Each year every Health Department is required to create an assessment, that reports on the Public Health standing of the community they serve. The largest one required is the Community Health Assessment (CHA). It is required to be completed every three to four years. This assessment provides an overview of the significant community health needs that are identified within the community itself. Data is gathered in many forms and assembled into the CHA which is then disseminated to the community and stakeholders.

The purpose of the CHA is to provide organizations comprehensive information about the community’s current health status, needs, and issues. The CHA identifies and offers meaningful knowledge and information on Public Health priorities using the analysis of the data collected to offer guidance how to address those needs. Attention is typically focused on vulnerable, at-risk populations, health disparities, health inequities, social determinants, and other input obtained directly from the community.

The CHA is used in conjunction with other reports including the Community Health Improvement Plan (CHIP), the State of the County’s Health (SOTCH), and Health Department’s Strategic Plan. Community stakeholders and partners usually assemble, with the Health Department, to create the CHIP. Progress on the priorities identified in the CHA as well as the strategies identified in the CHIP are documented so the community’s public health may be monitored. Any emerging issues impacting public health may also be included, as well as new initiatives created to address concerns.

The main reason for the creation and utilization of these documents is to provide and connect community members with the resources they need to improve public health challenges they may encounter.

Pamlico County Health Department (PCHD) continues to experience significant change since the last CHA and SOTCH reporting. Under its new leadership, PCHD continues to prioritize the restructuring of programs and services to efficiently utilize staffing and resources to address Pamlico County’s health disparities and inequities as identified in the most recent CHA and research studies conducted by the Duke University Global Health Institute Student Research Team and the East Carolina University Brody School of Medicine department of Public Health interns. PCHD has filled several of its Advisory Board of Health vacancies with the exception of two to complete the 11 member board.  With the support of the Board of Health, PCHD has advertised to help fill staff vacancies and increase salaries according to a new County salary schedule. PCHD also received approval to increase provider hours from 24 hours per week to 32 hours per week to meet anticipated client increases, community needs, and to meet in-network requirements to bill Medicaid, Medicare, and private insurances.  Onboarding and program specific training has been conducted to strengthen employees’ knowledge of public health and to bring awareness of local concerns. PCHD has also addressed infrastructural needs. Renovations continue to be an ongoing concern until the County may secure funding for a new facility. To date, PCHD has replaced antiquated flooring to decrease safety risks and transmission of disease, updated sinks and counter tops in examination rooms, replaced a portion of roofing that exhibited damage from ongoing leaks, updated interior wall paint in the lobby and clinic areas, purchased ADA compliant furniture and desks, added essential laboratory equipment, repaired portions of the subflooring that exhibited water and mold damage, and replaced obsolete electronic equipment and data management systems. 

Many new initiatives have taken place since January 2023 and the prior CHA and SOTCH reporting. PCHD coordinated with stakeholders and partners to identify Pamlico County’s vulnerable population and to explore opportunities to increase their access to health care.  In October 2022, PCHD successfully completed its accreditation site monitoring visit, using an accreditation team approach.  In March 2023, PCHD was awarded accreditation with honors, a historical event for Pamlico County.  In July 2023, PCHD’s application for Centers of Disease and Prevention (CDC) Public Health Associate was accepted; however, due to restructuring and budgeting constraints encountered by the CDC, PCHD was not matched with a candidate. In 2024, PCHD re-submitted its application for Centers of Disease and Prevention (CDC) Public Health Associate. PCHD's application was accepted and matched with a public health associate. This public health associate will be the first Associate assigned in Pamlico County.  In January 2024, PCHD expanded its preceptorship and internship opportunities to now include graduate level students from East Carolina University Brody School of Medicine department of Public Health.  In 2024, PCHD Environmental Health was awarded the FDA grant for Food Safety and the Mosquito Vector grant for trapping, identification, and spraying.  In September 2024, PCHD’s new public health nurse was awarded North Carolina Credentialed Public Health Nurse (CPHN) credentials. All of PCHD's public health nurses are now credentialed as CPHNs.  In January 2025, PCHD will expand its preceptorship opportunities to include University of North Carolina Wilmington School of Nursing. 

Since the last CHA and SOTCH reporting, a newly appointed public health nurse was employed and assumed the lead in immunization and adult health services. PCHD was awarded the NC DHHS through the Office of Rural Health Telehealth Infrastructure grant (pending Board of Health approval) and plans to hire an additional public health nurse to assume the lead in primary care, telehealth services, and shared health educator duties.  PCHD's health educator position remains vacant. PCHD plans to seek approval from its Board of Health to hire a full-time health educator.  

Overview of the items encountered in 2024:

• Staffing and provider shortages
• Restructuring organization, job descriptions, and duties
• Restructuring billing and coding policies and procedures
• Restructuring onboarding and training for staff and board members
• Aging facility with chronic structural issues
• Residual pandemic impacts
• Increasing outreach activities and partnerships
• Increasing provider hours and services to meet community needs
• Increasing student internship/preceptorship opportunities
• Community Health Assessment (new cycle)
• NC Local Health Department Accreditation (new cycle) 
• Vacancies/Recruitment of Advisory Board of Health members
• Increased participation with professional organizations (e.g. NACCHO, EDNCPHA, NCAPHNA, NCAPHA, NENCPPA, etc.)
• Increased participation with community outreach (e.g. Imagine Pamlico, HeartWorks, PrimeTime, local schools)

According to the 2018-2022 Detailed Mortality Statistics for Pamlico County, there were approximately 218 deaths including 180 White, Non-Hispanic, 30 African American, Non-Hispanic, four Other, Non-Hispanic, and four Hispanic with the highest percentage of deaths occurring in the month of July (26). The most current Detailed Mortality Statistics for Pamlico County data has not yet been released.  

The 2019 NC State Center for Health Statistics indicates the leading causes of death, ranked from highest to lowest percentage, in Pamlico County to be:

• Diseases of the Circulatory System: Including common heart-related illnesses (e.g. hypertension, myocardial infarction, heart failure, ischemic heart disease, hemorrhage, cardiac arrhythmias, peripheral vascular disease, etc.). 23.2%

• Malignant Neoplasms: An abnormal mass of tissue in nature can invade other parts of the body. Including common malignant illnesses (e.g. colon, stomach, esophagus, skin, pancreas, liver, breast, nasopharynx, female and male genital organs, thyroid, etc.). 20.5%

• External Causes of Morbidity: Including accidents, accidental and exposure poisoning, intentional self-harm, falls, motorcycle, exposure to smoke, fire, flames, complications from medical procedures, etc.). 6.5%

• Diseases of the Respiratory System: Including common respiratory illnesses (e.g. influenza, pneumonia, respiratory failure, chronic obstructive pulmonary disease, etc.). 5.4%

• Diseases of the nervous system/disorders of mental, behavioral health, and neurodevelopmental: Including psychological and physiological conditions (e.g. dementia, Alzheimer’s disease, Parkinson’s disease, epilepsy, anoxic brain injury, etc.). 3.2%

• Diseases of the Endocrine, Nutritional, and Metabolic Diseases: Including common endocrine system (e.g. diabetes, obesity, hyperlipidemia, metabolic disorders, thyroid disorders, etc.). 2.2%

Pamlico County Health Department has identified the following emerging issues that prompted discussion, collaboration, and actions towards addressing the issues:

Opioid Abuse.  Pamlico County has been previously identified as one of the leading counties in North Carolina experiencing an opioid crisis. PCHD has researched Healthcare Kiosks and North Carolina’s Syringe Service Program as a possible solution to address opioid, mental health, and communicable disease in Pamlico County. According to the 2018-2022 CDC Division of Vital Statistics branch, Pamlico County had 116.2 reported crude deaths rate per 100,000 population for deaths of despair (suicide and drug/alcohol poisoning) and 63.7 crude deaths rate per 100,000 population for opioid overdose. Both indicator rates are above the North Carolina and United States averages. Post mortem findings related to opioid or suspicious deaths are delayed in reporting by at least one year to NC Database Application for Vital Records. In 2024, Pamlico County Rescue Squad continues to respond to opioid-related calls stating they administered 8-12 mgs of naloxone per individual. In contrast and according to the local EMS Chief, "each opioid overdose is requiring more milligram dosing per individual to revive the individual and not all opioids are now reported to E-911 because naloxone is more accessible." This observation requires further investigation.  In 2024, PCHD received a one-time shipment of naloxone from NC Department of Health and Human Services (DHHS) and donated the shipment to Pamlico County Rescue Squad EMS.  Currently, PCHD is exploring and evaluating suggested interventions provided by NC DHHS to address the opioid crisis in Pamlico County. 

Child Fatality and Protection Awareness.  In 2024, Pamlico County's Child Fatality Prevention Team (CFPT) and Community Child Protection Team (CCPT) met quarterly to identify at-risk children and discuss strategies to reduce child fatalities in Pamlico County.  In 2024, Pamlico County's CFPT had no deaths to report. Reporting of child fatalities to local health departments are delayed by one year from the time of death.  In 2025, the CFPT and CCPT will be merged to form a new local fatality team and will meet bi-annually.  In addition to providing nutritional supplement and breast feeding services, WIC is now providing car seat safety training.  In 2024, PCHD's WIC distributed 111 car seats and provided 111 individualized car seat safety training sessions to Pamlico County residents.  PCHD's WIC program received a $5000.00 grant from Pamlico Partnership for Children to purchase additional car seats.  PCHD also received a Safe Sleep trainer to share with partners to train staff and parents methods to reduce sleep-related deaths.

Tobacco use/Vaping in Public Schools.  PCHD and Pamlico County Schools are collaborating to develop a vaping cessation program for public schools.  PCHD is actively participating in the reinstatement of Pamlico County Schools' Student Health Advisory Council (SHAC) to develop alternatives to address tobacco product use by students and staff.  SHAC is scheduled to meet quarterly and will be comprised by a variety of partners including school administration, school nurses, social workers, local law enforcement, parents, and students. 

Communicable Disease.  PCHD's laboratory testing and events reported in North Carolina Electronic Disease Surveillance System (NCEDSS) demonstrate an increase in positive test results for syphilis, HIV+, and latent tuberculosis (LTBI) in Pamlico County.  In 2024, Pamlico County, through testing from the health department, the following communicable diseases have been identified and treated: eight newly diagnosed cases of syphilis, one newly diagnosed HIV, one active tuberculosis, and five newly diagnosed LTBI.   This does not include individuals already living with diagnosed communicable diseases, those who have not been tested, or events not yet reported. Additional information has been provided to primary care providers and to the community regarding communicable disease transmission, screening, treatment, and prevention.  PCHD has recently included Urine Nucleic Acid Amplification Testing (NAAT) for Chlamydia and Gonorrhea as an option to increase male client participation in STD screenings.  In 2024, no foodborne outbreaks were reported. 

Health Care Access and Transportation.  Lack of access and transportation for health care services continues to negatively impact Pamlico County residents seeking care/services.  Pamlico County does not have a public transportation system.  Residents must rely on private vehicles, CARTS, and/or BATS for transportation to health care appointments resulting in an increase in health disparities and inequities.  PCHD is actively collaborating with several non-profit organizations to identify opportunities to address lack of access and transportation in Pamlico County (e.g. Community Health Workers, Volunteers, Urgent Care, etc.) Collaborating with Duke University Global Health Institute, Duke University School of Nursing, and East Carolina University Allied Health to conduct research and increase student internships/preceptorships can help supplement provider shortages to accommodate expected increased client needs in Pamlico County.   PCHD has developed plans to strategically increase provider hours per week.  The additional provider hours will increase access to health care by supplementing local health care agencies, qualify for in-network insurance participation, and provide additional primary care access to accommodate Medicaid expansion, and improve the overall social determinants of Pamlico County residents.  PCHD is partnering with the Department of Veteran Affairs to explore opportunities to increase veteran health care access and transportation for participating veterans to scheduled medical appointments. 

Billing and Coding Reimbursements.  PCHD has recently discovered billing and coding discrepancies in their policies and procedures.  Historically, due to staffing shortages and leadership turnover, PCHD has not designated specifically trained staff to address billing and coding needs.  PCHD has been working with its electronic health records vendor, State consultants, and neighboring local health departments who utilize similar electronic systems to identify and correct billing and coding practices.  PCHD received approval from their Board of Health to reclassify designated staff and provide specific training to address billing and coding needs.  Monthly chart audits are being performed to track quality assurance since new practices have been implemented. PCHD has set a new goal of achieving 95% accuracy with first-time billing submissions.   

Medicaid Expansion. PCHD has recently added Primary Care and Telehealth to its services.  HOPE Clinic, the free health clinic utilizing PCHD facilities, is no longer able to provide services to clients who are newly eligible to receive Medicaid.  Access to care due to provider shortages and transportation barriers has increased the burden of clinics to obtain primary care services locally.  PCHD is partnering with Duke University School of Nursing to pilot Telehealth by scheduling eight provider hours per week through its HRSA grant until June 2026. PCHD was awarded $250,000 from the NC DHHS through the Office of Rural Health's Telehealth Infrastructure grant to help with start up expenses to support Telehealth modalities in an effort to increase access to primary and specialty care services to Pamlico County residents. 

Academic Partnerships.  PCHD has expanded its academic partnerships to include Duke University Global Health Institute, Duke University School of Nursing, East Carolina University Brody School of Medicine department of Public Health, and University of North Carolina Wilmington School of Nursing.  These academic partnerships provide positive learning environments for interns, nurses, and mid-level providers, expanding healthcare access to vulnerable populations in rural health communities.  Estimated in-kind donations and contributions exceeds $200,000.  

Pamlico County Health Department has recognized in efforts to decrease social determinants in Pamlico County the necessity to explore new opportunities and the expansion of resources, services, and programs. PCHD has initiated several new initiatives since the last CHA and SOTCH reporting to address behavioral abuse/mental health, community wellness, and workforce development concerns as identified in the CHA.

The following are new initiatives identified in the Scorecard:

• Adult Health, Primary Care, and Telehealth Services
• Pre-Employment Physicals
• Mass Immunizations
• Prevent Blindness of NC School-Age Vision Screenings (partnership with HeartWorks)
• Mental Health First Aid Training for Staff (partnership with HeartWorks and StillWaters)
• NC DHHS Office of Rural Health Telehealth Infrastructure Grant
• East Carolina University Brody School of Medicine Allied Health Student Internships (Public Health)
• Duke University School of Nursing Telehealth Pilot (HRSA Grant 2024-2026)
• Duke University School of Nursing Community Health Improvement Partnership Grant for laboratory equipment
• CDC Public Health Associate (2024-2026)
• VaxCare (Immunizations and LARCs for private insurance)
• Vitamin Angel (Prenatal vitamins) for women of childbearing age
• Increased provider hours from 24 hours to 32 hours per week 
• On-Call After Hours service for Primary Care
• Mosquito Vector Control Grant
• Bacterial and Metal Well Sample Kits
• Emergency Preparedness and Bioterrorism FIT testing instructor training
• Free Vector Control Larvicide (Dunks)
• Community Food Pantry Box
• REHS Governing Board Member
• FDA Grant (food/lodging)
• Medication Management for new family counseling office 

Pending discovery/approval:

• Community Health Workers (partnership with Imagine Pamlico and Pamlico Community College) - exploring training and funding resources
• CVS Foundation Grant for Aging (partnership with Duke University School of Nursing)
• Veterans' Health onsite clinic
• Specialty Telehealth (partnership with Duke University School of Nursing and East Carolina University Brody School of Medicine)
• NCCARE360
• FIT testing for respirators (community and first responders)
• REHS dual authorization (wells and onsite wastewater)

Paused:

• NC Syringe Service Program (approval denied by BOH)
• Tobacco/Vaping Cessation Programs for Schools (approved by BOH, pending Board of Education approval)
• Tobacco/Vaping Resolution 2024 (approval denied by BOH)

Discontinued:

• Department of Social Services CAP/Disabled Adults Nurse Assessments