Addressing Montana’s Health ‘Deserts’

Larger health care centers collaborate with rural areas to break down geographic barriers

By Maggie Dresser
Kalispell Regional HealthCare’s mobile nuclear medicine unit. Courtesy photo

In a state as dispersed and rural as Montana, access to health care is a growing issue that reflects a national concern over accessibility.

Montana has the nation’s third lowest population density with 7.1 residents per square mile, and its larger hospitals are located in denser areas, which leaves clinics and hospitals that offer fewer services as the only option for patients in rural communities.

For example, Lincoln County is home to two medical facilities, Cabinet Peaks Medical Center in Libby and Lincoln County Public Health in Yaak, which both list access to health care as a top priority in their facility reports, according to data collected by the Montana Office of Rural Health through Montana State University.

Residents in some rural communities must travel more than 100 miles to get care for simple medical examinations such as mammography scans or MRIs. Often, they don’t have reliable transportation or don’t want to travel unless they absolutely have to.

But larger hospitals in Montana are seeking to provide better access by going to those rural areas. Kalispell Regional Healthcare (KRH) has three mobile health care units that travel to more than 30 locations, ranging from Eureka to Malta.

Since 2008, KRH’s mobile mammography coach has provided screening to rural areas, including Browning, Choteau, Polson and Townsend. Named after Jane Winkley, a Kalispell native and breast cancer survivor who donated the unit, the Winkley Women’s Center drives to various locations on weekdays.

“Mobile units from a mammography standpoint are used in a lot of big cities because it doesn’t just break down a geographic barrier, it breaks down a convenience barrier,” said Dr. Melissa Hulvat, the KRH Medical Director of the Cancer Program and a breast surgeon at Bass Breast Center.

Unlike an in-hospital visit, radiologists are able to review images before the patient leaves to give the results. Hulvat says without the mobile unit, many people wouldn’t make the trip to Kalispell or a larger hospital for a screening.

“I’ve heard a lot of people say, ‘If it wasn’t parked there, I wouldn’t get one,’” Hulvat said.

If screening results are clean, the patient doesn’t need to make a follow-up appointment and everything can be completed in one visit. Hulvat says the collaboration between KRH and medical facilities in the state has been a key player in the success of the mobile health units.

“It’s a partnership with these hospitals,” Hulvat said. “When the Winkley Women’s Center shows up, that becomes an extension of their radiology department. These are their patients.”

With limited services offered in rural areas, Hulvat says these facilities are very supportive of the mobile units because they are able to offer medical care to the community that wouldn’t otherwise be available.

“It would really leave these hospitals in a pickle because they can’t invest in resources in hiring a radiologist, buying a mammography machine or hiring a mammography technician,” Hulvat said. “This is good for the health of those communities.”

Last year, the mammography coach was taken off the road, but KRH plans to have a new vehicle on the road by the spring. An upgraded vehicle will replace the two-dimensional imaging with updated three-dimensional technology.

“We want to keep bringing the latest and greatest and best,” Hulvat said. “If it’s what people in Kalispell and Whitefish deserve, then gosh darn it, it’s what people in Malta deserve.”

In the meantime, KRH is using a leased vehicle and providing ultrasound and mammography services to the same locations.

New in 2017, KRH also uses a mobile magnetic resonance imaging (MRI) mobile unit, which serves medical centers in Shelby, Conrad, Chester and Malta. The unit parks in Shelby, which acts as its area headquarters, MRI technician Angie Tennison said.

KRH also offers a nuclear medicine unit which provides cardiac imaging, bone scans, pre-operative lymphatic sentinel node tracking and gastrointestinal testing.

Clear Choice Clinic in Kalispell also provides care to Eureka, Browning and Polson with early pregnancy diagnosis and sexually transmitted disease testing and treatment with a mobile unit. Executive Director Michelle Reimer says an ultrasound machine and lab services onboard allow her team to provide all of the same services that can be done in the clinic.

Nationwide, there are more than 2,000 mobile clinics on the road, serving more than 5 million annual visits, according to 2017 report by the U.S. National Library of Medicine.

In addition to mobile health care units, KRH also uses telemedicine to assist patients via video chat for certain levels of care. Telemedicine is growing substantially in rural communities, and research suggests it’s an efficient form of health care, according to Kristin Juliar, the director of the Montana Office of Rural Health and Area Health Education Center. She says it works especially well for fields like dermatology and mental health.

Juliar says hospitals such as KRH and St. Patrick Hospital in Missoula also set up rotations where physicians travel to rural areas to provide medical care.

While alternative methods are helping address health care access, Juliar says the main challenge is attracting people to work in rural areas.

“In Montana, like other states that have a pretty rural and frontier population, we do face challenges recruiting physicians and health care providers into rural areas to live and work,” she said.

But with the growing demand of methods like mobile units, telemedicine and rotations, Juliar says those types of medical care are proving to be successful.

“(They) correspond to what the community’s needs are,” she said.

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