Health Care for the Future: Growing the Family Practice Clinic Report to the Community From the Wahkiakum Family Practice Clinic Advisory Board October 2008

Health Care in Wahkiakum County

The central health care provider in Wahkiakum County is the Wahkiakum Family Practice Clinic. The practice was established in 1954 and has been active continuously as a full scope Family Practice through 2006. The Clinic was transferred from PeaceHealth, a system of health care organizations and hospitals, in 2005. PeaceHealth was in the process of closing a number of satellite clinics that were not as profitable as desired. Wahkiakum County Commissioners acquired the Clinic from PeaceHealth and assumed the responsibility for its patients, staff, and equipment. The County also purchased the building from the Avalon Family which had retained ownership throughout the PeaceHealth years. Maternity services were dropped in 2006 due to the high cost of malpractice insurance.

The Wahkiakum Family Practice Clinic presently employs 11 people in full and part-time positions including a Board Certified Family Practice Physician, a Board Certification Physician’s Assistant, a Board Certified Family Practice Advanced Register Nurse Practitioner, a Registered Nurse, three Medical Assistants, as well as appropriate support and billing staff. The Clinic served as the state designated Medical Control for the county’s Emergency Medical Services including four ambulances and 45 EMS volunteers until June 2008. Since transfer of Medical Control for the EMS, the Clinic remains closely involved with the care of patients being attended to by the EMS volunteers. The Clinic also provides the medical services required for the licensure of the Columbia View Care Center, the county’s nursing facility with 36 certified skilled nursing beds for rehabilitation and long term care.
In addition to the Family Practice Clinic and Columbia View Care Center, Wahkiakum County is also the home of the Hotel Cathlamet, a twenty-bed, locally owned, Assisted Living facility. Many of the patients housed at the Hotel Cathlamet are also patients of the Family Practice Clinic. In addition, there are several foster care homes providing full time care for both adults and children. Finally, Clinicians also make rounds with Hospice patients.
Our community is lucky to have the services of the following additional private health care providers:

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  Cathlamet Pharmacy, Mike Heriford, Pharmacist
  
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  Jared Seal, DMD, River’s Edge Dental
  
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  Cathlamet Eye and Vision, Dr. Terry Tack Optometrist (soon to be joined by Dr. Sarah Rondeau, Optometrist)
  

The Wahkiakum County Department of Health and Human Services (HHS) is responsible for public health, environmental health and a wide range of human services programs. This department provides a range of:

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  Public health services from First Steps Maternity and the WIC program for mothers, to communicable disease surveillance, testing, and investigation, as well as environmental services such as septic system permits, water testing and certification, and food safety inspections and food worker training.
  
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  Mental health services include, but are not limited to, counseling and treatment (group and individual), psychiatric assessment and medication management, case management, supported employment and 24/7 crisis response.
  
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  Developmental disability services including supported employment, community access and 0-3 year old support services.
  
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  Chemical dependency services including assessment, outpatient treatment, referrals, and school based services.
  
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  Prevention services including substance abuse and tobacco prevention, community education, and youth prevention programs.
  

Family Practice Clinic Today

The Family Practice Clinic is located at 335 Una Avenue in the Town of Cathlamet. The Clinic is housed in a stand alone facility with five exam rooms, a minor surgery room, onsite lab, limited x-ray, EKG and two offices. The building was built in 1984. Client ages range from newborn to centenarian and can include four to five generations of the same family.

Wahkiakum County has demonstrated the need for and support of the Family Practice Clinic since 1954. Besides providing routine medical care for the community, the Clinic has served as a leader in building an excellent volunteer emergency medical service organization and has routinely participated in the stabilization of critically ill or injured trauma victims. With emergency hospital care more than 40 minutes from most locations in the community, the Family Practice Clinic has saved many lives which would have otherwise been lost.

Factors which contribute to the critical importance of the Family Practice Clinic to the community include:

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  Limited access to Wahkiakum County occurring primarily via State Route 4 and the River Ferry Wahkiakum crossing from Westport, Oregon to Puget Island. Both these routes are periodically disrupted due to storms, flooding and landslides. Therefore, access to emergency and hospital care can become very difficult, making the need for local health and trauma care important to the well-being of the community.
  
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  With a higher percent of elderly residents, the Family Practice Clinic provides ongoing care and treatment for those who are more vulnerable can travel less easily, and who require more care.
  
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  Maintaining a community based skilled nursing facility that can address the long-term care and rehabilitation needs of community members means greater contact for families because of the location of these services in the community. Regular family contact with patients can improve their overall health and recovery.
  
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  Limited openings in medical practices in Longview and Kelso mean that Wahkiakum County families would have a difficult time obtaining health care in Cowlitz County if the Family Practice Clinic were to close or substantially reduce its services.
  

The Family Practice Clinic currently serves a patient base of 3,390 individuals. Of these, 87% live in Wahkiakum County and 13% reside primarily in the neighboring counties of Pacific and Cowlitz in Washington, and Clatsop and Columbia counties in Oregon. The age and gender breakout for the patient panel appears in Figure 4. There are approximately 10,000 patient visits per year with approximately 20 to 25 visits per day for each Clinician.

Figure 2. Age and Gender of Family Practice Clinic Patients

SUMMARY
AGE	TOTAL	MALE	FEMALE
0-4	129	62	67
5-9	140	68	72
10-14	189	107	82
15-19	270	136	134
20-24	168	86	82
25-29	164	79	85
30-34	138	66	72
35-39	155	78	77
40-44	176	86	90
45-49	224	120	104
50-54	247	120	127
55-59	292	142	150
60-64	273	136	137
65-69	257	130	127
70-74	168	91	77
75-79	145	73	72
80-84	101	40	61
85+	135	41	94
	3,371	1,661	1,710
Source: Wahkiakum Family Practice Clinic

Of particular importance is the patient population aged 65 and over. The patients in these age groups equal approximately 24% of the Family Practice Clinic current patient panel. The 1,181 patients who are 65 years and up generally require a higher degree of medical care than those who are younger. This is demonstrated clearly in Figure 5 which follows:

Figure 3. Average Annual Patient Visits by Age and Gender by Year

	PATIENTS	VISITS
AGE	TOTAL	2005	2006	2007	Average/Year
0-4	129	460	431	328	3.14
5-9	140	296	304	211	1.93
10-14	189	300	371	284	1.68
15-19	270	608	653	465	2.13
20-24	168	274	275	213	1.51
25-29	164	280	315	286	1.79
30-34	138	270	361	272	2.18
35-39	155	308	301	320	1.99
40-44	176	412	431	414	2.38
45-49	224	714	596	561	2.78
50-54	247	672	735	660	2.78
55-59	292	946	912	1017	3.28
60-64	273	996	914	776	3.27
65-69	257	910	1006	820	3.54
70-74	168	756	767	679	4.36
75-79	145	648	727	670	4.70
80-84	101	680	669	608	6.45
85+	135	768	911	781	6.07
TOTALS	3,371	10,298	10,679	9,365	3
Source: Wahkiakum Family Practice Clinic

Note the average number of visits per year and how these increase when patients reach their 60s, with steady increases in each of the following decades. It is important to also note that 1,181 patients who are 65 years and up are served by Medicare. Medicare reimbursement levels are very tightly controlled and present a challenge for medical practices around the nation. When the Wahkiakum County took responsibility for the Wahkiakum Family Practice Clinic, the County applied for and received status as a Rural Health Clinic provider. This designation provides a higher rate of reimbursement for both Medicare and Medicaid patients. This program was established to provide stable access to primary care in underserved rural areas.