Yell County Rural Health Consoritum

Located in west-central Arkansas, with approximately 18,000 residents, Yell County is the fifth largest county in the State in terms of land mass and is bordered by the Ozark Mountains to the north and the Ouachita Mountains to the south. Danville, Arkansas, which is located in Yell County, has approximately 2,300 residents. The county’s Hispanic population has grown dramatically. In 1995, enrollment of Hispanic children in the Danville School District was 7 percent. In 1999, Hispanic children accounted for 32 percent of the district’s students. Danville’s Hispanic population grew from 1 percent in 1990 to 43.5 percent in 2000.

The goal of the Yell County Rural Health Consortium was to increase access to basic health care and to improve the cardiovascular health of the residents of Danville and the surrounding areas. The project was designed to achieve this goal primarily through health education and the delivery of primary preventive services.

Chambers Memorial Hospital, a 41-bed rural hospital serving some 38,000 residents in the 3-county area, led the project consortium. The hospital was responsible for providing project direction, coordinating and implementing community outreach programs, and hiring a bilingual physician. The Arkansas Tech University’s Department of Nursing, which enrolls 50 to 60 nursing students each year, implemented the school-based program and supported community screenings and educational programs. The head of the department also served as the project evaluator. The Danville School District, which had more than 700 students in schools covering an area of 141 square miles, provided facilities for and coordinated the implementation of the school-based program.

Clients who received services ranged from elementary schoolchildren to older adults. Modeled after a nationally tested program, a school-based cardiovascular disease (CVD) prevention program was implemented in two rural elementary schools, with participation by third, fourth, and fifth grade students. The fifthgraders also participated in a tobacco prevention class. The project provided community health screenings at local civic organizations, churches, businesses, community groups, and poultry processing plants. Screenings included blood pressure, cholesterol, HDL cholesterol, and blood sugar checks. In addition, the project offered community education classes. To improve access to primary health care services, Chamber Memorial Hospital added a bilingual family practice physician to its staff.

One of the project’s goals had been to increase to at least 40 percent the number of Danville residents who accessed primary health care services, health education programs, and screening services. This goal was met in the project’s first year. By the end of the grant cycle, the project recorded more than 14,000 service encounters.

The school-based smoking prevention program was offered in three of the five proposed schools. At one school’s request, the program was expanded to include not only fifth graders but seventh and eighth graders as well.

Evaluation of the Yell County Rural Health Consortium project revealed a significant increase in the number of patients accessing care. In fact, the number of unduplicated visits by Hispanic patients increased each year to a high of 1,227 patients by the end of the third year.

One potential challenge for other communities may be recruiting bilingual medical personnel. Rural areas frequently have difficulty recruiting and retaining qualified staff. Bridging the cultural and linguistic gaps also may be a challenge for communities seeking to replicate this model as a means to improve the health status of some ethnic minority populations. In addition, it is important to engage community leaders from target populations to be actively involved in planning and promoting project services for the target population.

Health screening and community education programs continue to be offered by Chambers Memorial Hospital. The hospital also continues to provide primary health care services to the target population and covers the salary of the bilingual physician. The Arkansas Tech Department of Nursing will continue to use the facility as a clinical site, and nursing students will participate in community outreach programs as part of their clinical rotations. Arkansas Tech also is evaluating its future curriculum needs and hopes to continue the school-based educational program, if feasible.