Addressing Pulmonary Health Disparities In Central Appalachia

PULMONARY HEALTH DISPARITIES IN CENTRAL APPALACHIA

Dr Drew Harris (left) at the Wise remote clinic with former UVA pulmonary fellow Dr Sean Callahan and retired pulmonologist and health wagon volunteer Dr Joe Smiddy

In part as a result of the decline in extractive industries such as coal mining, Appalachian counties in Virginia face ongoing socioeconomic challenges with high rates of poverty and unemployment and low educational attainment levels. Given the robust evidence that the social determinants of health contribute to life expectancy and overall health and well being across populations and disease states, it is therefore not surprising that Virginians living in Appalachia face a range of pulmonary health disparities. The region faces disparities in smoking rates, COPD and lung cancer. Unique to the region is disparate outcomes in black lung disease (caused by lung injury from inhaling toxic dusts in coal mines). Black lung disease in the US has increased since the turn of the century and is especially prevalent in Southwest Virginia, where recent surveillance of 3 black lung clinics uncovered the largest cluster of progressive massive fibrosis (PMF) ever reported. A major factor driving pulmonary health disparities in Appalachia is inadequate access to care to because of geographic isolation.

Since his arrival to Virginia in 2017, UVA pulmonologist Drew Harris has been committed to addressing pulmonary health disparities in central Appalachia. Initially starting as a volunteer at the remote area medical (RAM) clinics in Wise VA– the largest free pop-up medical clinic in the country – Drew has been increasingly engaged in Appalachian health. Through monthly trips to Lee County VA, Drew is establishing community partnerships and programs to improve health care delivery to the region. Drew is currently the medical director of the only federally funded black lung clinic in Virginia at Stone Mountain Health Services. Drew is working with Brian Dunn and David Cattell-Gordon at the Karen S. Rheuban UVA Center for Telemedicine, Jim Werth, Margie Tomann and Jody Willis at Stone Mountain Health Services, and UVA transplant pulmonologist Sarah Kilbourne to improve access to pulmonary subspecialty care through 4 new programs:

1) A pulmonary telemedicine clinic: This clinic will work towards improving access to subspecialty care for those with complex lung disease including black lung in central Appalachia. Internal Medicine residents will have an opportunity to learn about rural healthcare disparities and the challenges of rural healthcare delivery through this clinic as part of a new “Community Partnered Medicine” rotation for all rising PGY3’s.

2) A bridge to lung transplant program: This program aims to identify patients with advanced black lung disease at Stone Mountain, and utilize technology to facilitate their pre-and post-transplantation evaluations by the pulmonary transplant team at the University of Virginia.

3) A pulmonary rehabilitation program for patients with black lung disease: Pulmonary rehabilitation is known to improve quality of life and reduce pulmonary symptoms for a range of lung diseases, yet is woefully under-prescribed and under-utilized in rural areas. Through a new program at a Stone Mountain black lung clinic in St. Charles Virginia, access to pulmonary rehabilitation for those with black lung disease in central Appalachia will be improved. Future plans include utilizing a technology to implement a home-based program using remote patient monitoring.

4) A Project ECHO targeting lung disease in central Appalachia. Through web-based, real time connections between UVA pulmonologists and community providers in central Appalachia, 10 project ECHO sessions will begin with a tele-health lecture delivered by a content expert on a range of relevant pulmonary topics (e.g. black lung disease, smoking cessation, interpreting pulmonary function testing, pulmonary rehabilitation). Each lecture will be followed by a case-based group discussion on a related topic that allows community providers to share information and real world experiences about their patients and community.

 

Filed Under: News and Notes, Pay It Forward: Community Service, Top News

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