Developing a system for diabetes management in Pamlico County, NC

Arianna will be working on developing and implementing a diabetes management pilot program for patients at Hope Clinic in Pamlico County, NC.

Pamlico County is located in a rural area of Eastern North Carolina. With a population of approximately 12,800, 30 percent of the population is elderly (ages 65 years and over) and close to 16 percent of the population lives in poverty. Rural communities across the U.S. face a variety of challenges, such as limited access to healthcare, higher rates of uninsured residents, and a higher prevalence of chronic conditions. In 2019, the Pamlico County Health Department released a Community Health Needs Assessment that gave insight into the health needs that need to prioritized in the county. Access to health services and diabetes were two of the top five significant health needs that the county health department identified as priorities for Pamlico County.

Hope Clinic is one organization working to meet the health needs of the Pamlico community. Hope Clinic is a part of the North Carolina Association of Free and Charitable Clinics and offers free healthcare to low-income and uninsured individuals in Pamlico County. A large percentage of the patients Hope Clinic serves live with chronic conditions. Due to funding constraints, the clinic has a few paid staff but relies heavily on a network of volunteers to meet the needs of the community. Open one day per week, the clinic primarily focuses on clinical appointments and has limited capacity to offer many programmatic services to their patients. In hopes of developing a chronic disease management program, Hope Clinic formed a partnership with Duke University that began through a Bass Connections project in 2020.

The purpose of the year-long project was to develop and begin piloting a chronic disease management program. Through a series of conversations with Hope Clinic in the fall, my team and I honed in on developing a pilot program for the clinic’s patients that are diabetic, as a starting point to pilot the chronic disease management program. As 30 to 50 percent of the clinic’s patients are diabetic, the pilot will test the program’s effectiveness on the patient population with the greatest need at this time. Based on effectiveness of the pilot and the clinic’s capacity in the future, the pilot may be scaled up to address the needs of people living with other chronic conditions.

The initial steps that were taken in the fall of 2020 included a thorough literature review and interviews with experts and innovators who have experience with diabetes management, and more broadly chronic care management, programs. This phase of research was crucial in proposing potential elements of the pilot to Hope Clinic at the end of the fall semester. While the pilot proposal is still in draft form, pending feedback from the clinic’s leadership and patient input, this semester we plan to begin implementation and evaluation of the pilot program.

I chose to be on this project as it overlaps with my background in public policy and public health. I have a particular interest in expanding access to healthcare for the most vulnerable populations in our country, primarily low-income individuals who are uninsured and forego access to healthcare, making their health conditions worse. While the Affordable Care Act (ACA) has made healthcare more accessible for more individuals, a key piece of the ACA was expanding Medicaid eligibility so that more low-income people would qualify for free or low-cost health coverage. Left up to states to expand the program, North Carolina is one of twelve states that have not adopted Medicaid expansion. As of 2019, North Carolina’s uninsured rate was one of the highest in the country, at 13.6 percent. The services at clinics like Hope Clinic are essential, working on the ground to fill in the gaps that a lack of policy implementation has filled in North Carolina.

This project provides the opportunity to expand health services to individuals in Pamlico County who are most in need. I am interested in how to expand these services in a cost-effective and innovative way, ensuring that the program put in place is sustainable given the limited resources and funding that Hope Clinic has. This project provides the opportunity for me to apply the course work that I have learned as well as previous work experience, through implementing a program and evaluating the program’s effectiveness. Additionally, this project is beneficial for Hope Clinic as a thorough pilot program has been drafted and proposed based on extensive research conducted by my team and me. This project provides an opportunity to improve the lives of many of the patients that Hope Clinic serves.

Arianna Farmer is a second-year Master of Public Policy candidate. She studied global health and social policy as an undergraduate at Northwestern University. Arianna is interested in implementing policy changes to increase equitable health outcomes at the state and local levels, particularly in underserved communities. She hopes to better understand health disparities in rural communities and develop innovative models to address those disparities.

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