Celebrating National Rural Health Day: In smaller towns, ‘you make a bigger impact on that community’

At Essentia Health, we fully understand the challenges that accompany rural health care. We navigate them every day. Rather than deter us, they deepen our commitment to providing expert, compassionate and comprehensive care in the communities we’re privileged to serve.

Thursday, Nov. 17, is National Rural Health Day, and Essentia is intensely grateful to all of our clinicians and care teams who work tirelessly to deliver this care across our service area, about 84% of which can be classified as rural. The majority of our clinics (66%) are located in small towns. This allows us to provide care close to home for many of our patients and boldly confront health disparities that traditionally have plagued rural Americans.

“In a small town, I think people kind of forget that we’ve all trained in the big cities and big universities and teaching hospitals, and what’s fantastic is these folks get that training, get that exposure, and then come out to rural Minnesota and be able to provide that care for our patients,” said Essentia’s Dr. Shiela Klemmetsen, who practices family medicine in Baxter. “They had that awesome training, but they live here, they work here, they’re involved in this community and really truly invested in it.”

People in rural areas are more likely to have a chronic disease than their city-dwelling counterparts, are more prone to cancer and strokes and are at greater risk for vehicle crashes and opioid overdoses. In general, they “tend to be older and sicker” than residents of urban areas, according to the Centers for Disease Control and Prevention.

There are myriad reasons these disparities exist. The U.S. Food and Drug Administration lists the following:

• Less access to care because of fewer providers, medical facilities and transportation options.
• Exposures to specific environmental hazards, such as pollution and poor air and water quality.
• Higher rates of cigarette smoking, high blood pressure and obesity.
• Less leisure-time physical activity.
• Lower seatbelt use.
• Food deserts, areas with fewer grocery options and lower availability of healthy foods.
• Higher rates of poverty and less likelihood of having health insurance.

When it comes to health care, minutes matter. Being forced to travel long distances to receive that care isn’t conducive to successful outcomes.

“For me, one of the main reasons that I like smaller towns is that you make a bigger impact on that community,” said Dr. Susan Bauer, a family medicine specialist for Essentia in Park Rapids. “There’s much more need; in a rural town it’s harder to get providers there, so the impact felt by every provider that is or isn’t there is much more profound.”

Essentia Institute of Rural Health fosters innovation

Driving our pursuit of health equity is the Essentia Institute of Rural Health (EIRH). Established in 2010 — but dating to 1978 — the EIRH has become a leader in rural health care innovation by combining educational experiences and research activities. The focus of EIRH research is to improve our patients’ health by engaging in studies of rural health care delivery, government and industry-based clinical trials and disease-related issues.

Through the transformational EIRH, Essentia participates in numerous nationwide and groundbreaking studies, such as the All of Us Research Program and the Preventable study. All of Us aims to compile health data from at least one million Americans in an effort to accelerate improved health; by engaging in this work, Essentia ensures the massive study has rural representation. Preventable, one of the largest research efforts among older adults, hopes to determine whether a statin could help prevent dementia, disability or heart disease in seniors.

All told, Essentia is involved in 196 currently operating clinical trials. Many of these are oncology-related, helping our patients receive the best cancer care. The Essentia Health Community Cancer Research Program (EHCCRP) was selected as a lead site within the Minnesota Discovery Research and InnoVation (MnDRIVE) partnership with the State of Minnesota. Community education and outreach is a significant component of the EHCCRP, which has increasingly added telehealth options to better serve rural clinics and patients.

Through the EIRH, Essentia is at the forefront of substance use disorder research. Not only is this reflected in our treatment of addiction; it’s also evident by the numerous community collaborations of which we’re a part. Beginning last spring, several rural Essentia clinics expanded access to medication for opioid use disorder. This stemmed from a Minnesota Department of Human Services State Opioid Response Grant worth more than $523,000. These funds have equipped our providers with additional resources to treat patients struggling with substance use. In turn, they are able to improve outreach, more effectively assess social determinants of health and increase referrals to treatment and recovery programs.

Delivering outstanding rural health care requires a willingness to brainstorm and implement innovative solutions. Our partnership with North Dakota State University on a residency program for nurse practitioners in rural clinics fits that description. Nurse practitioner graduates benefit from hands-on clinical experience and training as well as enhanced educational content, all of which is specific to rural settings. Patients in these smaller communities benefit via continued access to terrific care.

Telehealth emerges as key tool

When the COVID-19 pandemic hit in March 2020, Essentia hadn’t performed a single virtual visit. Within weeks, we were doing thousands a day, ultimately surpassing 400,000 of them in the first year — plus 100,000 e-visits, which are slightly different in that they specifically target 20 common conditions. Telehealth has become an important care-delivery tool, especially for patients who live in remote areas, where traveling to and from a clinic is inconvenient, potentially dangerous depending on weather and not always feasible. Telehealth also eliminates a major hurdle for mental health patients, where the most daunting task can be simply getting out of the house.

“One of the very few silver linings of COVID is our ability to now provide a lot of telehealth care for patients who live in a rural area. That’s just been really awesome to be a part of,” said Dr. Michele Thieman, a family medicine specialist for Essentia in Park Rapids. “Not only can I provide virtual care for my patients when they’re at home, but I can also bring them into my clinic and say, ‘You’re gonna sit in this room with a nurse and have a great visit with a nephrologist and he’s gonna be able to see all of your lab results and talk to you about what the next steps are.’

“And they are always really grateful when we’re able to provide that high-quality level of care without them necessarily having to drive, especially in the wintertime.”

The challenges of rural health care — workforce shortages, lower patient volumes, heavy reliance on government payers, etc. — make the successful delivery of it even more rewarding. Hospitals and clinics in small towns take on many roles besides merely providing care. They are part of the fabric of their communities, often the largest employers and give those communities some of their autonomy.

Everyone deserves access to health care, regardless of where they live. That belief underlies our recent investments in places like Deerwood, Moose Lake and Cloquet, Minnesota, as well as Lisbon, North Dakota. Essentia has built, or is building, brand new clinics in those rural communities. We also are collaborating with multiple partners — the City of Devils Lake, Spirit Lake Nation and Altru Health System — to build a state-of-the-art medical campus in Devils Lake, N.D. This unique public-private partnership will fill a community need and make outstanding care more accessible in the Lake Region.

“I just feel like if we really want to make a difference in our communities, we have to start at the grassroots, which is where the grass is — in that rural setting,” said Cheryll Simmons, an advanced practice registered nurse and doctor of nursing practice who specializes in family medicine at the Essentia Health-Wahpeton Clinic.