By Michele Pilon
Chief Executive Officer, Transylvania Regional Hospital
A term on the tongues of many in healthcare today is “social determinants of health (SDOH),” or a wide range of conditions that affect people’s ability to access healthcare and take the best care of themselves. These factors span everything from safe housing and neighborhoods, reliable transportation, and access to healthy food and educational opportunities, to diverse employment prospects, having health insurance, and the quality of community members’ social connections. For example, if a person doesn’t have a way to get to a doctor’s appointment or a place to buy fresh produce, their chances of enjoying good health are hampered.
Transylvania Regional Hospital (TRH) has participated in two Community Health Needs Assessments (CHNA) over the last four years, the most recent of which was in 2018. The CHNA’s purpose is to identify and study Transylvania County’s top three health concerns and devise strategies to effectively address them. TRH works on this project in partnership with WNC Healthy Impact, an alliance between hospitals and health departments to improve regional health, and the WNC Health Network, a nonprofit that works with regional hospitals to improve health and healthcare. The SDOHs are deeply embedded in the evidence- and survey-based findings of the CHNA.
The 2018 CHNA determined that the three most urgent health needs for Transylvania County are medication/substance misuse and abuse, mental health issues and healthy lifestyle, all of which are impacted by poverty. Teri Redmond, TRH’s Manager of Disease Management and Clinical Cardiology, believes community health can only be heightened as goals are set according to the CHNA findings, but that the key is organizations working together. “There’s so much power in partnership. TRH’s coordinated work with county programs to help improve SDOH so community members have every opportunity to lead healthy lives and lower their rates of illness is our main priority. These alliances are now and will continue to be key in helping our neighbors access needed care and focus on the health issues that affect them most.”
The most pervasive cause of unintentional death is overdoses, and 42 percent of respondents stated in an assessment-related survey that their lives had been negatively affected by their own or someone else’s substance abuse. TRH has addressed these issues by partnering with the C.A.R.E. Coalition, an agency that raises awareness about substance misuse and abuse, employs harm reduction techniques, like distributing naloxone in the community, and providing education about what factors increase a person’s risk to abuse substances. The TRH emergency department has also initiated a lockbox program whereby patients who have prescription medications can safely store and access them. In addition, the TRH emergency department also provides Deterra bags, which deactivate unused medications.
Additionally, tobacco use is higher in our county than the region, state and country. Smokeless tobacco and e-cigarette use are also concerns. Fortunately, TRH can connect patients with the Mission Health Nicotine Dependence Program.
In the last four years, residents’ reports that they could not access needed mental health services more than doubled, and treatment resources remain insufficient for our community’s needs. We are working with law enforcement agencies, mental health services providers, local government and county crisis agencies to provide earlier and more frequent screening and collaborative care for those in need of mental health services. TRH offers Fresh Start, an adult outpatient program for people with a behavioral health diagnosis. Patients can self-refer or be referred by a medical provider.
Excess weight, nutrition deficits and lack of physical activity all raise the risk of the serious health conditions that plague our community, from cardiovascular disease to diabetes. Nearly one-fifth of county residents reported being food insecure in 2018, which puts them at risk for not consuming enough fruits and vegetables. Likewise, one-fifth reported that they did not engage in recreational physical activity. On this front, TRH’s Community Diabetes Management Manager has partnered with NCWise to provide patient education through the NC Diabetes Prevention Program.
TRH is now poised to enter into diverse partnerships with local organizations to more powerfully address SDOH. The CHNA study has given us critical information about what differentiates us as a community in terms of the health and well-being of our residents. Armed with prioritized goals and community allies, we intend to enhance the health of our community in new and exciting ways.
Michele Pilon, MS, BSN, RN, NE-BC, is Chief Executive Officer and Chief Nursing Officer of Transylvania Regional Hospital. Her diverse professional experience includes service as a bedside nurse and over a decade as a leader at healthcare institutions in Virginia, Florida and North Carolina. Ms. Pilon earned a Bachelor’s in Nursing from Ohio’s University of Akron and a Masters in Health Services Administration from the University of St. Francis in Illinois; she is also a Board-Certified Nursing Executive.