Innovative Approaches Hold Promise for Improving Rural Health Across Region

November 17, 2022 by John Turner

Located in a rural state with a population among the oldest in the nation, the Larner College of Medicine has long been committed to finding innovative ways to provide and improve access to health care for not only the elderly, but also all residents, regardless of location or socioeconomic status. Several research initiatives at the college focus on new approaches to help patients in these regions.

Due to his interest in rural health, medical alum Jordan Munger, M.D.'22 (rear center), completed clinical training with pediatrician Irene Flateau, M.D., in a Hudson Headwaters Health Network clinic in upstate New York. (Photo: David Seaver)

In most circumstances, the terms “innovation” and “rural” are not typically bedfellows. Yet for researchers at the University of Vermont’s Larner College of Medicine, these words represent an approach that shows promise for improving the health of residents in Vermont, New Hampshire, Maine, and northern New England.

Located in a rural state with a population among the oldest in the nation, the College has long been committed to finding innovative ways to provide and improve access to health care for not only the elderly, but also all residents, regardless of location or socioeconomic status.

Since 2017, a team of Larner faculty and staff has co-led the Northern New England Clinical & Translational Research Network (NNE-CTR), which provides a foundation for research and incorporates innovative strategies and technologies that address health and healthcare challenges focused on the rural nature of the region. The NNE-CTR is a health care collaborative network comprised of academic institutions, health care organizations, and local community stakeholders, which, in addition to Larner, includes MaineHealth, University of Southern Maine, and the Northern New England Practice-Based Research Network Co-Op.

A newer initiative for the NNE-CTR is the development of a Rural Health Communications Network to promote two-way communication of health information to improve health literacy, enhance rural participation in clinical trials, promote access to health and social services, and help respond rapidly to public health emergencies.

Jan Carney, M.D., M.P.H., NNE-CTR Community Engagement & Outreach Core director and UVM associate dean for public health and health policy, said, “From a health perspective, place matters, and where you live may adversely impact your health. As an example, people living in more rural areas may find it more challenging to find a primary care physician, find transportation, access primary and preventive care, and experience more challenges related to employment. We have learned that people in rural settings in Vermont prefer to receive health information from town papers, newsletters, word of mouth, and Facebook – and that this differs from the more urban parts of Vermont. How people receive and use health information is essential to improving health in our rural areas, and over time, will help us strengthen health literacy in our state.”

Thanks to a recent $20 million-dollar renewal grant from the National Institutes of Health (NIH), residents in Vermont and Maine — and particularly the elderly, New American and Indigenous populations — will receive greater support to address such chronic and life-threatening diseases as cancer, substance use disorders, food insecurity, obesity, diabetes, Alzheimer’s, and cardiovascular disease.

“The NNE-CTR has exceeded expectations,” said Gary Stein, Ph.D., NNE-CTR co-principal investigator and UVM chair of biochemistry. “We are optimistic that this grant will provide the resources necessary to make chronic and life-threatening diseases preventable and curable.”

Clifford Rosen, M.D., NNE-CTR co-principal investigator and director of the Center for Clinical and Translational Research at MaineHealth, said, “In just a few years, we are seeing the impact that access to clinical research has on rural communities. This new grant will help us build on this success and do more to address health equity and disparities encountered by at-risk populations.”

In addition, the College provides rural medicine experiences for students within the UVM Health Network and is home to the UVM Center on Rural Addiction.

Funded by a Health Resources and Services Administration grant, the UVM Center on Rural Addiction (CORA) serves as a resource for scientific and technical assistance, and provides information and training to clinicians, programs, and policymakers seeking guidance on how to address opioid addiction and other substance use disorder challenges in their rural communities. Vermont Center on Behavior and Health researcher and Professor of Psychiatry Stacey Sigmon, Ph.D., leads the center.

While CORA’s strategic partners and efforts are focused mainly on Maine, New Hampshire, northern New York and Vermont, its expertise, research, and tools are used by many other health care providers and communities across the United States.

Sigmon, whose research has been published in the New England Journal of Medicine, JAMA Internal Medicine, JAMA Psychiatry, The Lancet, and other journals, has built a national reputation for developing and testing innovative treatment options to bridge the gap in treatment access for patients in rural areas. In 2021, Fast Company recognized Sigmon for her work developing new models of opioid treatment delivery.

"The mission of UVM’s Center on Rural Addiction is to support the rural healthcare providers who are on the front lines fighting this continuing opioid epidemic by providing them with evidence-based resources, training, technical assistance and other support,” says Sigmon.  

“As the only medical school in a small, rural state, we have a commitment to supporting the addiction treatment providers in our rural communities. We are proud to have reached 30,688 rural health care providers across Vermont and 46 other states in the past three years.”