Rural Health Care Providers Get New Program That Fits Their Community's Needs

05/02/02    Portland, Ore.

Reedsport, nestled between Coos Bay and Florence on the Oregon coast, is similar to many small rural cities in Oregon. It struggles economically. Younger people are moving out. Older people are moving in. It no longer depends on natural resources such as timber and fishing for its economic vitality, and it is looking for other ways to survive.

"Most people are having a hard time. A lot of family-wage jobs are gone," says one of the town's physicians, Robbie Law, M.D., who practices at the Dunes Family Health Clinic. An OHSU School of Medicine graduate, Law has been at the Dunes since he finished his OHSU residency in family medicine in 1991.

Health care for the approximate 4,500 residents, however, may be about to improve.

Law is particularly excited about something new that is going to help his patients and his community. The Oregon Rural Practice-Based Research Network (ORPRN) will be coming to Reedsport, as well as Baker City, Hood River, John Day, Lakeview and Lincoln City during the first year of its development. Created by practicing rural clinicians in collaboration with Oregon Health & Science University, it is a plan to better rural health care and will be partially funded by The Oregon Opportunity money, which will be on the May 14 ballot.

"We'll be directing the research. We'll say what's important to help us survive out here," says Law.

The network will expand to other Oregon rural communities during the next several years, says Lyle J. Fagnan, M.D., ORPRN director and associate professor of family medicine in the School of Medicine. And many are interested. According to a recent survey, 42 clinicians from 20 rural communities indicated they want to be a part of the network.

What this network will do is simple. It will be going into the rural communities and asking the community and health care providers what they want to see in terms of information and research on issues relating to clinical practice, health care delivery, including access to care, improvement of care, patient safety, chronic illness management and communication technology.

"I am anxious to see this network get started. There is an unending need for research to better serve our patients," says Tina Castañares, M.D., medical director at La Clínica del Cariño in Hood River. About half of the rural clinic's patients are Hispanic, and many are unemployed and without health insurance. She says she would like to see research into how to get health care to people who live too far away from medical services or can't afford them. La Clínica serves people in Hood River and Wasco counties in Oregon, and in Skamania and Klickitat counties in Washington.

"For this research to be meaningful, it needs to have a strong presence from rural physicians, a broad range of other health care professionals and the health officers in rural counties," she says.

Fagnan agrees.

"We want a bottom-to-top approach. We are taking our current medical knowledge and research at OHSU and making it more relevant to people who live outside the Interstate 5 corridor, which is where many Oregonians live. The research will come from what the rural practitioners tell us they need. This will have an impact on improving health care throughout the state," he says.

For example, in Reedsport, Law would like to know better ways to deliver health care to a community like Reedsport, which does not have a lot of financial or medical resources.

"We need to know how best to help our patients," says Law. "Let's say I have a patient with congestive heart failure. There are a lot of things I can tell him about how to take better care of himself, but I don't always have adequate time to educate him in all the things he needs to know. We need to investigate to see if group appointments with similar patients would be effective. Maybe we can reduce emergency room visits, hospital stays and reduce health care costs."

He also wants research to find ways to attract and keep younger medical professionals to rural areas. In his community many physicians are in their late 40s, and he worries about the future when they all retire.

Another of the network planners, John Saultz, M.D., professor and chairman of family medicine in the School of Medicine, says that the ORPRN will have an impact on rural communities, businesses and people's health. Saultz is also the director of the Area Health Education Centers program and the director of primary care clinical services at OHSU.

"Let's face it. It's a lot easier for some Oregonians, such as those in urban areas, to get the most current and modern treatment. We want to take this technology, this information and these innovations in health care and have it accessible to all Oregonians. It's exciting for rural patients. It brings an academic health center to their back door," he says.

The network will also bring grant money and jobs, such as research associates, into rural communities. The Oregon Opportunity money will be used as starter funds, but then the program is expected to be funded by a variety of grants, according to Karen Whitaker, vice provost and director of the Office of Rural Health, and the OHSU Center for Rural Health.

Better health care also helps communities attract businesses to their areas. For physicians, it promises to bring the research and technology necessary to treat patients more effectively.

Law sees another advantage of the network.

"The Oregon Rural Practice-Based Research Network will help those of us in rural practices pool our knowledge and our solutions. We can have a unified voice across the state," he says.

 

###