Key Findings – 2016 CHNA

Wake County was ranked as the healthiest county in North Carolina in March 2016 and is consistently ranked as one of the best places in which to live, work, play, and learn. This success is largely due to the collaborative efforts of various partners, including those involved in the development of this Community Health Needs Assessment (CHNA) and
the residents of Wake County.

Based on the findings of the 2016 CHNA, the priority areas that will be addressed in community health improvement planning for Wake County in the next three years include:

• Health Insurance Coverage
• Transportation
• Access to Health Services
• Mental Health and Substance Use

Priority 1: Poverty and Unemployment
Access to health insurance coverage rose to the top as one of the most important issues faced by residents of Wake County. Specifically, regardless of survey method (telephone or Internet-based), individuals identified this issue most frequently when asked what most affects our community’s quality of life. While this concern certainly relates to those not having coverage at all, more frequently than ever concerns are being raised by those who have insurance regarding other
critical issues, such as:

▶Limitations on what insurance does or does not cover.

▶Complexity of the system and the need for education related to how insurance works and how
to use it.

▶Ability to afford post-insurance financial obligations related to visits and prescriptions, particularly for those with chronic diseases or conditions.

▶Remaining barriers to access for certain insurance types, namely Medicare and Medicaid, as some
physicians and providers have limited or suspended their acceptance of those insurance type.

Priority 2: Transportation
Access to and cost of transportation is an issue that impacts every resident of Wake County, regardless of their background or social status. It also has multiple implications on health as it can impact healthy lifestyle choices, physical activity levels, air quality, and traffic incidents. For the elderly or those with limited resources, lack of timely transportation can have an even more direct impact on health as it can limit their ability to make physician appointments or visit their local pharmacy to obtain needed prescriptions. When asked about the service needing the most improvement, transportation was frequently selected across all survey methods utilized in this assessment. Through the hard work of its residents, community leaders, hospitals, and providers, Wake County is very fortunate to have significant levels of health resources beyond what most
communities might ever imagine. However, particularly for our most disadvantaged residents, transportation issues can significantly limit their ability to access those resources. In fact, results from this assessment cited transportation concerns as one of the major reasons why residents might put off going to the doctor.

Priority 3: Access to Health Services
Access to health services is a key topic that continues to be discussed and analyzed at the local, state, and national levels. From a health need perspective for Wake County it encompasses those areas or items that present a barrier to residents receiving the care they need. As such, this need area can be fairly broad; however, through the work and research completed in this assessment the key access concerns for Wake County appear to relate most to:

▶System Complexity
– Residents are either unaware of available resources or unable to access resources given confusion regarding how to navigate the system.

– Very much related to the Health Insurance Coverage priority discussed previously, this
relates to the need for increased numbers of sliding scale providers and facilities.

▶Provider Availability
– Long wait times, limited availability of appointments, and inconvenient hours of operation were all cited as barriers to access and drivers of inappropriate emergency department usage in the county.

▶Primary Care Access
– The need for access to primary and preventive care (including dental) was cited as one of the top community need areas by those surveyed and is considered a key need area given the associated implications on quality of life and longer term health needs and costs.

Priority 4: Mental Health and Substance Abuse
Although often considered to be stigmatized topics of conversation, acknowledgement by the general community regarding the need for mental health and substance abuse resources has continued to increase as most are recognizing that it impacts not only individuals but also their families, friends, and the broader community. Also, at a time when the prevalence of mental illness and substance abuse has been increasing, there is an understanding and belief that associated resource levels are not expanding to meet that need, which has compounded the concern.

Specifically, when asked to select the top community need, individuals identified this issue most frequently regardless of survey method (telephone or Internet-based).Expanded education and public information was cited as a need in order to combat associated stigmas and help individuals understand where assistance is available. In fact, when asked about the health behavior for which residents need more information, emotional and mental health was the most frequently selected across all survey methods utilized in this assessment. In addition, many believe that access to providers and facilities, particularly for the uninsured, remains a significant concern. Given the increase in heroin and inappropriate prescription drug use within Wake County, ensuring the availability of facilities and programs is particularly important to the community.

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