University of Kentucky Research Foundation

Revolutionizing Access to Healthcare (REACH): The Collaborative Practice Initiative

Health care access

We will expand access to primary healthcare for people living in Appalachia by using pharmacy-centered collaborative practices, thereby improving overall health and increasing life expectancy.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

A baby born and living in Appalachian Kentucky can be expected to live 8 fewer years than one born just an hour away. This large disparity is driven by poorly treated chronic diseases such as diabetes, heart disease, hypertension, obesity, substance use, and cancer. A major underlying cause is lack of access to primary healthcare, which is exacerbated by both geography and poor socio-economic conditions. The University of Kentucky is expanding a proven, sustainable, collaborative REACH model that pairs nurse-practitioners with pharmacists in independent pharmacies. Unlike medical clinics, most people live within five miles of a pharmacy, even in rural areas, and have a preferred pharmacy. REACH will increase access to quality care within these existing pharmacies in the 11 Appalachian Kentucky counties with the lowest life expectancy. Bringing sustainable healthcare services to these communities will improve health outcomes and ultimately the quality of life in Appalachia.

Problem Statement

Appalachian Kentucky has the highest rates of diabetes, heart disease, cancer, and drug use disorders in the United States. Residents have significantly shorter life expectancies and lower quality of life. This high mortality rate disproportionately affects those of lower socioeconomic backgrounds, children, and people of color. Many people living in this area cannot easily obtain routine healthcare needed to manage or prevent their chronic conditions, which can result in a slow, steady decline of health. Traveling two hours to see a physician is not uncommon in this region; travel costs and work loss further preclude access. When care is obtained it is often through emergency or acute care clinics – which rarely address care for chronic illnesses. This creates a cycle of expensive and ineffective care that treats acute symptoms but not the underlying condition. The solution is to provide routine and easy access to primary care by increasing coordinated use of health care extenders. While medical clinics are not easily accessed, pharmacies are usually close at hand, often within five miles of a patient’s home. For example, Owsley County Kentucky has one practicing physician but four operating pharmacies. Most people have a pharmacy to which they already affiliate – providing a clear access point to care. Many of these pharmacies are independent businesses with the ability to agilely accommodate new activities. Leveraging the geographic distribution, physical space, and patient affiliation of pharmacies may provide the route to solving this dilemma.

Solution Overview

This proposal addresses rectifying one of the largest health disparities within our Nation – strongly reduced life expectancy and quality of life for people living in Appalachia. The underlying issue driving this disparity is poor access to primary healthcare for chronic diseases. Our solution is to create collaborative healthcare teams within existing pharmacies to provide easy physical access to primary healthcare for people in Appalachian Kentucky. Such collaborations have been proven to improve patient care. This model will build a physician-led county health clinic with multiple practice sites housed within pharmacies for each county in the area. Because the majority of people in the area are within five miles of a pharmacy, as opposed to more than 60 miles from a medical clinic, this approach directly targets the access issue using a proven approach. Our solution will immediately improve Appalachian patients’ access to care, which can be directly measured. Over time, expanded access will decrease patient health disparities, and these improved health outcomes can be measured within the communities. Over a five-year period, we expect to have demonstrateble significant improvements for both of these measurable outcomes across the 11 counties of Appalachian Kentucky that have the shortest average lifespans. We also expect the business model will be self-sustaining at the end of the five-year period, leaving a lasting and highly impactful legacy within Appalachia. If successful, this model could be reapplied across the United States in any area with high health disparities, thus providing a much wider base

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