By SARA ARTHURS
ADA — In a rural area where there aren’t many doctors and many people don’t have cars, a group from Ohio Northern University is bringing health care to where the people are.
The team has been operating a mobile clinic throughout Hardin County for three years, and recently got a $100,000 grant to expand its mental health and substance abuse care efforts.
The university is in Ada, in northwest Hardin County. Most of the health care in the “very rural county” is located in Kenton, and residents of the other communities within the county may not have as much access to care, said Steven Martin, dean of the ONU College of Pharmacy. And, he said, some of the county’s doctors aren’t taking new patients.
So the pharmacy college started the ONU HealthWise mobile clinic.
‘A solid foundation’
At first, clinic director and assistant professor of pharmacy practice Amy Fanous would pack up equipment and students in her car and drive to, say, a church or a food pantry — “wherever people would have us.” Funding was eventually secured for a bus, which includes two “patient rooms” — areas where a door can be closed to create private spaces.
Behind those doors, ONU pharmacy residents Morgan Borders and Ashley Zupancic meet with patients. They ask basic questions about chronic conditions the patients already know they have, and check their blood pressure, blood sugar and cholesterol. They can also screen for osteoporosis and skin cancer. They can also measure A1c, which is an average of blood sugar levels over three months.
Martin said up to 35 percent of the people they see are referred to a doctor for further care.
Pharmacists are among the most trusted health care professions, said Michelle Musser, an assistant professor of pharmacy who coordinates students’ outreach efforts. “We’re approachable,” and everyone sees a pharmacist right at their grocery store, she said.
Martin said people tell pharmacists things they might not tell their doctors. And there aren’t many situations that allow someone to get free advice from someone who has a doctorate.
Borders said pharmacists can also track trends, such as whether a person’s blood pressure or blood glucose is going up or down over time. And they can recommend lifestyle modifications that might make a difference, sometimes even considering the patient’s family history.
The team has pieced together a network of people they can refer patients to. Many are in Kenton, but they’ve also referred patients to Blanchard Valley Health System in Findlay or St. Rita’s in Lima.
Now they are trying to strengthen those relationships in behavioral health. Cardinal Health provided the grant to expand into substance abuse and behavioral health, with a goal to “build a larger coalition here in our county,” Martin said.
Those relationships will grow with the new push to expand because Adellyn McPheron, the new coordinator of the mobile unit, has been getting involved with many other community organizations. The grant included funding for her position through Americorps.
Over the first two years, Fanous relied on a variety of community partners including the Kenton-Hardin Health Department, Hardin Memorial Hospital, community centers, food pantries and churches. It took time to build trust and relationships, “but it really laid a solid foundation” for the mobile clinic, she said. Now, Fanous can see the difference they have made.
The clinic sees many of the same patients regularly, and they get to see how their patients’ health has improved. Fanous has heard from people who said they would not have gone to the doctor without the influence of the mobile clinic. And many of the conditions the clinic’s team screens for — like diabetes, high blood pressure and high cholesterol — may not have symptoms, so it’s important to get the screenings done, she said.
Other patients have simply brought in their medications and asked the mobile clinic staff to walk them through what they are used for, or for help establishing a schedule to take the medications.
“I just want to help people,” Fanous said, adding she knows there’s a need in the community, especially with regard to mental health and substance abuse. She hopes to be able to look back and know that she’s helped address this need.
Substance abuse and mental health are a particular concern in Hardin County. And it isn’t just opioids.
Since the passage of the Affordable Care Act, less than 10 percent of the county’s population is uninsured, Martin said. But it still can cost to see a doctor or get medications.
“Typically people only access care when something breaks,” and in the case of behavioral health, the person themselves may not recognize that it’s broken before friends and family do, Martin said.
He said people concerned about a loved one who is using drugs can come to the mobile clinic as a resource.
And he recognizes there are other things that need to be done to address the problem. For example, there are not enough beds available for substance abuse treatment.
Ross Kauffman, assistant professor and director of public health at ONU, chairs the campus’ opioid task force. While many other community organizations are working to address the issue, leaders feel the topic “should be at the center of our conversation” on campus.
“Many of the assumptions and much of the work that’s been done on addiction traditionally has been focused more on urban addiction and what that looks like,” Kauffman said.
In rural areas, care is less centralized and transportation is an issue. (Hardin County has no public transportation.) Others may not have “the money to put gas in the car,” said Kim Reisinger, who works with community outreach at OhioHealth Hardin Memorial Hospital in Kenton.
And “the interconnectedness of rural communities” makes residents more “aware of our neighbors’ business.” So one might feel less privacy attending, say, a Narcotics Anonymous meeting.
Donna Dickman is executive director of Partnership for Violence Free Families, a behavioral health agency serving Allen, Auglaize and Hardin counties. She said there are other organizations, too, that provide mental health care. But the HealthWise clinic will expand some of that care.
“That’s so important,” she said.
As well as teaching at ONU, Musser is a practicing pharmacist at a Kenton clinic and works at the hospital in the summers. Her clinic works with many diabetic patients, and they talk about the challenges to diet and exercise.
“Some of the small towns, there’s not a grocery store” and no sidewalks or other paths to walk or bike, she said.
Musser doesn’t go out much with the mobile clinic, but she interacts with students who do. They’ve told her that if they tell patients they have high blood sugar, for example, and should see a doctor, some say, “I don’t have a doctor.” So the pharmacy students ask if they, at least, can follow up. Often these students are the first health care providers the patient has seen in a long time, and no appointment is needed for the consultation.
Reisinger said the ONU clinic plays a huge role in the community. The clinic refers patients to the hospital, and they have also collaborated in other ways, such as a dietitian teaching classes related to diabetes on the bus, and other staff offering a smoking cessation class.
Borders said the work on the bus doesn’t feel like work.
“People are grateful,” she said.
Seniors are particularly easy to talk to, and that generation takes the time to talk and shake hands, Borders said.
“This is, like, my dream job this year,” said Zupancic, who hopes to go on to work in a free clinic.
A schedule is posted on the clinic’s Facebook page, ONUHealthWise.