Examining equity in rural, urban healthcare

When it comes to healthcare, a state-of-the-art facility in the center of an urban area doesn’t necessarily mean that there is access to quality healthcare. Conversely, living in a rural area doesn’t mean that the healthcare available is inadequate. Working on dispelling those preconceptions about rural vs. urban healthcare is the goal behind the Health Equity Leadership Program, a program between the University of Wyoming (UW) School of Pharmacy and the Howard University School of Pharmacy.

“It’s a partnership between the University of Wyoming School of Pharmacy and the Howard University School of Pharmacy,” said Tonja Woods, associate dean for the UW School of Pharmacy. “We wanted to partner with Howard because we wanted to do a rural and urban exchange around the topics of health equity, primarily and then also as a means to help develop leadership in our doctoral students who are becoming pharmacists.”

Four students from bothPharmD schools are selected following an application process. Before embarking on their tour to see rural vs. urban healthcare, the students work together through Zoom, a video-conferencing program. 

The inaugural run of the program had PharmD students from both schools visiting Saratoga to tour the Saratoga Care Center, Platte Valley Clinic and Platte Valley Pharmacy. 

“Last year was our inaugural series of the program and was a great success. Our students came back with a lot of positive feedback around, really, kind of learning about what were perceived barriers and then realistic barriers,” Woods said. “I think a lot of the students made assumptions that perhaps you can’t, or don’t, receive as much access to care in a rural environment and realize that maybe that’s not as much the truth as they initially thought and that perhaps you would naturally receive better or more care in an urban environment and realize maybe that’s not always the case because it’s dependent on other things.”

While the group last year arrived on a Friday and were able to see all three places in action, the group this year arrived on January 5, a Sunday. Though they were unable to see the pharmacy, they were given a tour of the clinic and got some hands on experience at the care center. Administrator Mark Pesognelli gave a tour of the clinic to half the group while the other half worked with Dr. Emma Bjore, a geriatrician and medical director of the Saratoga Care Center.

The tour of rural healthcare in Saratoga is only the first part of the program. Along with touring Saratoga, the students will also tour facilities in Wheatland and Guernsey to get a broader view of rural health. In March, the second part of the program begins as students from UW School of Pharmacy will travel to Washington, D.C. and experience healthcare in an urban setting.

“I think, right away, it’s just been amazing how much we have in common,” said Taylor Wilde, a UW student from Gillette, Wyoming. “I was a little nervous right away like, ‘I don’t really know. They come from all over the place. I’m this small-town girl from Wyoming, I haven’t had a lot of interaction with that.’ It was like an instant click. It really is surprising how many similarities there is rather than our differences. I think that’s been really amazing to see.”

“I think one of the biggest reasons I’ve wanted to come on this trip is because I felt like I really needed to re-evaluate my own perception of health equity or health inequity. It looks a lot different in D.C.,” said Rukiya Umoja, a student at Howard. “I’ve worked with, or I’ve primarily been around, a lot of African-Americans and our issues are being overlooked and access to healthcare, not having quality access to healthcare. For me, here, it’s pretty similar. When someone mentioned that the nearest hospital was 45 miles away. That was mind blowing to me because we’ll have 10 hospitals within a two-mile radius.” 

Just because there are 10 hospitals nearby doesn’t necessarily mean that those facilities can, or will, provide the healthcare needed for the community. Umoja provided an example using a recent rotation at a hospital in Washington, D.C.

“I recently rotated at a hospital which is in not-the-best part of D.C. and just the way that the patients were treated—not all the time, but sometimes—as if they weren’t even human, not having all of the meds that you need. In such a large institution in D.C., there’s no reason why you shouldn’t have everything that you need right there,” Umoja said. “The patient population at this particular hospital is, I would say, about 95 percent African-American. That’s pretty tough to grapple with.”

While this group is just getting started on their visits of rural areas, Woods said that group from last year had remarked on how the rurality of an area can have an affect on the healthcare given.

“Really what everybody was blown away by was how we all come together and the level of care that’s provided because of that rurality. How do we run a code here in this clinic? How does the nurse practice at a much higher level of that license because she’s in this clinic and has to do x, y and z? Where as in the urban setting a nurse would never do that because there’s a specialist and a subspecialist,” said Woods. “We just don’t have all of those folks here, so you better be ready to pony up and do all of this level of care at the top of your license and maybe beyond. So, that was really a scope of practice and care that they thought was really phenomenal.”

Claudia Adonah, a student from Howard University, added that a perception she came into the program with was that the opioid epidemic didn’t have as much of an effect in rural areas as it did in urban areas. That perception, however, was dispelled as she began to hear about cases of polypharmacy in which multiple drugs are used at the same time to treat a single condition.

“That was surprising to hear because that completely shut down that perception that I had of a rural healthcare facility,” said Adonah.

Samantha Coppola, a UW student, said that even before touring an urban area, talking with students from Howard University has challenged her perceptions of urban healthcare.

“I was originally thinking that it’s an urban area and it’s really big and they have a lot of hospital and physicians and they have the best of everything and I’ve started to realize that it’s maybe not as perfect or as great as I was thinking as a big city would be able to offer to the people there and maybe some communities are lacking in the type of care that they should be receiving as opposed to other areas,” said Coppola.

“Something that came up last year from students that visited is, coming in, they felt that, maybe being a rural area, the pharmacy might be less specialized. Little did they know that here, since you only have one pharmacist, they’ll have to do everything. So, they’re way more specialized,” said Estela Lajthia, a clinical assistant professor from Howard University. “They have to know everything, whereas, in D.C., you have a pharmacist for critical care, you’ll have a pharmacist for chronic disease management. So, if I get somebody that has critical care needs, I won’t even have to do anything, I’ll just send them to the specialist for that whereas, here, there’s one person that does everything. So, they are technically way more specialized.”

By noon, PharmD students had been given their tour of the clinic by Pesognelli and had received hands on experience with Bjore. With their tour complete, the students went to lunch before returning to Laramie.