On rural healthcare in Iowa

Two recent stories in the Des Moines Register have touched on rural health care issues in Iowa.

This story in today's paper is dateline Greenfield, Iowa, population 1,982, where an innovative and quickly brokered solution is keeping the local pharmacy open.  That solution involves Greenfield's older pharmacist, a newer pharmacist, and NuCara, a small chain of pharmacies, working with both of them.  Kevin Hardy writes for the Register about Greenfield, a town that "seems to punch above its weight," but which "almost became a town without a pharmacy":

Greenfield, about 50 miles southwest of Des Moines, is no stranger to the long-term trends that continue to redraw the rural American landscape. After all, the southwest Iowa community's population peaked nearly four decades ago.

Greenfield is the county seat of Adair County and it's also home to a hospital, a factory, and schools, as well as shops and a single-screen theatre on the courthouse square.  But what saved the pharmacy, it seems, was the commitment of the two local pharmacists, the flexibility of NuCara, and even the expedited review of the federal Drug Enforcement Agency.  The new pharmacy opened in a building that previously housed the Adair County Memorial Hospital's business office. The younger pharmacist, Rachel Hall, owns a 20% stake in the new business.  She is from a neighboring town.  Interestingly, when the prior chain pharmacy, Shopko (based in Wisconsin) closed, it sold its patient/client records to Walgreens, whose nearest location is 50 miles away.

Hardy puts what has happened in Greenfield in context:

The loss of Greenfield's only pharmacy would have tracked with decades of changes in Iowa's pharmacy industry. While the number of Iowa pharmacists has grown in recent decades — from 2,344 in 1996 to 2,991 in 2017 — they have increasingly consolidated in larger communities, according to the Iowa Pharmacist Tracking System. 

Over those 21 years, the number of Iowa communities with at least one pharmacist dropped from 251 to 223 — a decrease of 11 percent.

In 2017, every Iowa city with a population of at least 5,000 was home to at least one pharmacist. But of 867 communities with populations below 5,000, only 143 had a pharmacist.

Reading this rural pharmacy story today reminded me of this Des Moines Register story from January, on mental health services in Carroll, Iowa, population 10,103.  The lead for Tony Leys story is:

St. Anthony Regional Hospital's leaders couldn't bring themselves to do what eight other rural Iowa hospitals have done in recent years: Shutter their psychiatric unit. 

The Carroll hospital's board nearly pulled the plug several years ago. The inpatient mental-health program was losing money, and it struggled to keep psychiatrists and other professionals on staff. 

But St. Anthony's is the only hospital in Carroll County or the seven surrounding counties that offers inpatient care to people having mental health crises.

Ed Smith, the hospital's chief executive officer comments:   

If we don’t do it, who’s going to?

Here's more context on what's at stake in Iowa, particularly in the counties that have closed their inpatient psychiatric units.  Note the criminal justice interface.

Nearly 100,000 Iowans live in those eight counties, which cover 4,600 square miles. Without the Carroll program, psychiatric patients would have to be shuttled to faraway hospitals. Many would face the humiliation of being driven an hour or more in the back of a sheriff's squad car. 

St. Anthony's scrambled to find a full-time psychiatrist. It is spending tens of thousands of dollars on training for local nurses to become psychiatric nurse practitioners.  

One St Anthony's patient commented on the importance of being seen by medical professionals who know them, as opposed to traveling an hour or more to get treatment: 

It means the world. These people here care about us so much.