Together, weâ&#x20AC;&#x2122;re building new roads to better health.
Hiking trail at Mt. Mitchell in North Carolina, the highest point in the U.S. east of the Mississippi River.
Go instead where there is no path and leave a trail. — RALPH WALDO EMERSON
Our region is known for its vast network of beautiful hiking trails, but not for robust healthcare resources outside of the greater Asheville area. In fact, our largely rural region has shortages of primary care, ob/gyn, mental health, and dental providers in nearly all of our 16 westernmost counties. Which is why MAHEC has partnered with the University of North Carolina to expand the reach of our innovative healthcare education, training, and practice models. With your support this past year, we’ve been able to go where the need is greatest whether that’s sending medical students to train in rural practices, establishing clinical pharmacy services in under-resourced communities, or developing home-based primary care for at-risk older adults. Our academic health center is committed to building a roadmap for rural health that can be replicated here and across the nation. We encourage you to read on to learn where these roads are taking us!
Going Where the Need is Greatest
Following a passion for rural primary care North Carolina native and fourth-year medical student Travis Williams didn’t always plan to pursue a career in medicine. In fact, he didn’t think he had the mind for it. But having a father who experienced complications from type 1 diabetes exposed him to medicine at an early age. Over the years, Travis saw the impact of the doctor-patient relationship on his father’s health and his family’s peace of mind.
“I can relate to patients and their families,” Travis shares. “I know what it’s like to sleep in a hospital room all night—I guarantee I’ve done it 100 times.” When it came time to apply for medical school, having nationally ranked UNC Chapel Hill’s School of Medicine in his backyard made the choice easy, but his next choice would take him farther from home. Travis decided to apply to UNC’s Kenan Primary Care Medical Scholars Program, which brought him to MAHEC to learn what it’s like to practice medicine in rural Western North Carolina, where the need for primary care providers is greatest.
“I jumped at the chance to learn from those committed to small-town medicine,” he recalls. For Travis, the opportunity afforded by the Kenan Scholars program included a six-week summer internship in a small family practice in Linville and a year of clinical rotations and didactics in Asheville and Hendersonville learning alongside dedicated physicians.
His third-year experience was so rewarding, Travis decided to stay in Western North Carolina for his fourth-year electives.
“I know that I want to do family medicine, and I know that I want to do rural. Everything I need is up here,” he shares. That couldn’t be more true. The Asheville campus’ longitudinal curriculum enabled Travis to develop close relationships with his patients over a period of time and across a variety of healthcare settings. Patients often planned their follow-up appointments around his clinical schedule to ensure he would be part of their medical visit. These relationships—characterized by trust, comfort, and reassurance—echo the one that inspired him to pursue a career in medicine: the relationship with a trusted physician who left his own family one Christmas to visit his in the hospital, where his father was suffering from double pneumonia. That visit was good medicine, and it’s the kind of medicine Travis intends to practice in one of Western North Carolina’s small towns with fewer resources. His training here at MAHEC and UNC’s Asheville campus will ensure he is well prepared to practice it.
Morgan Burke and Jeyhoun Allebaugh at UNC Chapel Hill contributed to this story. For more of Travis’ story, please visit unc.live/avlcarolinastory.
â&#x20AC;&#x153;I know that I want to do family medicine, and I know that I want to do rural. Everything I need is up here.â&#x20AC;?
“When you are in a rural setting, you have to bring creativity to the game because resources are scarce. You have to keep your skills sharp…”
Making Good Dentists Great
Columbus practice bridges gaps in rural care and training When Landon first came to MAHEC Dental Health Center at Columbus, his providers had their work cut out for them. Negative childhood experiences had kept him out of the dental chair for many years. Intense pain finally convinced him to come back, and only then with a great deal of trepidation.
“Landon was so nervous, he wanted to be knocked out,” his mother Marcella recalls. “Although they don’t do sedation dentistry at MAHEC, they do go out of their way to ensure patients are comfortable and not in pain. This was important, because Landon needed a lot of dental work.” Marcella half-expected her son to leave in the middle of his first appointment like he did seven years ago at another dental office. Instead, his dental hygienist Amy Corrigan made him laugh. Then Matthew Wolfe, DMD, ensured he was fully numb and relaxed before starting treatment. Out in the waiting room, staff offered Marcella coffee and a small bouquet of flowers when she checked out.
“We’ve never had this level of customer service from a dental office,” Marcella admits. It is one of many reasons she and Landon will continue to drive to Columbus for oral healthcare. In rural Polk County, where the dental health center is located, families have fewer choices. MAHEC is one of only two general practices that accept Medicaid, which can be the difference between being able to access dental care and having to go without it. One of
MAHEC’s first patients waited more than a year to see a dentist who accepted this form of insurance.
“We were living in a dental desert before MAHEC opened its doors in August,” her mother explains. “I used to live in Asheville, so I was familiar with MAHEC’s good work. When I saw the logo on the sign here in Columbus, I knew it would be our new dental home. I was confident we’d be able to get quality care at an affordable price.” MAHEC is an academic teaching center with a long history of training healthcare providers who have a passion for serving rural and under-resourced communities. The Columbus practice trains dental assisting students from Isothermal Community College and fourth-year students from UNC Adams School of Dentistry in Chapel Hill. It’s also a rural training site for MAHEC dental residents. This rural teaching focus is what makes good dentists great, according to the practice’s medical director Blake Gutierrez, DDS.
“When you are in a rural setting, you have to bring creativity to the game because resources are scarce,” he explains. “You have to keep your skills sharp and think outside the box to come up with options that work for each patient’s circumstances.” If Landon and other patients are any indication, this teaching model is working. Over time, it has the potential to make good dentists great for rural practice across the region.
It’s Just a Pill, Isn’t it?
MAHEC’s children’s musical begs to differ The idea for the children’s musical It’s Just a Pill came to Melody Hays in a dream. After hearing Dr. Blake Fagan, a family physician at MAHEC, give a talk on opioids, Melody, a healthcare education planner at MAHEC, dreamed that she asked him, “What are we doing for the children?” Upon waking, she decided to write a musical that would educate children about substance and opioid misuse.
It’s Just a Pill had its debut run of 16 performances during the spring of 2019. It reached 3,600 students, mostly fifth- to eighthgraders, and 425 educators, parents, and community members in six counties across North Carolina. Melody has been touched by the stories of conversations that have taken place between family members because of the musical.
More and more children are experiencing the negative effects of opioids, whether directly or through family members’ substance use. Opioids are far more than just a pill, and even children as young as fifth grade should know about the negative impact a pill can have.
“I think the play impacted families the most, especially when parents and kids watched it together,” Melody said. “There was a synergy that was really sweet. It opened up a lot of positive conversation.”
“When you look at the stats, a lot of kids are getting hooked on drugs prior to the age of 18, and there’s data that shows when young people talk about substance use in the home, they’re 50 percent less likely to try drugs,” Melody said. “When I started to dig more into the issue, I realized this is a really vulnerable population.” Melody, who has a background in managing children’s productions, wrote the script and lyrics for It’s Just a Pill with input from Dr. Fagan and a number of behavioral health, school health, and parenting program specialists. The 55-minute play follows a 10-year-old girl as she learns about the dangers of opioids in school. In the play, students learn how to dispose of medications by making a slurry with cat litter and coffee grounds, and what to do if they suspect a friend or family member is misusing substances.
One woman, a self-described recovering addict who began using after taking opioids for a back surgery, saw it with her niece.
“I brought my 11-year-old niece, and she loved it,” she shared. “This provided a great opportunity for us to talk about a very difficult subject. I don’t want her to have the same challenges I have faced.” It’s Just a Pill is currently available for license through MAHEC for anyone who wishes to independently produce and use the play as a prevention and awareness resource. The initial funding for the play’s production, prevention toolkit, and spring 2019 tour were made possible through funding from an NC AHEC Innovation Grant, a SAMHSA Opioid STR Grant, and individual donors. “It was such a group effort,” Melody said. “I was really touched by that and by knowing that people could give a little or give a lot, and every contribution helped make it happen.”
“I brought my 11-year-old niece, and she loved it. This provided a great opportunity for us to talk about a very difficult subject.” Photo © Buncombe County Schools Communications
“I would have been in dire straits without the help of MAHEC … the injury had me bedbound … They’ve gotten me on the recovery trail.” The home-based primary care team for older adults includes healthcare professionals from MAHEC, UNC, Mission Health Partners, the Council on Aging of Buncombe County, and Insightful Rehab.
Expanding Our Reach to Help Adults Age in Place
If you can’t come to us, we’ll come to you
For many older adults, leaving home for a doctor’s appointment can be a monumental, if not impossible, task. Obstacles such as reduced mobility, a fixed income, and increasing social isolation can keep older adults from getting the medical care they need. These challenges and a greater likelihood of needing follow-up care for complex health conditions can lead to a cycle of poor health management, making medical care more expensive and a bigger burden for both patients and caregivers. A pilot program at MAHEC will provide home-based primary care for older adults who are homebound or home-limited. This program is a collaboration between UNC Eshelman School of Pharmacy and MAHEC’s Center for Healthy Aging and will support 50 of MAHEC’s at-risk elderly patients with home-based primary care. Under the leadership of Dr. Will McLean and Tasha Woodall, PharmD, the core team will consist of a physician, a nurse practitioner, pharmacists, an occupational therapist, a resource specialist from the Council on Aging, and a care coordinator from Mission Health Partners. The team will provide not only full primary care services at home, but also comprehensive medication management and home safety and social determinants assessments in order to treat the full scope of patients’ needs.
“The main goal is to keep patients in their homes and as independent as possible,” Tasha explained.
For patients like Greg McCarter, this home-based approach can make a big difference in their ability to recover from a major accident or illness. Greg suffered from severe back pain and was unable to walk after a debilitating fall in March 2019. A visit to the emergency room immediately following the accident left Greg with no relief from his back pain, no closer to being able to walk again, and expensive medical bills. After his fall, Greg could not leave his house for doctor appointments or physical therapy. So MAHEC brought the doctor to him.
“I would have been in dire straits without the help of MAHEC, because I couldn’t get to a primary care physician because the injury had me bedbound,” Greg shared. “Had it not been for them being able to come into the home, I would never have gotten the attention that I need. They’ve gotten me on the recovery trail.” This pilot program is being supported by a $100,000 one-year grant from the WNC Bridge Foundation, a community-based nonprofit that assists in addressing the health challenges of people living in Western North Carolina. MAHEC’s Center for Healthy Aging hopes this program can be adapted and scaled to meet the needs of older adults throughout Western North Carolina and inform home-based care initiatives serving other populations.
Taking the Pharmacist Out of the Pharmacy Mobilizing resources to benefit rural communities What happens when you take the pharmacist out of the pharmacy? Quite a lot, actually, especially when you send them into rural communities. This is exactly what we do at MAHEC with the support of UNC Eshelman School of Pharmacy’s Rural Pharmacy Health Initiative and generous donors like Lynn and Bob Kieffer who are making it possible for us to place more pharmacy fellows in rural primary care practices across Western North Carolina. MAHEC pharmacy residents and fellows are encouraged to perform a variety of functions within a multidisciplinary team to ensure they can meet the needs of their patients, especially those living in rural communities where healthcare access is more challenging. From performing annual wellness visits to reviewing existing medications for potential interactions to recommending the best dosages, these clinical pharmacists make medication expertise available when and where it is needed most—at the point of care. Second-year resident Gwen Seamon, PharmD, is currently working with Mountain Community Health Partnership in Yancey and Mitchell counties. In MCHP’s small but busy rural clinics, Gwen helps perform initial medical intakes, where medication-related questions typically come up. This approach streamlines the practice’s workflow and enables physicians and medical support staff to perform other vital services. Gwen loves being able to spend more time with patients and earn their trust. She asks all of her patients the same question, “How can I support you today?” Putting her patients’ goals first helps guide
her recommendations and is something she learned while working to support pregnant women with substance use disorders through Project CARA at MAHEC. Hospital pharmacist Matt Ransom has ventured even farther from the pharmacy, logging countless hours of “windshield time” driving through Yancey, Mitchell, and Avery counties for his summer practicum through the UNC Gillings School’s Master of Public Health Program in Asheville. Matt’s willingness to go the distance helped him gather input from public health officials and community stakeholders to develop mobile harm reduction services in this remote corner of the state. Transportation challenges coupled with increased stigma associated with substance use disorders has prevented some residents from accessing the life-saving care they need to prevent overdoses, health complications, and the spread of infectious diseases. Matt is using both his pharmacy and his public health training to help remove these barriers.
“A public health perspective gives me an excuse to think more broadly in terms of relationships and systems so I can have a bigger inf luence,” Matt explains. This commitment to thinking and practicing outside of the pharmacy is just one of the many ways MAHEC and UNC are innovating team-based care to improve patient outcomes.
â&#x20AC;&#x153;A public health perspective gives me an excuse to think more broadly in terms of relationships and systems so I can have a bigger inf luence.â&#x20AC;?
“Going through it all at the same time really created a sense of community, and that was what I found to be the most comforting…”
Patients Teaching Patients
The wisdom is in the group
Pregnancy care has long centered on a trusted relationship between a woman and her ob/gyn provider. Prenatal visits sometimes include a family member or support person but rarely other expectant moms—until recently, that is. Centering Pregnancy is a model of prenatal care that expands this circle of trust to include more sources of support by moving prenatal visits to a group setting. This encourages women to take a more active role in their pregnancy while they learn with, and from, other women. Every year, up to a third of pregnant patients at MAHEC Ob/Gyn Specialists participate in Centering, a group model of prenatal care recommended by the American College of Obstetricians and Gynecologists. Studies have shown that Centering Pregnancy reduces risks for preterm delivery, low birth weight, and cesarean section, and families spend more time with their providers than they would in a traditional office visit. Each Centering group consists of about 10 women who are all due around the same time, their support person if they choose to bring one, and two facilitators from MAHEC Ob/Gyn Specialists. The two-hour group prenatal sessions follow the same schedule as traditional prenatal care, occurring monthly in the early stages of pregnancy and then more frequently as due dates near. Each session begins with a traditional healthcare checkup followed by a group discussion where every woman has an opportunity to voice her experiences, concerns, and questions.
“The wisdom is in the group,” explains Amanda Murphy, CNM, MAHEC’s medical director for Centering Pregnancy. “It’s not a class where they meet with me as a nurse-midwife, and I teach them what I think they need to know. It’s a facilitated discussion where the majority of the questions are answered by the women in the group.” These group discussions are the heart of Centering Pregnancy. In a traditional doctor’s visit, patients may be reluctant to bring up seemingly inconsequential worries. But in a more relaxed group setting, women often open up and bond with one another over shared experiences during pregnancy.
“Going through it all at the same time really created a sense of community, and that was what I found to be the most comforting about this whole experience,” shares Emily Helms, former Centering Pregnancy participant. “Knowing that there were many other women who are going through the same aches and pains and joys as you are. You’re not alone.” This year, MAHEC’s Centering Pregnancy program received a grant from the Community Foundation of Western North Carolina to further support this model of prenatal care. Participants also receive board books at Centering sessions as part of a pilot program with Reach Out and Read. But perhaps the greatest benefit—in addition to improved health outcomes—is the opportunity to create friendships that last well beyond pregnancy. After all, it takes a village, and Centering Pregnancy helps mothers build one.
Our Mission MAHECâ&#x20AC;&#x2122;s mission is to train the next generation of healthcare professionals for Western North Carolina through quality healthcare, innovative education, and best practice models that can be replicated nationally.
Our Values Excellence Innovation Compassion Collaboration We represent these values through quality education, innovative ideas, compassionate care, community partnerships, and professional standards. Our work is grounded in principles of civility, inclusivity, and empowerment.
Who We Are
Board of Directors William R. Hathaway, MD | Chair Alan Stiles, MD | Vice Chair Kenneth M. Partin | Secretary/Treasurer W. Louis Bissette, Jr. Robert A. Blouin, PharmD Carol Burton, PhD Casey Cooper Bruce Deighton, PhD David Franklin, MD James M. Kirby, II Danielle Mahaffey, MD Paul McDowell Alfred Mina, MD Joseph Pino, MD, MHA Darin Waters, PhD Jeffery E. Heck, MD | MAHEC CEO
UNC Health Sciences at MAHEC
Our academic health center opened in August 2019 and supports medical, public health, pharmacy, and psychiatry learners in addition to academic research.
MAHEC Dental Health Center at Columbus
Our rural dental teaching practice opened in August 2019 and supports learners from MAHEC, UNC Adams School of Dentistry, and Isothermal Community College.
Three Rural Teaching Practices
We collaborated with Blue Ridge Health and Mountain Community Health Partnership to establish rural teaching sites in Haywood, Polk, and Yancey/Mitchell counties.
Two Additional GME Programs
Our second rural residency program and an addiction medicine fellowship were approved in 2019 with more programs in development.
High Points of 2019 $1,390,327
Provided in Charity Care
Total Patient Visits
Centering Pregnancy Patients (newly enrolled)
Continuing Professional Development Programs (11,009 unique attendees)
MAHEC Employees (full and part time)
Simulation Programs (9,716 total attendees)
Total Employees Hired
Providers Trained to Treat Opioid Use Disorder
Rural High School Students Participated in Health Careers Workshops
Medical & Dental Graduates (to date)
New Positions Added
New Research Projects (involving 27 faculty and 33 learners)
Articles Published by MAHEC Faculty and Researchers
UNC Health Sciences at MAHEC opened its doors in August 2019.
The MAHEC Philanthropy Department connects the generosity of the community with opportunities to improve healthcare in WNC.
For questions, information, or campus tours, please contact our Philanthropy Department:
Lizzie McKenna Cozart 828-771-4203â&#x20AC;&#x201A; |â&#x20AC;&#x201A; email@example.com