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Staffing and Resource Considerations for Rural Chronic Disease Management Programs

Staffing Considerations

Rural chronic disease management programs can benefit from a robust health workforce. Types of staff may include:

  • Program managers
  • Pharmacists
  • Care coordinators
  • Health coaches
  • Community health workers
  • Specialty care providers

Successful rural programs describe the benefits of having staff who are passionate, motivated, and committed. When possible, rural programs should seek to hire staff who are from the community and have first-hand experience with chronic disease management. Staff who represent communities served can help build trust between providers, program staff, and patients. Some programs have trained community members as community health workers (CHWs) or health coaches to promote wellness within the community.

Rural communities often experience challenges with staff recruitment and retention. This is particularly true for specialist positions such as endocrinologists and cardiologists. Some of the approaches rural communities have used to address this challenge include using telehealth, remote patient monitoring, and mobile clinics to increase access in rural communities. Additionally, rural chronic disease programs can consider recruiting community volunteers and building partnerships with other organizations to offer support services.

Resource Considerations

Rural communities should consider the resources needed for implementing chronic disease management programs. In addition to staffing, programs for chronic disease management may require training, technology, equipment, funding for medication, facilities, and flexible hours.

Training. Rural programs may need to implement staff training initiatives. For example, it may be helpful for CHWs or program staff to receive specialized chronic disease management training, such as through Project ECHO, to better meet the specific needs of patients in a rural chronic disease management program. Experts also recommend chronic disease program staff and rural primary care providers are trained in motivational interviewing techniques, to better elicit the behavior change needed for chronic disease management.

Technology. Many rural chronic disease management programs use technology, including telehealth, to reach patients, provide services, and track progress. Remote patient monitoring is a type of telehealth useful for monitoring patient health status and managing chronic illness from home. Rural programs using technology should consider how best to provide patients with equipment and troubleshoot issues with the technology. For example, some patients may lack access to strong internet connections required for telehealth services. The Washington County Mobile Integrated Healthcare Network (MIHN) uses an internet connection from their medical transport vehicle if broadband access is limited in areas where community paramedics serve patients. Text messaging can be a helpful tool for patient reminders, such as for medication or appointments. Text messaging can be especially useful in rural communities as it requires little data and doesn't rely on an individual's ability to access the internet, although it does require cellular service and a strong enough signal from a cellular network.

Equipment. Chronic disease management programs may require the use of specialized medical devices or self-monitoring equipment, such as glucose monitors and blood pressure cuffs. Programs with a telehealth component may also require equipment, such as cellular data-enabled tablets or Wi-Fi hotspots. Programs may be able to seek reimbursement for medical equipment as part of remote patient monitoring.

Funding for medication. Some chronic disease management programs can provide resources to assist patients with limited incomes who cannot afford medications. Many rural programs rely on the 340B Drug Pricing Program to help patients with certain chronic diseases afford medications. This federal program requires drug manufacturers to offer outpatient medications to qualifying entities, like health centers and hospitals, at a reduced price. Rural programs have also found the national nonprofit NeedyMeds to be a useful resource in helping patients obtain additional funds for medications and other healthcare costs. More information about funding and sustainability can be found in Module 6.

Facilities. Some rural programs may need to identify and secure facilities, such as meeting space for educational classes or space for delivering healthcare services. Rural programs should consider the proximity and convenience of accessing these facilities. For in-person care and services, facilities should be within a reasonable distance of the community. Mobile health units are one option that allow programs to provide accessible care in rural communities. Mobile health units can include wraparound services, health coaches, and visits from specialists or pharmacists.

Flexible hours. To meet the needs of patients and make chronic disease management more accessible, rural programs may consider offering flexible clinic hours. For example, programs designed for working age populations may be offered in the evening, or after work hours. Programs designed for older adults may be offered during the day.

Resources to Learn More

Impact of Clinical Pharmacy Expansion within a Rural Federally Qualified Health Center through Implementation of Pharmacist-Led Medicare Annual Wellness Visits
Examines the clinical and economic value of pharmacist-led Medicare Annual Wellness Visits (AWVs) between October 2021 and February 2022 in a rural Federally Qualified Health Center (FQHC). Compares the rate of pharmacist and physicians completing the AWV, patient satisfaction between the two AWV providers and additional revenue generated for FQHCs.
Author(s): Royals, C., Barfield, R.K., Newman, M.F., et al.
Citation: Pharmacy, 10(6), 160
Date: 11/2022

Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study
Describes a study examining the feasibility and acceptability of an mHealth diabetes education program combining Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives to encourage participation of rural residents.
Author(s): Zenong, Y., Lesser, J., Paiva, K.A., et al.
Citation: Journal of Medical Internet Research Mhealth and Uhealth, 8(3)
Date: 3/2020