medical Center to receive their treatments. Despite being a small hospital it’s great to see that that patients can get the care they need without having to travel a long distance, which is sometimes the difference between whether a patient completes their treatment plan or not.

 

UNE to Offer Opioid Use Disorder and Medication Assisted Treatment Workshop

September 26th, 2017 by healthinnovation

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In July 2017, UNE received $80,000 in supplemental funding from its HRSA Primary Care Training and Enhancement (PCTE) grant to further increase education around Medication Assisted Treatment (MAT) in primary care to address the opioid crisis. In 2016, 313 Mainers died of an opioid-related overdose, which represents 83% of all drug-related deaths in the State. Currently the demand for MAT in the state still outpaces the supply, especially among those who lack health insurance or live in health professional shortage areas.

To address the critical need for training, UNE’s Center for Excellence in Health Innovation will be hosting an Opioid Use Disorder and Medication Assisted Treatment Workshop on Saturday, October 28, 2017. The workshop will host experts discussing the current climate in Maine concerning the opioid epidemic and its impact on the state. Attendees will gain knowledge in areas including OUD diagnosis, prevention and treatment, and emphasizing MAT. Day of presenters will include:

  • Dora Anne Mills, MD, MPH– University of New England
  • Toho Soma, MPH- University of New England
  • Peter Michaud, JD, RN– Maine Medical Association
  • Matthew Braun- Young People in Recovery
  • Clay Graybeal, PhD, MSW – University of New England
  • Bethany Fortier, MPH – University of New England
  • Brianna Nalley, MPH– University of New England
  • Lisa Letourneau, MD, MPH– Keynote Speaker
  • Alane O’Connor, DNP– MaineGeneral Medical Center
  • Mary Beth Leone – Thomas, LCSW– Penobscot Community Health Care
  • Noah Nesin, MD– Penobscot Community Health Care

The workshop is free and open to all UNE health professions students, UNE faculty, and interested community members. Student attendees to this workshop can apply their attendance toward SBIRT Student Leader Certificate, IP Honors Distinction, or Care for the Underserved Pathway (CUP) scholar distinction. Contact hours will also be available for practicing clinicians.

For more information and to register please visit:  http://www.une.edu/calendar/2017/opioid-use-disorder-and-medication-assisted-treatment-workshop