COMMUNITY HEALTH ASSESSMENT OF BERKELEY COUNTY, WEST VIRGINIA by Shepherd University Department of Nursing Education senior students in NURS 413, Community Health Care, in collaboration with The Berkeley County Health Department Shepherd University Department of Nursing Education Spring, 2007
1 CONTENTS CHAPTER 1—A DESCRIPTION OF THE COMMUNITY.................................................................... 2 CHAPTER 2—DATA COLLECTION AND INITIAL INTERPRETATION .......................................... 4 Windshield Survey.....................................................................................................................4 Demographic Data .....................................................................................................................6 Epidemiology ..........................................................................................................................17 Key Informant Interviews .........................................................................................................25 General Public Surveys.............................................................................................................28 CHAPTER 3—DATA ANALYSIS AND IDENTIFICATION OF COMMUNITY NEEDS AND RESOURCES................................................................................................................................... 35 Priority Issue 1: Affordable Health Care .....................................................................................35 Priority Issue 2: Lack of Specialty Services .................................................................................38 Priority Issue 3: Health Prevention and Promotion .......................................................................42 CHAPTER 4—CONCLUSIONS AND RECOMMENDATIONS.......................................................... 48 APPENDIX A—WINDSHIELD SURVEY RAW DATA...................................................................... 52 APPENDIX B—LIST OF KEY INFORMANTS................................................................................... 63 APPENDIX C—BERKELEY COUNTY KEY INFORMANT SURVEY.............................................. 66 APPENDIX D—GENERAL PUBLIC SURVEY................................................................................... 67 APPENDIX E—PRIORITY MATRIX.................................................................................................. 68 APPENDIX F— SHEPHERD UNIVERSITY DEPARTMENT OF NURSING EDUCATION FACULTY AND STUDENTS WHO PARTICIPATED IN THIS ASSESSMENT........................... 69 REFERENCES...................................................................................................................................... 70
2 CHAPTER 1—A DESCRIPTION OF THE COMMUNITY Berkeley County, West Virginia, is located in the Eastern Panhandle of the state and is bordered by Washington County, Maryland, and the Potomac River to the north; Frederick County, Virginia, to the south; and the West Virginia counties of Jefferson and Morgan to the east and west, respectively. The 321­square­mile county’s close proximity to Washington, DC and Baltimore, Maryland, has contributed to the rapid growth of its population, which increased by 23% during the period from April 1, 2000 to July 1, 2005 (Map Stats, 2007). Berkeley County is located within the Appalachian mountain system that runs north and south along the eastern region of the United States. The county encompasses three ridges and valleys: North Mountain, Third Hill Mountain, and Sleepy Creek Mountain. Altitude ranges from 300 to 2,200 feet elevation, with the higher regions located primarily in the western part of the county (Doherty, 1972). Rivers and streams in the county include the Potomac River along its northern boundary, Back Creek and Cherry Run in the western part of the county, and Opequon Creek in the east, as well as numerous natural springs. During the 20 th century, the full extent of the area’s natural wealth became known, and writers described it as “full of natural treasures” such as “iron ore, mineral water, sulfur, sandstone,[and] potter’s clay,” as well as a fertile area for producing “wheat, barley, oats, and corn” (Doherty, 1972, p. 4). The county currently includes numerous fruit orchards. Historically, Berkeley County has been a county of both Virginia and West Virginia. In 1734, Frederick County, Virginia, was formed from part of Spotsylvania County because of the difficulty of the distant commute for residents to meeting places and court appointments (Gardiner & Gardiner, 1938). In 1772, Berkeley County was formed from part of Frederick
3 County. At the time it was formed, Berkeley County also occupied the present­day areas of both Jefferson and Morgan Counties (Gardiner & Gardiner, 1938, p. 16). The areas within the county on which our assessment focused were Martinsburg, Hedgesville, and Inwood. Martinsburg, the county seat, has a population of about 15,000 with a density of 2,976 per square mile over a city area of 5.1 square miles, according to the United States Census (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). The city is located in the center of the county, with the small towns of Hedgesville to the northwest and Inwood to the south.
4 CHAPTER 2—DATA COLLECTION AND INITIAL INTERPRETATION This chapter will describe our findings regarding Berkeley County gathered from windshield surveys, epidemiological and demographic data, and key informant and general public interviews. We collected windshield survey data by direct observation, and we conducted face­to­face or telephone interviews with key informants and members of the general public. Windshield Survey Senior nursing students of the Shepherd University Department of Nursing Education conducted windshield surveys of the Hedgesville, Martinsburg, and Inwood areas of Berkeley County between January 17 and 28, 2007, at various times of day. The purpose of the surveys was to objectively identify areas of concern without physical interaction and to get an overview of the unique aspects of the county’s population centers. Berkeley County is bordered by Maryland, Virginia, and two other West Virginia counties, Jefferson and Morgan. Interstate 81, a four­ to six­lane interstate highway with plenty of shoulder room, runs through the middle of the county from north to south. Other major roads include state routes 9, 45, and 51, and U.S. routes 11 and 340. Conditions on these roads vary; some have no shoulders or have potholes and cracks, and some are extremely narrow and curvy. Within the major population centers of Martinsburg and Hedgesville, there are sidewalks, traffic signals, and well­marked traffic signs. In and near Martinsburg, public buses provide access to limited areas of the county. Trains have a large presence in the community, with numerous railway crossings and a passenger station located in north Martinsburg. The West Virginia Regional Airport in south Berkeley County serves small aircraft.
5 Health care access is primarily located in Martinsburg, at or near the campus of City Hospital Inc., a West Virginia University–East partner, with many physicians’ offices and ancillary services located nearby. The Veterans Affairs Medical Center is located in south Martinsburg. Hedgesville and Inwood have a limited number of primary, secondary, or tertiary health care settings, consisting of family physicians, dentists, counselors, and pharmacies. Businesses seen in the county include bars and clubs (especially prominent in south Berkeley), grocery stores, restaurants, gas stations, and banks. Utility companies, media outlets such as radio stations and billboards, campgrounds, and industrial parks containing factories and other businesses also are a part of the county’s landscape. Housing in Berkeley County varies greatly by location, style, age, and condition. We saw many new developments all over the county, primarily outside of the major population centers. Within these population centers the homes tend to be older and small, but there are some older, larger homes on or near farms in the rural areas of the county. Many Christian places of worship are scattered throughout the county, including Baptist, Catholic, Methodist, Presbyterian, and independent churches, a Jehovah’s Witness meeting hall, and other denominations, mostly in the population centers. In Martinsburg there is also a synagogue, which has since announced its closing. We did not see any mosques during the windshield survey. Houses of worship vary from large to small, and new to old depending on location, age, and denomination. Public service and federal offices are present in the community; most being centrally located in and around Martinsburg. Services we observed in the county include volunteer fire stations, state and city police stations, post offices, military recruitment offices, a jail, a recycling center, an animal control agency, and the county health department. Schools are primarily
6 located near the major population centers of the county and include public and private elementary, intermediate, middle, and high schools, as well as a vocational school, a community college, and college branch offices. These buildings are primarily brick, and differ in age. Major concerns that arose from these observations were health care accessibility throughout the county, numbers of general and specialty practitioners, and safety issues such as poor upkeep of secondary roads, lack of sidewalks, and lack of fencing around some private pools and community areas. Another concern was the easy availability of alcoholic beverages, especially in south Berkeley County. For a more in­depth look at the windshield survey data, see Appendix A. Demographic Data In this section we will compare demographic characteristics of the United States (US), West Virginia (WV), and Berkeley County. The overall population for the US in 2000, according to the U.S. Census Bureau, was 281,421,906. During the year 2000, the Census Bureau stated that the population of WV was 1,808,344, which rose to 1,816,856 in 2005. The population of Berkeley County in 2000 was 75,905, which the Census Bureau estimated rose to 93,394 in 2005 (Map Stats, 2007). As Table 2­1 shows, population gender was similar for the US, WV, and Berkeley County, with slightly more females than males in each population (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Table 2­1: Gender 52 e g a t n e c r e P 50 MALES 48 FEMAL ES
46 Berkeley Co. West Virginia United States 7 As shown in Table 2­2, the largest population group was between the ages of 25 and 54. The age distribution of the populations of Berkeley County, WV, and the US are similar (Berkeley County Quickfacts from the U.S. Census Bureau, 2007), but compared to both the US and WV, a greater percentage of Berkeley County residents were in the 25 to 54 age group. Whites were the predominant race in all areas, as shown in Table 2­3. There were higher percentages of Whites in WV and Berkeley County than in the US, and a higher percentage of Blacks in Berkeley County and the US when compared with the state of WV. The percentage of Hispanics living in the US and in Berkeley County was higher than that in WV (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Table 2­3: Race 100 e g a t n e c r e P 80 60 Berkeley County 40 West Virginia 20 United States
0 WHITE BLACK Other HISPANIC 8 According to the 2000 U.S. Census, the percentages of residents born in Berkeley County (98%) and WV (99%) were higher than the U.S. average (90%). The 2000 U.S. Census also found English to be the predominant language spoken in most Berkeley County homes. Spanish was the second most common language, with a greater percentage of Spanish­speaking households in Berkeley County than in the state as a whole (Berkeley County Quickfacts from the U.S. Census Bureau, (2007). According to the 2000 U.S. Census, the average household size in Berkeley County was 2.53 people per household, slightly higher than the WV average of 2.38 people. Both these averages were slightly smaller than the average household size for the US, which was 2.59 people. As shown in Table 2­4, the average family size for Berkeley County was 2.99 people, similar to the WV average of 2.91 people. However, the average family size was slightly smaller than the US average of 3.14 people per family (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Table 2­4: Average Family Size 3.2 f l o s a r u 3 e d b i v i 2.8 m u d N n I 2.6 Berkeley County West Virginia United States
Average Family Size In Berkeley County, 37% of households included individuals under the age of 18, a percentage similar to that of the US (36%) and higher than the WV average (31%). However, WV had a higher percentage of households with individuals age 65 and over (28%) than the US (23%) and Berkeley County (21%). In 2005, the Census Bureau reported that 25% of people 9 living in Berkeley County were under the age of 18; the WV average was 21%. Almost 11% of individuals living in Berkeley County were over the age of 65, less than the WV average of 15% (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Berkeley County and WV had a greater number of people who own their houses than the national average. In Berkeley County and WV, 74 % of residents reported living in their own houses, compared with the national average of 66%. The number of housing units for Berkeley County reported in 2005 was 39,522, compared to WV, which had 872,223 housing units in 2005 (Berkeley County Quickfacts from the U.S. Census Bureau. (2007). Table 2­5 shows that the US had a higher percentage of individuals attending or graduating from college than WV and Berkeley County. Berkeley County had a slightly higher percentage of individuals with a 12 th grade or lower educational level than individuals in WV and US (Berkeley County Quickfacts from the U.S. Census Bureau. 2007). Table 2­5: Educational Attainment 45 40 Berkeley County West Virginia United S tates
s t n e d i s e r f o e g a t n e c r e P 35 30 25 20 15 10 5 0 10 According to the 2000 U.S. Census, 23% of Berkeley County residents ages 15 years and older had never been married. This percentage was below the state average (24%) and national average (27%). The population of Berkeley County residents 15 years and older who were married was 57%, slightly higher than averages for the state (56%) and nation (54%). The population of Berkeley County residents who were divorced during the 2000 census was 12%, which was slightly higher than the rates for WV (10%) and the US (10%). Table 2­6 illustrates the distribution of marital status throughout the three regions (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Table 2­6: Marital Status 60 50 t 40 n e c r 30 e P 20 Berkeley County West Virginia United States
10 0 Never Married Married Separated Widowed Divorced Marital status The 2000 U.S. Census also revealed that 45% of grandparents in Berkeley County cared for one or more grandchild under the age of 18. This was lower than the state average of 49% and higher than the national average of 42% as shown in Table 2­7 (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). . 11 Table 2­7: Grandparents as Caregivers 50 t n e c r e P Berkeley County 45 West Virginia United States
40 35 Residency The increasing number of grandparents as caregivers is believed to be correlated with the teen pregnancy rate. According to the National Campaign to Prevent Teen Pregnancy (n.d.), in 2000, WV ranked 16 th in the nation in pregnancies occurring between the ages of 15 to 19. West Virginia’s pregnancy rate was 67 per 1,000 teens compared to the 2000 US rate of 87 per 1,000. According to the West Virginia Adolescent Pregnancy Prevention Initiative (n.d.), 158 Berkeley County teens between the ages of 15­19 were pregnant in 2000. Possibly because of the Veterans Affairs Medical Center located in Martinsburg, the percentage of veterans older than 18 was higher in Berkeley County (17%) than the state (15%) and national (13%) averages. The 2000 U.S. Census also revealed that the percentage of disabled residents ages 5 to 64 was higher for Berkeley County (32%) than the state (28%) and nation (27%). In contrast, the percentage of disabled residents over 64 years of age in Berkeley County was slightly lower than that of the state and nation. Table 2­8 illustrates the distribution in all three areas (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). The unemployment percentages in 2007 for Berkeley County, WV, and US were estimated to be 4.7, 5.4, and 4.5 respectively, as shown in Table 2­9. West Virginia had a higher unemployment rate than the US and Berkeley County (Map Stats, Feb. 2007). 12 Table 2­8: Disabled Residents 50 Berkeley County West Virginia United States
e 40 g a 30 t n e 20 c r e P 10 0 5 to 20 21 to 64 Age in Years 65+ Table 2­9: Unemployment Status 6 e g a t n e c r e P 4 Berkeley County West Virginia United States 2 0 Area The distribution, as shown in Table 2­10, between classes of workers in Berkeley County was similar to the US and WV. However, the percentage of private wage and salary workers was slightly higher across the US. Both Berkeley County and the state of West Virginia had a higher percentage of government workers than the nation, but WV was higher than Berkeley County (Berkeley County Quickfacts from the U.S. Census Bureau. 2007). According to the 2000 U.S. Census (2007), residents of Berkeley County spent on average 4 to 5 minutes longer commuting to work than US and WV residents, possibly because of the availability of well­paying, high­tech jobs in the Washington, DC, and Baltimore Table 2­10: Type of Worker 13 80 70 60 Percentage 50 Berkeley County 40 West Virginia United States 30 20 10 0 Private Government Self­employed Unpaid metropolitan areas. As shown in Table 2­11, family income in the US was higher than that for WV and Berkeley County, although Berkeley County’s median family income is higher than the WV median family income (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). n n i 100,000 s a i e r a d m l e o 50,000 o d m c n i Table 2­11: Median Income Comparison Berkeley County West Virginia United States
0 Area 14 More recent statistics from 2003 showed the median family income in Berkeley County was $43,300, compared with $32,967 in WV (Map Stats, Feb. 2007). According to the 2000 U.S. Census, more WV residents than county or U.S. residents reported living below the poverty line, as shown in Table 2­12. The 2003 data listed individual poverty status for WV as 16%; US, 3%; and Berkeley County, 12% (Map Stats, 2007). Table 2­12: Poverty Status e n i l y t r e v o p w o l e b e g a t n e c r e P 18 16 14 12 10 8 Berkeley County West Virginia 6 United Stat es
4 2 0 Families Individuals Medicare, the federal program that provides health insurance for people 65 years of age and older, disabled individuals, and people with chronic kidney failure, is divided into two parts: Part A, otherwise known as Hospital Insurance, and Part B, also called Supplementary Medical Insurance, which covers services. Members are enrolled in either part A, part B, or both. The percent of WV residents enrolled in Medicare remained consistent from 2000­2004. However, the percent of change for the U.S. residents has continued to increase as shown in Table 2­13 (Medicare Enrollment Reports, 2005). 15 The number of enrolled beneficiaries in Medicare parts A and B in the US declined slightly in 2004; a decline in enrolled individuals was also present in WV in 2004 and in 2005. Table 2­14 summarizes Berkeley County Medicare Enrollment in 2003 (Medicare Enrollment Reports, 2005). According to the 2000 Census, the median value of homes in Berkeley County ($99,700) was slightly less than the median value of homes in the US ($119,600). The median value of homes in WV was the lowest, at $73,000. More recent statistics from 2003 showed the U.S. median household value had risen to $140,000 and the WV median value had risen to $78,200 (Percentage of million­dollar homes nearly doubles since 2000, 2005).
16 Table 2­15 shows that over 50% of homes in the US and WV used electricity as the primary heating source. In Berkeley County, the two most common home heating fuels were electricity (54%) and fuel oil (23%). Gas heat was the third most common heating source in WV. The high prevalence of electrical heating sources in Berkeley County could be a result of the rapid growth in the region, including the increased rate of new housing developments being built. Table 2­15 compares major home heating sources in Berkeley County, WV, and the US (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). As shown in Table 2­16, the 2000 U.S. Census revealed that 4% of Berkeley County residents do not have telephone service. This is higher than the West Virginia and U.S. overall percentages of 3.5% and 2.4%, respectively. However, at 0.4%, the percentage of Berkeley County housing without complete plumbing and kitchen facilities is slightly less than the percentages of West Virginia residences (0.5%) and U.S. residences (0.7%). Fewer Berkeley
17 County residences lack complete plumbing and kitchen facilities than the US and WV overall percentages; however, Berkeley County residents are more likely to have no residential phone service (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). Epidemiology The epidemiologic focus of this study was based on data from the website of the West Virginia Department of Health and Human Resources (WVDHHR). Among the data groups from this source were selected causes of death in Berkeley County from 1992 to 2001; cancer incidence among county residents from 1999 to 2000; infant and fetal mortality, birth statistics, and fertility rates, all from 1997 to 2001; and a comparison of behavioral prevalences in the county between 1994 and 1999. Monthly reports showing communicable disease statistics from the first 8 months of 2006 were used as the most recent set of information related to communicable disease in Berkeley County. These data sources were chosen because they are the most recent and authoritative sources available.
18 Data on infectious diseases from January to August, 2006, showed 5 cases of campylobacteriosis, 10 cases of chickenpox, 407 cases of influenza­like illness, 3 cases of acute Hepatitis B, 1 case of H. influenza, 3 cases of animal rabies, 2 cases of aseptic meningitis, 1 case of neisseria, 14 cases of Streptococcus pneumonaie, 3 cases of salmonellosis, 2 cases of group B strep, and 1 case of toxic shock syndrome (West Virginia Monthly High Incidence Communicable Disease Infectious Disease Epidemiology Program [IDEP] Surveillance Data, January–August, 2006). From January 1 to September 30, 2006, there were 1350 confirmed reportable disease cases (Confirmed and Probable Cases by Month reported to WVEDSS, 2006). Statistics from the WVDHHR website showed that the top five causes of death in Berkeley County from 1992 to 2001 were heart disease, malignant cancer, stroke, chronic obstructive pulmonary disease, and injuries. All of these rates were significantly higher than national averages. Table 2­17 is a comparison of death rates from selected leading causes in Berkeley County, WV, and the US, from 1992­2001 (Berkeley County selected causes of deaths, 1992­2001, 2004).
19 According to the WVDHHR website, heart disease caused 341.9 deaths per 100,000 people in Berkeley County. This rate was 22.5% greater than the overall U.S. rate of 279 deaths from heart disease per 100,000 people (Berkeley County selected causes of deaths, 1992­2001, 2004). The second leading cause of death in the county in the years studied was malignant cancer, which caused 238.8 deaths per 100,000 people in the county, compared to a rate of 203.9 deaths per 100,000 people in the nation. The leading cause of cancer deaths in Berkeley County was lung cancer, with a death rate of 72.7 deaths per 100,000 people, compared to a rate of 57.6 deaths per 100,000 in the nation. This rate was 26.2 % higher than the national average. In Berkeley County, colon cancer was the next highest cause of cancer deaths, with a rate of 26 deaths per 100,000 in the county, a rate 42.1% higher than the national average of 18.3 deaths per 100,000. Breast cancer, with a rate of 29.1 deaths per 100,000 in Berkeley County, was only 3.1% higher than the national average of 28.2 per 100,000, and prostate cancer fell 16.1% below the national rate, with 28.4 deaths per 100,000 people in the county, compared to 33.9 deaths per 100,000 in the US (Berkeley County selected causes of deaths, 1992­2001, 2004). Because lung and colon cancer death rates are lowered by behavioral changes (stopping smoking and colorectal screenings, respectively), this information carries important public health implications for the county. Stroke (cerebrovascular disease) was the third leading cause of death in the county from 1992­2001, causing 67.5 deaths per 100,000 residents. The national average death rate from stroke was 61.6 deaths per 100,000 persons (Berkeley County selected causes of deaths, 1992­ 2001, 2004.)
20 Chronic obstructive pulmonary disease (COPD) followed stroke as the fourth leading cause of death in Berkeley County, causing 50.6 deaths per 100,000 county residents, a rate 22.3% higher than the U.S. average of 41.4 deaths per 100,000 (Berkeley County selected causes of deaths, 1992­2001, 2004.) Research has shown that smoking tobacco contributes to 80 to 90% of all COPD cases. In Berkeley County, 32% of residents smoked, making the county seventh in the state for number of smokers (1999 Berkeley County behavioral prevalences, 2004). Injuries accounted for 424 deaths in Berkeley County during the period reviewed. Of these, 272 were unintentional, including 129 motor vehicle accidents and 143 other non­vehicle accidents. Unintentional injuries accounted for 39.9 deaths per 100,000 county residents, a rate 12% higher than the national average of 35.6 deaths per 100,000. Intentional injuries, including 113 suicides and 39 homicides and deaths from legal intervention, accounted for 152 deaths in Berkeley County, a rate of 21.4 deaths per 100,000, compared to 18.4 per 100,000 nationally. While homicide and legal interventions caused a death rate of 5.5 per 100,000 people in Berkeley County, a rate 24.1% lower than the national average of 7.2 per 100,000, suicide rates were very high in the county. In the period studied, 16 persons per 100,000 took their own lives, a rate 41.2% higher than the national average of 11.3 persons per 100,000 (Berkeley County selected causes of deaths, 1992­2001, 2004). Other top causes of death in the county were diabetes, pneumonia, and influenza. Diabetes caused 26.2 deaths per 100,000 people, 10.2% higher than the national average of 23.8 deaths per 100,000. Pneumonia and influenza claimed 30.8 people per 100,000 in the county, a rate 8.1% lower than the national average of 33.5 deaths per 100,000 (Berkeley County selected causes of deaths, 1992­2001, 2004).
21 Information from the WVDHHR website also showed that Berkeley County had an infant mortality rate 19.5% higher than the national average. From 1997 to 2001, 8.5 infant deaths occurred per 100,000 population, compared to a US average of 7.1. Table 2­18 compares other related birth statistics for the county and the nation (Berkeley County 1997­2001 infant and fetal mortality, 2004; Berkeley County 1997­2001 selected birth statistics, 2004; WV Healthy People 2010, 2001.) Table 2­18: Comparison of selected birth statistics per 100,000 people for Berkeley County, the US, and WV Healthy People 2010 target rates. Fetal deaths, however, occurred at a rate 17.5% lower than the national average, with 5.5 deaths occurring per 100,000, compared to 6.7 in the nation (Berkeley County Infant and fetal mortality, 1997­2001, 2004). In that same period, there were 395 low­birth­weight babies born, a number similar to the national average. In Berkeley County, 144 mothers received no prenatal care, 1,423 mothers used tobacco (a rate 124.8% higher than the national population­based average), and 1,208 mothers had less than 12 years of education (Berkeley County 1997­2001 selected birth statistics, 2004).
22 Many behavioral factors contributing to non­infectious illness and death in the county are highlighted in Table 2­19. Over one­third of county residents (37.1%) were physically inactive, nearly one­fourth (23.8%) were obese, and 27.5% had hypertension. Nearly one­third of county residents smoked cigarettes and 8% used smokeless tobacco, while 7.4% were binge drinkers. In addition, one in five county residents ages 18 to 64 had no health insurance, and 14.5% had difficulty seeing a physician because of cost (1999 Berkeley County behavioral prevalences, 2004). Inactivity, hypertension, obesity, tobacco, and alcohol use are significant contributors to heart disease, cancer, stroke, and COPD, the four leading causes of death in Berkeley County. Fiscal disparities such as lack of insurance and inability to pay for care can be relevant factors to poor preventative, prenatal, and children’s health care. Healthy People 2010 (2000), a public health planning document published by the U.S. Department of Health and Human Services, has made specific recommendations and set objectives related to many of the diseases that are primary causes of death in the US. West Virginia Healthy People 2010 (2001), a related
23 document published by the WVDHHR, outlined similar objectives for West Virginia residents. These objectives are summarized and compared to Berkeley County actual rates in Table 2­20, below (Berkeley County selected causes of deaths, 1992­2001, 2004; West Virginia Healthy People 2010, 2001; Healthy People 2010, 2000). Table 2­20: Comparison of Objectives and Data 400 e l p o 300 e P 0 0 200 0 , 0 0 1 100 r e P Berkeley Co. Death Rates WV Healthy People 2010 Targets Healthy People 2010 Targets
0 Heart Disease Cancer Stroke COPD Injury With regard to cardiovascular disease, Healthy People 2010 (2000) objectives set a goal of no more than 166 deaths per 100,000 people (p. 12­16). West Virginia Healthy People 2010 (2001) targeted no more than 200 deaths from heart disease per 100,000 residents (p. 70). Healthy People 2010 objectives related to cancer target no more than 159.9 overall deaths per 100,000 residents (p 3­10), with no more than 44.9 of those from lung cancer, no more than 22.3 from breast cancer (p. 3­12), no more than 13.9 from colorectal cancer (p. 3­14), and no more than 28.8 from prostate cancer (p. 3­17). The Flagship Objectives of West Virginia Healthy People 2010 did not set overall cancer death target rates, but did set goals of reducing lung cancer to no more than 59 per 100,000 West Virginia residents (p. 18), breast cancer to no more than 21 per 100,000 West Virginia females (p. 19), and prostate cancers to no more than 19.5 per 100,000 West Virginia males (p. 19). In addition, West Virginia Healthy People 2010 24 recommended increased screenings for cervical and colorectal cancers (p. 20), and increased counseling regarding tobacco use cessation and diet modification (p. 17). Implementing such measures could impact future death rates from cancer in the county. Reducing the national death rate from stroke to no more than 48 per 100,000 persons was the goal of Healthy People 2010 (2000, p. 12­19), while reducing the stroke death rate to no more than 45 per 100,000 residents was set by West Virginia Healthy People 2010 (2001, p. 72). COPD death rates in the U.S. should be reduced to 60 per 100,000, according to Healthy People 2010 (2000 pp. 24­21). West Virginia Healthy People 2010 (2001) recommended a target of no more than 50 deaths from COPD per 100,000 people (p. 152). National Healthy People 2010 (2000) goals call for reducing deaths per 100,000 people from unintentional injuries to no more than 17.5 (p. 15­23) and from intentional injuries to no more than three homicides and five suicides (p.15­43). Without specifying an overall target rate for deaths from unintentional injuries, West Virginia Healthy People 2010 (2001) set several related objectives, such as reducing vehicle and ATV crash deaths (p. 95­96) by requiring seat belts, child safety restraints, and helmets for bikers and motorcyclists. The state initiative also did not set a specific overall goal of reducing deaths from intentional injuries and violence, but set related goals to reduce deaths from domestic violence (p. 93), as well as reducing sexual assault (p. 94) and child maltreatment (p. 95). Comparing actual disease rates in Berkeley County with goals set by Healthy People 2010 and West Virginia Healthy People 2010 indicated possible areas of direction for health care in the county in the future. Both Healthy People 2010 and West Virginia Healthy People 2010 also contained a number of recommendations and objectives aimed at improving health care in
25 the nation and the state, respectively, which could be implemented to provide longer, healthier lives to Berkeley County residents, while eliminating health care disparities in the region. Key Informant Interviews To obtain information from the community about the state of health care in Berkeley County, we conducted two series of interviews, one with members of the general public and another with select key informants. The key informants represented a broad cross­section of public and private organizations including, but not limited to, health care agencies, school system administrators, religious leaders, and elected officials present throughout Berkeley County. A listing of key informants who participated in our survey is found in Appendix B. We asked key informants two open­ended questions, which were: 1. What additional health care services would you like to see available in Berkeley County? 2. What do you think are the three priority health care needs for this area of Berkeley County? The results of the 30 individual key informant interviews are summarized below. The first question, about desired additional health care services, resulted in a variety of key informant responses. Of the 30 key informants interviewed, 97% (29) said they would like to see broader transportation access to health care facilities, increased access to specialized health care services such as dental and vision care, and improved and expanded behavioral and substance abuse rehabilitation and treatment facilities within the area. Ninety­three percent (28) of the key informants interviewed also indicated a desire for increased numbers of and access to specialized health care providers such as women’s health services, adult and pediatric dentists, physicians specializing in chronic diseases such as diabetes and respiratory disorders, and nutritionists for county residents. Collectively, all of the key informants stated a desire to
26 increase access to existing facilities for working residents through the use of flexible business hours. Three key informants noted that standard 9 a.m. to 5 p.m. health care office business hours were not convenient for most working residents, requiring them to miss work in order to visit a health care provider or agency. All 30 key informants expressed a desire to expand preventative health care like nutritional and obesity education and to increase no­cost health care and wellness screenings for children, adults, and elderly adults. The second interview question asked key informants to identify the three top priority health care needs for community residents. These three priorities included:
· access and availability of health care for underinsured, uninsured, and working poor individuals,
· broader specialized health care services and providers, and
· improving preventative health care screening and wellness for all community residents. All 30 key informants noted that the lack of affordable health care was a major issue of concern and that providing health care for all residents, either through public programs (Medicaid and Medicare) or private agencies was a priority community health issue. All key informants identified the necessity of providing health care access for uninsured, underinsured, and insured members of the community. Although all of the key informants interviewed recognized that there were agencies available to provide some measure of health care services, they pointed out the limitations and shortfall those agencies face in providing coverage to community residents. Also, not all key informants (7 of 30) were familiar with the resources and programs available to assist community residents. Key informants identified the need for broader, specialized health care services as a second priority health care need for Berkeley County. All 30 key informants identified the lack
27 of access and availability of general and specialized health care services such as pediatric and adult dental and vision specialists and women’s health services as a priority community need. Four key informants suggested that improving and expanding the community’s emergency medicine and emergency department facilities should be a priority issue. Additionally, 3 of 30 key informants cited the lack of a nutritional specialist to address obesity across the lifespan as significant absence with regard to improving community health. The third priority health care need for Berkeley County cited by key informants was the need for preventative health care for both well and chronically ill community members. All 30 key informants emphasized the need for improved and expanded community preventative health care. One key informant noted that the community suffered from “generational health care illiteracy,” suggesting that health care professionals must do a better job of educating community members about healthy behaviors. This health care education, encompassing issues such as smoking cessation, moderating alcohol consumption, healthy eating habits, maintaining an active lifestyle, and safe sexual practices must be provided in a tailored, culturally competent method to improve community health. Four key informants suggested prioritizing more preventative and aggressive health care screenings for hypertension, obesity, diabetes, and malnutrition or poor nutrition for all community residents. In summary, the top four issues identified by key informants were:
· access to affordable health care services to all community residents (30 of 30 informants),
· access and availability to general and specialized health care providers, including dental and vision providers (30 of 30 informants),
· improved and expanded community preventative and wellness health care (30 of 30 informants), and
28
· improved community health care education (13 of 30 informants). General Public Surveys In small groups, senior BSN students from our Community Health nursing class at Shepherd University surveyed the general public at local businesses and schools in Hedgesville, Inwood, and Martinsburg from March 1 to 16, 2007. We obtained a total of 400 completed surveys. We identified the participants’ genders and ages based on observation, and asked each individual five survey questions. Each individual’s responses were recorded on a separate survey sheet. All responses were then collected and will be presented in aggregate form. A copy of the survey can be found in Appendix C. The survey questions included:
· What county do you live in?
· What county do you work in?
· In what county do you get your health care?
· What health care services would you like to see available in Berkeley County?
· What do you think is the biggest health care need in Berkeley County? Martinsburg A total of 125 responses were received for the survey done in Martinsburg. Of the respondents, 72 (57.6%) were women and 53 (42.4%) were men. For the purposes of the survey, age groups were divided into teen, young adult (ages 20 to 39), adult (ages 40 to 59), and older adult (ages 60 and over). Of women, 16 (12.85% of total) were teens, 23 (18.4% of total) were young adults, 21 (16.8% of total) were adults, and 12 (9.6% of total) were older adults. Among men, 9 were teens (7.2% of the total), 10 were young adults (8% of total), 27 were adults (21.6% of total), 5 were older adults (4% of total), and 2 men did not specify their age (1.6% of total).
29 Ten of the respondents lived in West Virginia counties other than Berkeley County: six in Jefferson, three in Morgan, and one in Hampshire. One respondent lived in Warren County, Virginia, while five did not specify their county of residence. Forty respondents did not state that they work in Berkeley County, comprising 21 who were not currently working, either because they were teens or because they were retired, 9 others who did not specify in what county they work, and 10 who worked in other counties. Of those, one respondent worked in Frederick County, Maryland, one in Fairfax County, Virginia, and one in Warren County, Virginia, while six worked in Jefferson County, West Virginia, and one worked in a combination of three counties, including Berkeley. Most respondents obtained their health care within Berkeley County. Of those who did not, four went to Maryland: two to Washington County, one to Carroll County, and one to Frederick County. Nine respondents got their health care in nearby Virginia: nine in Frederick County, one in Fairfax County, and one in Warren County. Residents who got health care in West Virginia counties other than Berkeley included two in Morgan and three in Jefferson. Seven respondents did not specify where they received their health care. Respondents were asked what health care services they would like to see in Berkeley County. Among female and male teens, 6 of 25 respondents said they would like to see some sort of sports­related medical treatment facility: physical therapy, sports injury clinic, and trainers were among the answers. Teens also stated a need for specialists, including allergy specialists, to prevent lengthy trips elsewhere for such services. Young adult women mentioned that they would like to see more children’s specialists, orthodontists, dentists, obstetric and gynecological specialists, and specialists in general. Adult women stated that they would like to see more clinics, more general practitioners, a women’s center, fertility specialists, a wellness center,
30 acupuncture, and free medical services. Older adult women said they would like to see more specialists, clinics for low­income residents, and better eldercare facilities. Young adult men expressed a desire for lower cost health care options, specialists, and sports medicine facilities. Adult men also noted that they’d like to see more facilities for low­income residents, more dentists and other specialists, and more programs to teach health promotion and illness prevention. All other men (older adult and unspecified) said they’d like to see more specialists, better technology and emergency care, more health education, and expanded nursing education programs.
Respondents were also asked what they believe is the biggest health care need in Berkeley County. Among 25 male and female teens, 6 responded that the county’s biggest health care need is treatment for orthopedic or athletic injury needs. Teens also indicated a need for mental health promotion, dental and medical insurance, birth control, free care, allergy treatment, and a better hospital and emergency room. Young adult women said the county’s biggest need is more dentists and specialists, child and prenatal care, cancer treatment, obesity and weight management concerns, insurance for the poor and elderly, health promotion, and treatment for substance abuse including tobacco. Adult women saw the most important needs as education and health promotion, clinics and affordable health care, obesity, dental care, specialized care for groups including cardiac patients, substance abusers, and mentally ill individuals. Older women identified lower costs and better benefits, obesity and smoking, diabetic care, communication between Martinsburg City Hospital and Winchester Hospital, specialized care, and eldercare as outstanding needs. Young men ranked costs, obesity, sexually transmitted diseases (STDs), dental needs, and smoking as prime concerns. Among adult men, costs, insurance, physicians accepting new patients and insurance, obesity, smoking, homelessness, eldercare, cardiac care,
31 substance abuse, pediatric needs, and specialized care were identified as primary county needs. Older men pointed out needs for more emergency care, care for elderly and disabled residents, and more physicians. Hedgesville In Hedgesville, 124 persons responded to the survey; 53 (42.7%) were male and 71 (57.3%) were female. Eight respondents (6.45%) were teenagers, 45 (36.3%) were young adults, 45 (36.3%) were adults, and 26 (21%) were older adults. Of the total number of participants, 112 were residents of Berkeley County; the 12 who did not claim Berkeley County residency included 7 from Morgan County; 1 each from Allegany County, Maryland, and Rockingham County, Virginia, and Stephens City, Virginia; and 2 who did not specify. In terms of work location, 47 individuals surveyed did not work in Berkeley County, including 16 who worked in Maryland: 12 in Washington County, 2 in Montgomery County, and 2 in Frederick County. Five respondents worked in Virginia: two in Fairfax, one in Stephens City, one in Loudon County, and one in Arlington. One person who answered the survey worked in Morgan County, West Virginia; another worked in Washington, DC. Fourteen were retired, six were unemployed, one was disabled, and three did not specify. Of the participants, 79 received their health care within Berkeley County, 34 traveled outside Berkeley County for health care, and 11 did not specify where they obtained their health care. When asked about health care services wanted in Berkeley County, 78 participants listed specific concerns, and other participants listed items in general. With regard to specialists needed in the area, 25 individuals listed specific types, with 17 people citing a need for dental care. Cardiac specialized care followed, with a total of nine participants listing it, and five people mentioned a need for cancer specialists. Two people stated a need for neonatal care; dialysis,
32 pain management, obstetrics and gynecology, chiropractic, and dermatology were each listed by one individual. Besides specialty care, respondents’ next cited concern was the lack of physicians located in the Hedgesville area, with 23 participants listing this as a main concern. The need for medical practices to accept more insurance carriers and Medicaid was also an issue listed by 20 individuals. Lack of health education was mentioned by 18 respondents, of whom 7 specified obesity, 4 mentioned substance abuse, 2 stated the need for safe sex education, 3 cited teen pregnancy, and 2 noted HIV awareness. Of those surveyed, nine people expressed concern regarding health care options for the elderly in this area. Three people mentioned the necessity of better emergency department facilities at City Hospital and three mentioned the cost of health care. Other issues that were only mentioned by one person each totaled 17 miscellaneous categories. The data compiled by these surveys done in Hedgesville can be categorized into three main concerns: more area specialists in general, more family practice physicians located in the Hedgesville area, and payment issues related to area medical or dental practices not accepting certain insurance carriers, Medicare or Medicaid, or uninsured or underinsured clients. Inwood A total of 151 participants answered the general public survey in the Inwood community. Of those participants, 80 (52.9%) were female and 71 (47.1%) males, 7 (4.9%) teenagers, 57 (40.4%) young adults, 58 (41.1%) adults, and 29 (20.5%) older adults. Out of the participants interviewed, 127 (90.0%) lived in Berkeley County. When asked if they worked or received health care in Berkeley County 94 (66.6%) responded that they lived in Berkeley County; 108 (76.5%) received their health care in Berkeley County. Survey respondents were asked what health care services they would like to see in Berkley County. Of the respondents, 18 wanted increased dental care services, 13 wanted more
33 affordable health care services and more free clinics, 15 wanted more health prevention education, 17 wanted more primary physicians and specialists in the area, 9 people wanted more vision screenings, 14 wanted walk­in clinics, 10 wanted a better or upgraded hospital, and 6 wanted comprehensive health care. Needs cited by four or fewer respondents each were more rehabilitative services, better child care, more pharmacy help, more single­mom support, more labs or x­ray facilities, more urgent care facilities, assistance for the elderly and disabled, sleep clinics, increased activity choices, more legal support for medical staff, diabetic care, increased food choices, cancer research, and counseling services. Several statements indicated either that the respondent didn’t know what services were needed or that he or she believed that health care in the county was adequate. Next, members of the general public were asked what they believed to be Berkeley County’s biggest health care need. Responses indicated that the largest need was affordable health care, listed by 27 respondents, followed by more education programs for all ages, health problems, and preventative education. Of those surveyed, 17 people believed the biggest health care need was more physicians and specialists in Berkeley County, 13 people identified obesity help as a health care need, and 11 people identified alcoholism and drunk driving prevention and assistance a large need for the county. Ten people said they believe that teen pregnancy prevention was a significant need, and nine people named a need for dental care. Other concerns suggested by the general public that totaled fewer than nine responses each were more public transportation, pharmacy assistance, a newer or better hospital, more cardiac care, better emergency care, more mental health care, increased state funding, increased vision programs, more activities for children, more information about and prevention of sexually transmitted diseases, assistance for gambling addiction, elderly care, illegal drug use rehabilitation programs,
34 hypertension programs, more insurance, diabetes programs, smoking cessation, and violence awareness. In conclusion, out of the 400 respondents, 223 (55.6%) were female and 177 (44.4%) were male. Regarding ages of the participants surveyed, 40 (10.3%) were teenagers ages 12­19, 135 (34.6%) were young adults ages 20­39, 151 (38.7%) were adults ages 40­59, 72 (18.2%) were older adults ages 60 and over, and the ages of 2 (.5%) were not specified. The largest issues identified throughout the community were lack of affordable health care, lack of specialists, need for health promotion and education, need for assistance and rehabilitation programs to deal with substance and alcohol abuse, and lack of resource awareness.
35 CHAPTER 3—DATA ANALYSIS AND IDENTIFICATION OF COMMUNITY NEEDS AND RESOURCES Upon completion of the community assessment, we identified a list of problems and evaluated each problem on six criteria, which included community awareness, motivation to resolve the problem, nurses’ ability to influence the problem, the availability of expertise, severity of outcomes if left unresolved, and the quickness in which each problem can be solved. Each category was given a rating using a scale of 1­5, 1 being “none” and 5 being “extensive.” We then totaled up scores for each category of the problem and used the total number to determine the problem’s priority. The top five problems identified using the total score were prevention and promotion of health, substance abuse, access to affordable health care, awareness of resources, and lack of specialists. See Appendix D for a copy of the matrix. We further narrowed the top five problems to three, by placing the problem list on the board and voting for the two that were the highest priority for the community. The resulting top three priority problems were lack of affordable health care, lack of specialists, and illness prevention and health promotion. Each top priority issue was then analyzed to identify its contributing factors and data supporting the relationship. Concluding each section are potential partnerships that may be formed to solve this issue. Priority Issue 1: Affordable Health Care This section of the paper will discuss the first priority issue, lack of access to affordable health care. The following table provides an overview of factors contributing to the problem, offers supporting data, and concludes with goals and objectives.
36 Issue: Affordable Health Care Factors Contributing to the Problem Health insurance coverage a. Private insurance b. Medicaid c. Uninsured Data to Support the Relationship 1. Several residents reported in general public surveys that area health care providers do not accept their insurance, especially HMOs. 2. In August 2005, 32 % of Berkeley County residents had WVCHIPS or Medicaid (WVCHIP, 2005) 3. It is estimated that another 1,084 uninsured residents qualify. (WVCHIP, 2005) 4. 20.2% of the population of Berkeley County has no health insurance. (DHHR, 2007). Transportation 1. Residents of Berkeley County reported that public transportation is readily available in the city of Martinsburg, but more difficult to acquire in the outlying areas in the county. 2. Many residents also reported being unable to drive to appointments due to their age, medical condition, financial status, etc. Growing population 1. Between April 1, 2000 and July 1, 2005, the population of Berkeley County increased by an estimated 23% (17,489 residents) (U.S. Census Bureau, 2007). As Berkeley County’s population grows, additional residents have come to the area carrying insurance not accepted by local health care providers. In addition, the county’s public transportation system is unable to keep up with increased demands for transport to health care appointments. Also, the volume of people who cannot afford health insurance increases yearly. Without access to affordable health care, the rate of disease and death is sure to increase. To
37 address this issue we must consider potential partnerships that can begin to accomplish change through collaborative efforts. Potential partnerships and actions are suggested in the table below. Topics Partnerships Activity Health insurance coverage Physicians and their practices 1. Practices could participate in accepting more private health insurances 2. Educating patients on what insurances are accepted and what free services are available Transportation Taxicab services PanTran bus 1. Announce transportation schedules by placing schedules in or near health care facilities 2. Make transportation more affordable for patients commuting to and from health care facilities Shortage of general practitioners WVU–East medical students Specialists 1. Berkeley County is a large area in need of practitioners, particularly specialists—help make practitioners more aware of the difficulties that patients face finding health care in the county We have identified a lack of access to affordable health care in Berkeley County. To address this issue we must consider contributing factors: health insurance coverage, transportation, and shortage of general practitioners complicated by a growing population. With the identified potential partnerships we can began to accomplish change through collaborative efforts to achieve affordable health care. By identifying contributing factors and supporting data, we have shown a need for accessible, affordable health care in Berkeley County. A goal for the
38 future might be to make available affordable and accessible health care in a variety of specialties, including dentistry and general practice. Specific, measurable, attainable, realistic, and timely objectives related to this goal could include the following: 1. By 2017, 80% of county residents will receive basic health screenings on a yearly basis. 2. By 2014, the majority of county residents will report delays of no more than three weeks in scheduling primary health care appointments. 3. By 2012, mortality rates from the five major causes of death in Berkeley County will decline to be at or below the target rates set by Healthy People 2010. Priority Issue 2: Lack of Specialty Services This section of the paper will discuss the second priority issue—lack of specialty health service including, dental, mental health, pediatrics, women’s health–OB/GYN, vision, and specialty services such as cardiac, pulmonology, and neurology. The following table will provide an overview of factors contributing to the problem with supporting data and conclude with goals and objectives. Issue: Lack of specialty services Factors Contributing to the Problem Rapid population growth in Berkley County. Data to Support the Relationship 1. The population of Berkeley County increased by approximately 14,000 residents from 2000­2005 (U.S. Census 2000 and 2005 estimate). 2. Higher percentage of Blacks and Hispanics reside in Berkeley County compared to West Virginia (U.S. Census 2000). 3. Many county residents commute to the Washington, DC and Baltimore, Maryland metropolitan areas (public surveys); a major interstate (81) runs through the middle of the county from north to south; other major roads include state routes 9, 45, and 51, and U.S. routes 11 and 340.
39 Increased prevalence of 1. Stroke was the third leading cause of death in the county from1992­ acute and chronic diseases 2001, causing 67.5 deaths per 100,000 residents as compared to the and co­ morbidity factors. national average of 61 deaths per 100,000 persons. 2. Statistics from the WVDHHR website showed that the top five causes of death among West Virginians in the years 1992­2001 were heart disease, malignant cancer, stroke, COPD, and injuries. 3. According to the WVDHHR website, heart disease caused 341.9 deaths per 100,000 people in Berkeley County. This rate is 22.5% greater than the overall United States rate of 279 deaths from heart disease per 100,000 people. Increased number of pregnancies, including teen. 1. According to the National Campaign to Prevent Teen Pregnancy, West Virginia ranked 16 th in the nation in 2000 for pregnancies occurring between the ages of 15 to 19. 2. The West Virginia pregnancy rate was 67 per 1000 compared to the United States rate of 87 per 1000 in 2000. Malpractice insurance costs and lawsuit payouts with no state caps. 1. A recent survey of West Virginia physicians revealed that more than 40% were considering moving out of West Virginia and more than 30% were thinking of quitting medicine altogether (McCammon, 2007). 2. West Virginia has lost more than 300 physicians in the past few years and applications to the state's allopathic medical schools are down by as much as 40%, according to the West Virginia Board of Medicine (McCammon, 2007). 3. Medical Assurance, one of the state's leading malpractice insurance carriers, reported a significantly greater frequency of lawsuits against West Virginia physicians as compared to other states in which they operate (McCammon, 2007). 4. The average payout for each plaintiff verdict ($490,000) was more than twice the national average. This amount was primarily due to a greater frequency of jury verdicts in excess of $1 million in West Virginia as compared to other states (McCammon, 2007). Increased health care infrastructure and increased resources regarding research, facilities, technology 1. According to the community health assessment, health care access is primarily located in Martinsburg. 2. Hedgesville and Inwood have a limited number of primary, secondary, and tertiary health care centers.
40 3. Of the key informants, 96% indicated they would like to see broader public transportation access to health care facilities. 4. Key informants and members of the general public indicated that they would also like to increase access to specialized health care services such as dental and vision care, women’s health, and pediatric dentists; and improved and expanded behavioral and substance abuse rehabilitation and treatment facilities within the Berkeley County area. Reimbursement for services (insurance, Medicare) 1. The U.S. Census 2003 estimate showed the individual poverty status for West Virginia as 16%, U.S. 13%, and Berkeley County at 12%. 2. The median family income in Berkeley County was $43,300 compared with $32,967 in West Virginia from the 2003 U.S. Census. 3. Approximately 33,000 Berkeley County residents enrolled in Medicare in 2003 (Medicare Enrollment Reports, 2005). 4. All key informants interviewed mentioned the lack of affordable health care as a major issue of concern, and they stated that providing health care for all residents was a priority community health issue. Substance abuse 1. Smoking tobacco contributes to 80 to 90% of all COPD cases (Healthy People 2010, 2000). 2. In Berkeley County, 32% of residents smoke, making the county seventh in the state for number of smokers (1999 Berkeley County behavioral prevalences, 2004). 3. According to the 1999 Berkeley County Behavioral Prevalence chart (2004), 7.4% of Berkeley County residents were binge drinkers. 4. In the general public survey, 11 people identified alcoholism and drunk­driving prevention as a large need for the county. The findings from the community assessment indicate that there are many contributing factors leading to the issue of lack of specialty services in Berkeley County. This issue encompasses a lack of dental, vision, mental health, pediatric, women’s health, and specialty physicians such as cardiac specialists, pulmonologists, and neurologists.
41 The goal for this priority health issue is to increase the presence of specialty health services throughout Berkeley County. To achieve this goal, several community organizations could join together and form partnerships. Examples of potential partnerships focusing on increasing the presence of specialty health services are shown in the table below. Topics Dental health Potential Partnership West Virginia University (WVU) Eastern Division Berkeley County Schools Eastern Panhandle Oral Health for Kids Berkeley County Health Department Shepherd University Department of Nursing Education Activity 1. Bring mobile dental van/equipment to area. 2. Local dentists provide treatment 3. The nursing team and students triage patients, take patient history, and provide education. Vision 1. Allegheny Optical 2. Sears, Wal­Mart 3. Local optometrists and ophthalmologists 4. Berkeley County Schools and Parent­Teacher Organization 5. Berkeley County Health Department 6. WVU–Eastern Division 7. Shepherd University Department of Nursing Education 8. Lion’s Club 1. Set up screening at local schools 2. Medical students and nursing students take patient history and triage patients, screening by asking questions and collecting data. 3. Refer to local optometrists as needed for follow­up. 4. Work with Lion’s Club to obtain donated glasses Women’s health (OB/GYN) 1. Berkeley Health Department 2. Shenandoah Valley Medical System, Inc. (SVMS) 3. Local physicians, City Hospital– WVU East 4. Physicians, Veterans Affairs Medical Center 1. Offer OB/GYN clinic in Inwood and Hedgesville 1­2 days a week 2. Berkeley County Schools— education for pregnant teens 3. Support groups
1. 2. 3. 4. 5. 42 Pediatrics 1. Berkeley County Health Department 2. Local family practice physicians, pediatricians, nurse practitioners, City Hospital–WVU East 1. Set up area satellite clinics through these partnerships 1­2 days weekly or monthly to provide screening 2. Set up community programs provided by school nurses, nursing students, health department, community health center, etc. Mental health 1. Gateway of City Hospital 2. Berkeley County Health Department 3. Local therapists, psychologists, and psychiatrists 1. Set up sessions in local area twice weekly. 2. Work with nursing home and rehabilitation centers to accommodate patients 3. Encourage patients with alcohol dependency to attend Alcoholics Anonymous As our data have shown, many factors contribute to the scarcity of specialized health care providers in Berkeley County. Planning for the future must include the goal of increasing the number of specialized providers who serve in the county. Relevant objectives include: 1. By 2017, the ratio of specialists to county residents will be proportionate to the increasingly specific health care needs of the population. 2. By 2014, 50 % more specialists whose main practice is outside the local area will set up satellite clinics in Berkeley County. 3. By 2012, the majority of county residents who require specialized medical treatment will report that the treatment they need is available within the county. Priority Issue 3: Health Prevention and Promotion This section of the paper will discuss the third priority issue, lack of health promotion and illness prevention services. The following table will provide an overview of factors contributing to the problem with supporting data and conclude with goals and objectives.
43 Issue: Lack of Health Promotion and Illness Prevention Services Factors Contributing to the Problem Educational level Data to Support the Relationship 1. Approximately 22% of Berkeley County residents have less than a 12 th grade education (2000 US Census). 2. Increasing percentage of Spanish­speaking residents in Berkeley County (2000 US Census) 3. Berkeley County ranked ninth in the state for <12 years of education among mothers (Berkeley County 1997­2001 selected birth statistics, 2004). 4. Berkeley County residents are unaware of relationships between lifestyles and physical illnesses according to the WVDHHR (2000). Lack of access to health promotion and illness prevention activities. 1. Majority of health care services are centralized in Martinsburg and not spread throughout the county. 2. Lack of sidewalks. 3. Times available for medical services, other than the ED, are mainly limited to daytime hours. 4. PanTran bus transportation is available only in Martinsburg with limited services to other areas of Berkeley County. 5. Limited transportation services available to homeless and unemployed or underemployed residents, and migrant or seasonal farm workers. 6. Health care agencies providing transportation services including SVMC and City Hospital. 7. Limited taxicab services. Lack of knowledge and awareness regarding: a. Exercise b. Mental health issues and treatment c. Obesity 1. 31% of Berkeley County residents reported being inactive (WVDHHR). 2. According to WV Healthy People 2010 goals, there is a shortage of recreational facilities in Berkeley County. 3. Healthy People 2010 included a goal to improve mental health care for adults and children by increasing family­focused and community­based care. 4. The need for increased development of long­range strategic communications to promote key public health issues was advanced in WV Healthy People 2010. Lack of health insurance; uninsured or underinsured. 1. 20% of the residents of Berkeley County did not have insurance (WVDHHR). 2. The percentage of people on work disability is twice the national average (WVDHHR). 3. 32% of Berkeley County residents (age 5­64) are disabled (2000 U.S. Census).
44 4. Since the WVCHIP first reviewed children for Medicaid eligibility, another 20,000 may possibly qualify but aren’t enrolled (WV Chip Enrollment Report, 2005). 5. Berkeley County unemployment rate in 2007 was 4.7% (Mapstats, Feb. 2007). 6. Median family income of Berkeley County residents is $43,000 (Mapstats, Feb. 2007) with the average household size being 2.99 people (2000 U.S. Census). 7. 11% of Berkeley County residents are over age 65 (Berkeley County Quickfacts from the U.S. Census Bureau, 2007). 8. Lack of health insurance and inability to self­pay are significant factors that hinder preventative, prenatal, and pediatric health care. Morbidity rates 1. Heart disease, cancer, stroke, COPD, and injury rates are higher than the national average (Berkeley County selected causes of deaths 1992­2001). 2. Rate of heart disease in Berkeley County is 22.5% higher than the national average (WVDHHR). 3. 32% of Berkeley County residents smoke (WVDHHR). 4. The death rate from diabetes is 10% higher than U.S. average (WVDHHR). 5. Inactivity, hypertension, obesity, tobacco, and alcohol are significant contributors to leading causes of death in Berkeley County. Both lack of services and residents’ personal behaviors contribute to a scarcity of health promotion and illness prevention activity in the county. Related concerns are sexually transmitted diseases (STDs), obesity, smoking, lack of health screenings, and substance abuse. Patients’ lack of education, access, knowledge, and money are major contributing factors. The following table identifies potential partnerships that could focus on health promotion and illness prevention for county residents.
45 Topics Partnerships Activity Sexually transmitted diseases 1. The Living Room Free Clinic 2. AIDS network 3. Shenandoah Valley Medical System, Inc. 4. Berkeley County Health Department 5. City Hospital–WVU East 6. Berkeley County Public Schools 7. Shepherd University Department of Nursing Education students 8. Medical students having clinical rotations in the Eastern Panhandle 1. Offer STD testing at satellite clinics four times a year. 2. Health education for middle­ and high­school students about STDs. 3. Offer culturally diverse educational tools on safe sex practices. 4. Walk­in clinics at health departments three times a week. 5. Provide educational material, available in English and Spanish, in all area health care settings, including homeless shelters and migrant farm camps. Health screenings 1. Emergency medical services 2. Pharmacies 3. Shenandoah Valley Medical System, Inc. 4. Berkeley County Health Department 5. Churches 6. The Living Room Free Clinic 7. Shepherd University Department of Nursing Education 8. Berkeley County Public Schools—school nurses 9. WV Cardiac Kids 10. Parish nurses 1. Place announcements for free screenings in newspapers and on the radio. 2. Offer blood pressure screenings, cholesterol checks, and blood glucose checks at local schools, pharmacies, and stores on a monthly basis. 3. Offer educational material that is culturally diverse and written below an 8 th grade reading level. 4. Refer residents with high BP to health care agencies that provide free care and medication. 5. Teach preventative measures in schools. Obesity 1. Fitness or wellness centers 2. Dietician or nutritionist 3. Berkeley County School System 4. Berkeley County Parks and 1. Fitness centers could offer discount or free days 2 times a week. 2. Nutritionist or dietician to give counseling at the
46 Recreation 5. Berkeley County Health Department 6. WV Kids in Action 3. 4. 5. 6. Berkeley County Health Department. Schools offer nutritional options for meals and education on healthy eating. Berkeley County Parks and Recreation offer recreational activities several times a month. Berkeley County Health Department to offer screenings on obesity once a month. Children who are overweight are referred to WV Kids in Action. Smoking 1. Berkeley County Health Department 2. Berkeley County Schools 3. City Hospital—education department 4. Area cardiologists and pulmonologists. 5. Shenandoah Valley Medical System, Inc. 6. Churches 7. Big Brother/Big Sister 8. American Lung Association 1. Offer free or low­cost smoking cessation programs made available thru health care facilities every 3 months. 2. Offer tobacco education program (schools, SVMS, and City Hospital) on the effects of tobacco and about use and abuse of tobacco. 3. Support groups (SVMS, churches, Health Department) established once a month. 4. Weekly mentoring programs through Big Brother/ Big Sister and churches in the area. Substance dependency 1. 2. 3. 4. 5. 1. Police, past substance abusers, RNs, and role models visit and educate in schools about effects of substance abuse. 2. Provide treatment and screenings at free clinics. 3. Substance abuse hotline. 4. Offer support groups for individuals and families.
Berkeley County Schools Churches Police departments Health Department Veterans Affairs Medical Center 6. The Living Room Free Clinic 7. Community activists 8. Alcoholics Anonymous 47 and Al Anon 9. SVMS Behavioral Health 5. Distribute educational materials and resources in at­risk community areas. 6. Provide language­ and reading­level–appropriate educational resources.
The information we analyzed has also demonstrated a definite lack of health promotion and illness prevention activity and services in Berkeley County. A relevant goal is to increase availability and awareness of such activities and services. Related objectives could include: 1. By 2009, at least one wellness center will be established in the county, with ancillary clinics conducted by center staff at selected outlying locations on a bimonthly basis. 2. By 2008, a media campaign to educate the public about behaviors that lead to illness prevention and wellness promotion will be conducted through local television, radio, and newspaper outlets, with internet links and billboards providing further promotion aimed at selected demographic groups such as teens and non­English speaking residents. Summary In summary, the top three priority issues we identified included lack of affordable health care, lack of specialty services, and needs in the area of health promotion and illness prevention. We also gave examples of potential partnerships that could be formed to effectively address each of these broad issues. Finally we identified pertinent goals and specific, measurable, attainable, realistic, and timely objectives to guide progress toward those goals. 48 CHAPTER 4—CONCLUSIONS AND RECOMMENDATIONS Assessment of the health needs of Berkeley County led to recognition of three general problem areas related to health care in the county. These areas included lack of affordable health care, lack of specialty services, and lack of services focused on health promotion and illness prevention. A focus on improvements in these areas is key to moving toward the overall goals of Healthy People 2010, which include increasing the years of healthy life and eliminating disparities in health care for county residents. We found a lack of affordable health care to be a significant concern for county residents. The problem was exacerbated by practitioners who did not accept particular insurance coverage, who did not participate with Medicaid, or who were simply too busy to meet the health care needs of a rapidly expanding population. In addition, the county has a significant number of people who are uninsured or underinsured. Further compounding the problem of access to affordable health care was the lack of health care providers who offer flexible scheduling that could accommodate the needs of working families. Transportation, especially for elderly and disabled residents and residents of outlying areas, also added to the problem of access. As we plan for the future of health care in the county, it is imperative to set a goal related to increasing access to affordable health care for county residents. Simply stated, this goal might be to make available affordable and accessible health care in a variety of specialties, including dentistry and general practice. Objectives could include the following: 1. By 2017, 80% of county residents will receive basic health screenings on a yearly basis. 2. By 2014, the majority of county residents will report delays of no more than 3 weeks in scheduling primary health care appointments.
49 3. By 2012, mortality rates from the five major causes of death in Berkeley County will decline to be at or below the target rates set by Healthy People 2010. A second problem that we identified is the lack of availability of specialized health care providers in Berkeley County. One explanation for the disproportionate access of specialty care could be that the number of specialists serving the county has not kept pace with the county’s rapidly increasing population size and demographic changes. In addition, the increasingly specialized and illness­specific nature of 21 st century health care requires more highly trained providers to meet the needs of county residents. An overall goal related to this problem is to increase the number of specialized health care providers who set up practice within Berkeley County. Relevant objectives supporting this goal include: 1. By 2017, the ratio of specialists to county residents will be proportionate to the increasingly specific health care needs of the population, e.g., more cardiologists will be available to care for the needs of county residents with cardiovascular disease, more oncologists will practice locally, and more dental practitioners will open clinics in various areas of the county. 2. By 2014, 50 % more specialists whose main practice is outside the local area will set up satellite clinics in Berkeley County. 3. By 2012, the majority of county residents who require specialized medical treatment will report that the treatment they need is available within the county. A third problem identified by our assessment is two­pronged: lack of health promotion services and lack of illness prevention services. The problem, which is really two sides of the same issue, leads to many of the behaviors and conditions that predispose county residents to illnesses such as heart disease, certain cancers, lung problems, and diabetes. Our research and
50 surveys have shown that tobacco use, obesity, a sedentary lifestyle, and lack of awareness about the relationship of behaviors to overall health are common risk factors for illness in the county. A goal that encompasses both the lack of health promotion and illness prevention services is simply to increase residents’ awareness of behaviors that lead to these factors by increasing the availability and awareness of such services. Related objectives could include: 1. By 2009, at least one wellness center will be established in the county, with ancillary clinics conducted by center staff at selected outlying locations on a bimonthly basis. 2. By 2008, a media campaign to educate the public about behaviors that lead to illness prevention and wellness promotion will be conducted through local television, radio, and newspaper outlets, with internet links and billboards providing further promotion aimed at selected demographic groups such as teens and non­English s peaking residents. Collaboration with partners in Berkeley County has underlined the importance of goals and objectives such as those outlined above. Members of the general public and key informants who understand the county, its residents, and their needs have confirmed that affordable, accessible health care, specialized services to meet increasingly complex treatment regimens, and a combination of illness prevention and health promotion services are critical needs for Berkeley County residents both now and in the future. To initiate changes to meet emerging health care needs of county residents will require both vision and determination. Vision depends on the ability to view the county as it presently is and as it is becoming: no longer a rural backwater with a largely agrarian demographic, but as a rapidly growing suburban area located within commuting distance of several urban hubs, with an
51 informed population that will demand accessible, affordable, and expert primary and specialized health care to meet present and future needs. Vision must also entail seeing those needs and providing disease prevention and wellness promotion services to residents who may not yet be aware that such needs exist. Determination to carry goals through to completion can be bolstered by support from thoughtful community members who recognize health care needs and possible solutions. It can also be maintained by focusing on the overarching goals of West Virginia Healthy People 2010 and Healthy People 2010, which call for ongoing efforts toward increasing years of healthy life and reducing health care disparities for all residents.
52 APPENDIX A—WINDSHIELD SURVEY RAW DATA Martinsburg Boundaries: *I­81 (west); Route 9 East (southeast); railroads (north, east); Rt. 45 (south); 5­mile city radius; neighborhoods within the city were not distinguishable Housing and zoning: *older well­maintained Victorian, Georgian, Colonial, Italianate, Queen Anne, Gothic style houses on King & South Queen Streets *trash in yards on North Queen Street *old row houses in poor condition on side streets *mix of residential and commercial space; stores downtown with low­income apartments above them * historic neighborhood and buildings in town *newer houses and subdivisions on outskirts of town *abandoned homes along Rt. 9 east (condemned for road construction?) *2 trailer parks *Outlook Pointe assisted living apartments *Historic areas: Apollo theatre, Belle Boyd House, Boydville, Adam Stevens House, B & O Railroad buildings *Martin’s Landing subsidized housing development *Habitat for Humanity houses near low­income development *auto­repair garages in backyards *not many for sale signs in newer home areas Open space: *small yards for many in­town houses *low­income development has little open space or yard space *fairgrounds off Rte. 9; RV park and picnic ground by river on Rt. 9 *proposed bike path along Rt. 9
53 * 5+ cemeteries “Commons”: *restaurants *Elks’ lodge *Orioles clubhouse *softball field and tennis court *Faulkner Park; Lambert Park; War Memorial park *Public library courtyard *Martinsburg High school­­sporting events *playgrounds *church courtyards *Boys’ and Girls’ Clubs *shopping areas and mall Transportation; *Rt. 9 East congested but signs of road expansion—engineers’ trailers, surveyors’ markers *2 taxi companies *PanTran bus public bus system *Senior Service Center van *Shenandoah Valley Health System handicapped transportation *sidewalks; handicapped parking spaces in lots and on street *MARC train to DC; Amtrak station *sign to airport on Rt. 9 *proposed bike path Service centers: *4+ attorneys’ offices *Humane Society *2 city fire stations
54 *1 volunteer fire station (Rt. 9) *jail *Social Security office *Department of Health and Human Services *Rescue Mission, John Street *Homeless Shelter * Bethany House; Shenandoah Women’s Center for battered women and children *C­CAP (Church­sponsored)—rent, grocery, medical, and utility assistance *Senior Service Center *federal police at VA Center *ATF *FBI and drug task force agents *Berkeley County Sheriff’s Dept. *Martinsburg Police Dept. *city water works *1 high school *1 middle school *several elementary or intermediate schools * Berkeley County Board of Education *bail bondsman *courthouse *county animal control center *Blue Ridge CTC; Mountain State University Stores: *small businesses and specialty stores in residential areas; florists, restaurants, clothing and specialty stores downtown; 3 art galleries; Cherry Bomb tattoo shop/piercing shop and Variety Adult bookstore located near historic area; Mall; Wal­Mart; furniture stores; pawn shop; gas stations and car washes; palm reader; sporting goods store; thrift shop
55 People observed: *White middle­age man pushing shopping cart *children led by a nun *woman power­walking *men in business suits *White men in jackets outside Federal building *teenage boy riding bike without helmet *White woman delivering paper *Adelphia repair man *4 police officers on foot patrol *elderly woman holding cat on bench in library courtyard, surrounded by bags that appear to hold clothing *Hispanic man on pay phone, smoking *beauty school students talking and smoking *3 older men—1 Black and 2 White—standing and smoking *young men standing and smoking outside piercing shop *many obese people Signs of decay: *2+ handwritten “Beware of Dog” signs *holiday decorations left up *“Keep out” signs *signs for security system (all in or near low­income housing) *trash in yards on North Queen Street *spray paint, vandalism, broken windows, and damaged cars in subsidized housing area *run­down houses and fences on side streets *general aura of decay of in­town homes on side streets Race: predominately White; near Martin’s Landing—Black and Hispanic Ethnicity: billboard in Spanish; Mexican restaurants and grocery store (Mi Mercadito)
56 Religion: *Roman Catholic church with parochial school and other office buildings *many Protestant churches, with large denominational churches on main streets, smaller independent churches on back streets and along Rt. 9 *Beth Jacob Synagogue *Jehovah’s Witness hall Health and morbidity: *Veterans Affairs Medical Center (Rt. 9 East) *Carehaven Nursing Home *Heartland Nursing Home *City Hospital (WVU­affiliated) *many primary physicians’ and specialists’ offices near City Hospital; Shenandoah Valley Medical Health System *EastRidge Health Systems *Berkeley County Health Department *Panhandle Home Health Service *sign in window of rundown house—“Oxygen in use” *pharmacies *urgent care center *dialysis center Politics: Children’s Art Against Iraq display at elementary school, lots of American flags on businesses Media: *radio—WEPM, WRNR; WHAG TV (Hagerstown) *Adelphia Cable (city government info on channel 17) *The Journal Martinsburg daily newspaper *outdoor television antennas or satellite dishes on many homes *many advertising billboards, including some with public service messages promoting tooth brushing and HIV prevention
57 Hedgesville Boundaries: *eastern boundary of Hedgesville starts at James Rumsey technical school *west extends to the Post Office on Route 9 *northern boundary extends to the train tracks on Route 901 *southern boundary extends approximately 100 yards south of Route 901. Housing: * abandoned buildings and homes * neighborhood: Tomahawk Run—three­story homes; 7 big homes * small trailers right beside the nice development * some new homes being built: Cedar Creek * a lot of homes for sale * a lot of A­frame homes * Timber Ridge housing development * house with an outhouse * boarded­up homes on Mauve Road Open Space: *several wide­open fields *playgrounds *open area in front of intermediate school “Commons”: *19 th hole: small bar * Lone Star bar and grille * Burger King Transportation: *school buses *personal cars
58 *bicycles Stores: * Hedgesville Professional Tattoo *7­ Eleven *Stone Brook Village *Lone Star Bar and Grille *Food Lion *Burger King *Citgo *Dollar General *BB&T bank *Friends Hair Cutters *19 th Hole: small bar *RV repair shop *Wood contracting business *Carlo Kelly, public accountant *Country Quick Shop *NASCAR store going out of business *Hair salon: Jane’s House of Hair *3 used car lots *U.S. Post Office Services: *dentist office *family medicine office *volunteer fire station *counseling services *town dump
59 Religion: *Roman Catholic church * Episcopal church *Baptist church * Independent church * Presbyterian church *Mount Zion church Race: *mostly White people seen Signs of decay: *run­down houses *many new houses and newer developments going up Inwood Boundaries: Area encompassing Bunker Hill, Tabler Station Road, Routes 9 and 11, interstate 81 Housing: *ages of the housing ranges from approximately 50 years to brand­new *some are still being constructed *housing was constructed using wood, siding, brick *a couple of houses looked like log cabins, made with logs instead of lumber * a few older neighborhoods were all similar in age as well as the newer developments * some neighborhoods had newer houses mixed in with older ones * architecture varied depending on the time period they were built * older neighborhoods had a couple different types of houses repeated in the development; the same thing is done in the newer developments * Colonials, Cape Cods, townhouses, ranchers, a couple trailer parks, some trailer homes set on foundations, and split­foyer houses.
60 *most houses detached but some older houses had additions; either to make the house bigger or add a garage * space in front or behind the house varied * older developments have more space in the back yard and are set closer to the road * in the newer developments, larger lots, houses set back a little more on the lot * general condition of the houses varied; some older neighborhoods look as if the houses have been kept up *other neighborhoods have houses in disrepair * newer developments in good condition * houses in disrepair have some missing screens and broken storm doors Open Space: *amount—very minimal amount of open space in town was observed towards Bunker Hill, and Tabler Station Road more space for farm land, animal raising and breeding *quality—in­use land is well­maintained but most open space is farm land *lot size—in town ranging from quarter­acre lots to half­acre *outside of town starting at half­acre to well over 6 acres “Commons": *Musselman High School sports and events: events held in the evenings, Saturdays. Activities at the high school are territorial, and most of the town attends. *church activities: held through the week, and weekends, non­territorial, and open to strangers *bars: Some open in the afternoon, and closing between 2­3 a.m. Transportation: *most people use private automobiles. *very limited regional bus service available. *no identified foot path or walkways outside of neighborhoods; streets are generally paved and surfaced because of intensive use of private automobile, major roads and intersections are in relatively good condition *limited cracking and potholes *street markings/signs are not well lit. *major roads are identified by street signs and overhead signs
61 * limited traffic signals, most at major intersections but most were yield and 4­way stop signs *PanTran (the Eastern Panhandle Transit Authority), the non­profit public transit provider for Berkeley, Jefferson and Morgan, operates 51 fixed­route bus services Monday through Saturday. At the present time PanTran only serves Berkeley and Jefferson counties and has limited services in southern Berkeley County. *on­demand taxi service and shuttle is available for transport to the area’s hospital facility Service centers: *social centers included banquet hall with restaurant catering (no clients) *middle schools and elementary school * physician and dentist offices­­Urgent Care, Inwood Family Medicine, 2 dentist offices, Guardian Home Care Services (24­hour home care) *Parks­­football complex and baseball complex at local high school; Edgewood Manor historical property used for parties and weddings. *recycling drop­off center behind Food Lion for scrap metal, lumber, yard waste. *community library located at Musselman High School *storage bins areas Stores: *major shopping centers are located in Martinsburg, and Winchester; both within 25 minutes by highway. *local stores consist of cosmetologists (nail, hair, tanning etc.) and Paterson’s Pharmacy, which works side by side with the Shenandoah Valley Medical System. *Many real estate offices. Religion: * church denominations are Episcopalian, Roman Catholic, Four Corner, and Methodist. Health and Morbidity: *nearest hospital is City Hospital in Martinsburg about 15­20 minute drive and Winchester Medical Center in Virginia, about a 20­30 minute drive. Media: *many antennas seen, but residents confirm local cable, such as Adelphia. *numerous satellite dishes
62 *newspapers such as The Journal [Martinsburg], Hagerstown Herald Mail, Winchester Star, and USA Today can be bought in stands. Signs of decay *in general, neighborhoods on the way up; new houses being built; signs of other construction. * some abandoned cars not being used in some of the older houses’ side yards or in the back * a couple abandoned houses (falling apart, not inhabitable) * no visible trash. *no political posters or neighborhood meeting posters. * no zoning laws in Berkeley County so there could not be mixed zoning usage.
63 APPENDIX B—LIST OF KEY INFORMANTS American Red Cross, Berkeley County Chapter Arvon, Manny Superintendent of Berkeley County Schools Bivons, Lisa Administrator, Panhandle Home Health Brooks, Hillary Social Worker with the AIDS Network Byers, April Legal Assistant Carbin, Dorothy Clerk of Session, Tomahawk Presbyterian Church Catlett, Mary Sue Mayor of Hedgesville Cincinnati, Joseph, MD President of Medical Staff, City Hospital Cogswell, Margaret, RN Executive Director, Hospice of the Panhandle Coleman, John Pastor, Valley View Church Corbin, Barbara Director of Marketing, VA Medical Center Johnson, Deputy Berkeley County Sheriff Department Drumond, Rex Paramedic Fant, David Executive Director, Shenandoah Valley Medical Systems, Inc.
64 Fox, Lori, RN Nursing Coordinator, East Ridge Health Services Frye, Doug Vice President, C­Cap and Fishes & Loaves Grove, Ed Pastor, Trinity United Methodist Church Groves, Micheal, RN, MGA, CNAA Vice President of Nursing, City Hospital Henning, Myke, RN Berkeley County School Nurse, Hedgesville High School Holland, James Principal, Musselman Middle School Jacques, Shirley President, C­Cap and Fishes & Loaves Jenkins, Vicki Director/Principal, James Rumsey Technical Institute Jones, Chris Youth Pastor, Hedgesville Assembly of God Karos, George Mayor of Martinsburg King, JoAnne, RN Berkeley County School Nurse, Tomahawk Intermediate School McGoff, Edythe, RN Emergency Department Manager, City Hospital Miller, Jonathan Delegate Reimer, Doris, RN Director for Special Populations, Shenandoah Medical Center
65 Riggleman, Alicia Second­grade teacher, Tuscarora Elementary School Rinard, Mary Jane, RN Berkeley County School Nurse, Eagle and Orchard View Intermediate Schools Schmidt, Nancy Project Director, Shalom Resource Center Traux, Robin Director, West Virginia Kids in Action Walter, Susan Chair, Service Work Group, Health & Human Services Collaborative Wilscher, Vicky Executive Director, CASA
66 APPENDIX C—BERKELEY COUNTY KEY INFORMANT SURVEY Name:________________________________________________________________________ Title:_________________________________________________________________________ Person conducting interview ______________________________________________________________________________ 1. What additional health care services would you like to see available in Berkeley County? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. What do you think are the three priority health care needs for this are of Berkeley County? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Other information: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
67 APPENDIX D—GENERAL PUBLIC SURVEY BERKELEY COUNTY KEY INFORMANT SURVEY (GENERAL PUBLIC) Person conducting interview:_____________________________________________________________ Date:________________________________________________________________________________ Place: _______________________________________________________________________________ Based on your observation, what are the key informant’s: • Gender o Male___________ o Female_________ • Approximate age group: o Teenager______________________ o Young adult (20–39)____________ o Adult (40–59) _________________ o Older adult (60 and over) ________ Questions: 1. What county do you live in? _____Berkeley _____ Other: Specify:_____________________________ 2. What county do you work in? _____Berkeley ____Other: Specify: _____________________________ 3. In what county do you get your health care? ___Berkeley __Other: Specify: _____________________ 4. What health care services would you like to see available in Berkeley County? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 5. What do you think is the biggest health care need in Berkley County? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
68 APPENDIX E—PRIORITY MATRIX Rating Scale: 5­­extensive 4­­much 3­­some 2­­little 1­­ none Problem Community awareness of problem (Interest) Community motivation to resolve the problem (Importance) Nurse’s ability to influence problem (Advocacy) Availability of expertise relevant to problem resolution (Partnership) Severity of outcomes if problem is left unresolved (Outcome) Quickness with which problem can be solved (Feasibility) Total score Lack of dental care 5 4 1 2 4 2 18 Lack of specialists 5 5 2 3 4 2 21 Access to affordable health care 5 5 2 4 5 3 24 5 Illness prevention/health promotion 5 5 5 5 3 28 Teen pregnancy 3 3 5 4 3 2 20 Substance abuse 5 5 4 4 4 3 25 Improved ED and EMS 4 3 2 3 4 2 18 Transportation to 3 health care 4 4 4 3 3 21 4 4 4 4 3 3 22
Awareness of resources 69 APPENDIX F— SHEPHERD UNIVERSITY DEPARTMENT OF NURSING EDUCATION FACULTY AND STUDENTS WHO PARTICIPATED IN THIS ASSESSMENT Faculty: Kathleen B. Gaberson, PhD, RN, CNOR, CNE, Department Chairperson; Charlotte Anderson, RN, PhD; Laura Clayton, RN, PhD; Victoria Greenfield, RN, BSN Students: Karen Bitner, Nicola Blake, Sarah Bunting, Ashley Campbell, Jessa Coelho, Letasha Combs, Kristin Cramer, Lauren Cunningham, Erin Dodge, Donald Fon, Masako Griffith, James Hazelip, Racheal Kelly, Crystal King, Jackie Mattingly, Jennifer Miller, Katie Moffett, Roderick Moore, Alicia Perez, Casey Perry, Kristin Porter, Summer Riddle, Vicki Rigot, Helen Safdie, Bridget Sanders, Julie Scherpt, April Smith, Holly Snyder, Kathy Warren, Amber Yourstone
70 REFERENCES Berkeley County 1999 behavioral prevalences. (2004). West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from http://www.wvdhhr/org/bph/oehp/hsc/profiles2004/cp02d.htm Berkeley County 1997­2001 infant and fetal mortality. (2004). West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from www.wvdhhr.org/bph/oehp/hsc/profiles2004/cp02e3.htm Berkeley County 1997­2001 selected birth statistics. (2004). West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from www.wvdhhr.org/bph/oehp/hsc/profiles2004/cp02e2.htm Berkeley County 1992­2001 selected causes of deaths. (2004). West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from http://www.wvdhhr.org/bph/oehp/hsc/profiles2004/cp02b1.htm Berkeley County Quickfacts from the U.S. Census Bureau. (2007). U.S. Census Bureau. Retrieved April 15, 2007, from http://quickfacts.census.gov/qfd/states/54/54003.html Doherty, W. T. (1972). Berkeley County, USA.: A bicentennial history of a Virginia and West Virginia county, 1772­1972. Parsons, WV: McClain. Gardiner, M. H. & Gardiner, A. H. (1938). Chronicles of Old Berkeley: A narrative history of a Virginia county from its beginning to 1926. Durham, NC: Seeman Press. Medicare enrollment reports. (2005) U. S. Department of Health and Human Services Centers for Medicare and Medicaid Services. Downloaded on April 27, 2007, from http://www.cms.hhs.gov/MedicareEnrpts/ Map Stats (January, 2007), Retrieved April 4, 2007, from http://www.fedstats.gov/qf/states/54/54003.html McCammon, K. (n.d.) The medical liability crisis. Retrieved April 4, 2007, from http://www.haciendapub.com/mccam3.html National Campaign to Prevent Teen Pregnancy, Retrieved March 26, 2007, from http://www.teenpregnancy.org/america/statisticsDisplay.asp?ID=38sID=18
71 Percentage of million­dollar homes nearly doubles since 2000. (2005). U.S. Census Bureau News: Median Housing Values Continue to Rise, Census Bureau Reports. Retrieved April 4, 2007, from http://www.census.gov/Press ­Release/ www/releases/archives/ american_community_survey_acs/004974.html Simmons, L. (n.d.) Berkeley County, West Virginia. 2 nd ed. Shepherdstown, WV: Explore Maps U. S. Department of Health and Human Services (2000). Healthy people 2010. McLean, VA.: International Medical Publishing. West Virginia Adolescent Pregnancy Prevention Initiative. (n.d.) West Virginia Department of Health and Human Resources. Retrieved March 26, 2007, from http://www.wvdhhr.org/appi/stats WV Chip enrollment report. (2005). WVCHIPS. Retrieved April 14, 2007, from http://www.wvchip.org/2007%20documents/county%20count%2033007 West Virginia healthy people 2010. (2001). West Virginia Bureau for Public Health. [Electronic version.] Retrieved April 4, 2007, from http://www.wvdhhr.org/bph/hp2010/objective/final2010.pdf West Virginia monthly high incidence communicable disease IDEP surveillance data Jan 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/monthlyData/Monthly_Data_Jan_2006.pdf West Virginia monthly high incidence communicable disease IDEP surveillance data Feb 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_Feb_2006 .pdf West Virginia monthly high incidence communicable disease IDEP surveillance data Mar 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_Mar_2006 .pdf West Virginia monthly high incidence communicable disease IDEP surveillance data Apr 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved on April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_Apr_2006 .pdf
72 West Virginia monthly high incidence communicable disease IDEP surveillance data May 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved on April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_May_2006 .pdf West Virginia monthly high incidence communicable disease IDEP surveillance data June 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved on April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_Jun_2006 .pdf West Virginia monthly high incidence communicable disease IDEP surveillance data July 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved on April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_July_2006 .pdf West Virginia monthly high incidence communicable disease IDEP surveillance data August 2006. (n.d.) West Virginia Department of Health and Human Resources. Retrieved on April 4, 2007, from http://www.wvdhhr.org/idep/pdfs/idep/MonthlyData/Monthly_Data_Aug_2006 .pdf West Virginia vital statistics 2004 Annual Report. (2006). Retrieved April 4, 2007, from http://www.wvdhhr.org/bph/oehp/vital04/vs_11.htm Your gateway to Census 2000. (2002). U.S. Census Bureau. Retrieved April 4, 2007, from http://www.census.gov/main/www/