Executive Summary

EXECUTIVE SUMMARY

Vision Statement

The vision of this report is to offer meaningful understanding of the most pressing health needs across Duplin County, as well as to guide planning efforts to address those needs. Community health needs assessment (CHNA) is a core tool of public health, but the assessment can serve many purposes. The health status of a community plays a large role in social and economic prosperity; hence it is important that a community strives to continually improve and maintain its health. Successful health programming is a collaborative process among multiple partners and must also include input from community agencies and community members.

Leadership

• Duplin County Health Department- Tracey Simmons-Kornegay, PHD, Health Director; Brittney Matthis, MSN, RN, Nursing Director; Maury Castillo, Health Educator; Samantha Kennedy, Administrative Assistant.
• ECU Health Duplin Hospital- Janetta Matthews, Community Health Improvement Coordinator, Laura Maready, Director of Marketing & Development, Christina Miller, BSN, RN, MBA, Director of Patient Care Services, Acute.
• ECU Health- Crystal Dempsey, Vidant Health Manager of Community Health Improvement, Melissa Y. Roupe, MSN, RN Senior Administrator, Community Health Improvement.

Partnerships

 Regional Contracted Services

The 2021-2022 Duplin County CHNA was developed through a partnership between the Duplin County Health Department, ECU Health Duplin Hospital, and Health ENC.  Health ENC is a collaborative initiative of health departments and hospitals in eastern North Carolina. The funders for the Health ENC are the Foundation for Health Leadership and Innovation (FHLI). The FHLI coordinates a regional CHNA in 35 counties of eastern North Carolina. Details of the regional leadership are included in the introduction section.

 Theoretical Framework

The social ecological model was used as a guide in the development of the CHNA. This model understands health to be affected by the interaction between the individual, the community, and the physical, social, and political environments. There is a complex role played by context in the development of health problems as well as in the success or failure of attempts to address these problems. There are four core principles that underlie the ways the social ecological model can contribute to efforts to engage communities:

• Health status, emotional well-being, and social cohesion are influenced by the physical, social, and cultural dimensions of the individual’s or community’s environment and personal attributes (e.g., behavior patterns, psychology, genetics).
• The same environment may have different effects on an individual’s health depending on a variety of factors, including perceptions of ability to control the environment and financial resources.
• Individuals and groups operate in multiple environments (e.g., workplace, neighborhood, larger geographic communities) that “spill over” and influence each other.
• There are personal and environmental touch points, such as the physical environment, available resources, and social norms, that exert vital influences on health and well-being.

 Collaborative Process summary

The leadership team initial planning meetings started after the 2018 CHNA was submitted in late 2019. In February 2020 the COVID-19 pandemic stopped all work on the CHNA as health department and hospital members were reassigned to communicable disease response and in-person meetings were suspended. It was not until January 2021 that the Health ENC steering committee was able to re-start the process. All meetings were held virtually, which did create some barriers for some community members to attend. First meeting was held virtually in February 2021 to discuss timeline, community survey development, and the training opportunities for partners in the Results Based Accountability (RBA) method. The surveys were ready for distribution in April 2021. The decision was made not to do in-person focus groups due to COVID-19 restrictions. Surveys were collected electronically from April 26th -June 18th.  The CHNA document was completed and submitted to the NC DHHS, June 1, 2022 and ECU Health will submit their document to their Board of Directors at the end of the fiscal year.    

Key findings

1. Demographic data- 5-year trends-population has decreased by 0.9%. Projected to increase by 4.3% over next 10 years. Gender essentially equal females to males.

2. Race/Ethnicity: stable at 71.2 % white, 23.8 % Black/ African American, 22.2 % Latino/Hispanic. Duplin has a significantly higher Hispanic/Latino population than the state and ENC region.

3. Social and economic factors are strong determinants of health outcomes. Those with a low socioeconomic status are more likely to develop chronic conditions.  Duplin was a Tier 1 county in 2019/2020. Tiers are calculated by unemployment rates, median household income, percentage of population growth and property tax base per capita.

4. Median household income lower in Duplin as compared to state and ENC counties. Poverty levels set by census bureau current 21% of the population lives below the poverty level, this is higher than state and ENC counties. Children living in poverty at 34%. At risk groups seniors, children, people with disabilities and minority groups

5. Severe housing problems (low wages, flooding in past years) is worsening.

6. Food insecurity, households with children that participate in SNAP benefits higher than state average and higher than Health ENC regions.

7. Residents without health insurance at 20%, unchanged from previous years, coverage is lower in Duplin as compared to state rate and Health ENC region.

8. Education: HSD attainment less than state and Health ENC region, though dropout rate and suspensions show decrease.

9. Primary data- Community Survey respondents’ top concerns related to:

• Low income /poverty

• Drug/alcohol/substance use

• Lack of county resources

10. Secondary data indicates the top leading causes of death (unchanged)- Heart Disease, Cancer, Stroke, motor vehicle injuries, Alzheimer’s Disease. Very similar to state and Health ENC region.

11. Healthcare workforce indicates low number of primary care provider per 10,000 population in Duplin. Access to care is limited.

 Health Priorities

The community engagement and health priority session were held virtually on November 10, 2021.  The group discussed the available and/or needed resources to impact goals. Special attention has been given to the needs of vulnerable populations, unmet health needs or gaps in services and input gathered from the community. The group decided on three health priories for 2021-2023.

1. Chronic Disease Prevention
2. Access to Care
3. Mental Health/Illness

 Next Steps

Findings from this report will be used to identify, develop and target initiatives to provide and connect community members with resources to improve the health challenges in their community. The goal was to convene community work groups in December 2021, the resurgence of COVID positivity rates in Duplin County have delayed this process. The leadership team will be setting up community health focus groups in the coming months to discuss each of the objectives and to develop health improvement plans. 

Priorities

Why Is This Important?

Federal poverty thresholds are set every year by the Census Bureau and vary by size of family and ages of family members. A high poverty rate is both a cause and a consequence of poor economic conditions. Children in poverty are more likely to have physical health problems, behavioral problems and emotional problems. Seniors who live in poverty are an especially vulnerable group due to increased physical limitations, medical needs, and social isolation. Persons with a disability are more likely to live in poverty compared to the rest of the population. Without adequate income, individuals with disabilities may not be able to afford necessary expenses, such as rent or mortgage, utility bills, medical and dental care, and food. In Duplin County an estimated 21.0% of the population lives below the poverty level, compared to 15.0% of the population in NC and 17.5% for the Health ENC Region. The percent of children living below the poverty level is much higher (34.0%) for Duplin County compared with N.C. (21.0%) and Health ENC Counties (25.5%). The rate of older adults age 65+ years living in poverty is 1.3% higher in Duplin County when compared with NC, and 0.1% higher than the Health ENC County Region. The percent of disabled people living in poverty in Duplin County (23.0%) is higher than N.C rate. (20%).

Medical costs in the United States are very high. People without health insurance may not be able to afford medical treatment or prescription drugs. They are also less likely to get routine checkups and screenings, so if they do become ill they may not seek treatment until the condition is more advanced, and therefore more difficult and costlier to treat.  Nearly 20% of the population 0-64 years of age in Duplin County are uninsured. The rate of individuals aged 0-64 years old that have health insurance coverage in Duplin County is 79.3%, which is lower than the rate for North Carolina (87.3%) and the Health ENC region (87.0%).

21% of the population in Duplin County is living below the federal poverty level and nearly 20% of the population is uninsured. When trying to address access to care, the Health Department had to keep these influential barriers in mind. Utilization of the mobile medical unit allows the Health Department to overcome the specific barriers of travel, payment, and convince. The Health Department also provides primary care and child health clinics with a focus of providing services to the underserved and those of Historically Marginalized populations within Duplin County.  NC MedAssist helps the Health Department provide medications to the same underserved and historically marginalized populations to ensure equitable access to a healthy life.

Alignment With Healthy North Carolina 2030

Uninsured

Primary Care Clinicians

What We Do

The Duplin County Health Department operates a Primary Care Clinic and Child Health Clinic five days a week. The decision to staff and maintain these clinics within the Health Department is driven by the low number of primary care and pediatric providers within the county. The clinic provides well visits, sick visits, physicals, and more. The clinics provide care that is person and family-oriented, collaborative, comprehensive, accessible, and equitable. 

Who We Serve

Duplin County Health Department provides preventative and primary care for adults and children with a focus on serving the uninsured and underinsured populations. In an area with a provider shortage, the health department is the only medical provider that offers a sliding fee scale, with no required co-payment.

How We Impact

By providing primary and pediatric care to the residents of Duplin County, we enhance equitable access to healthcare services while providing preventative screening and chronic disease management to make the community healthier.

Progress in 2022-2023

2023:

NC Medicaid Expansion planning

What We Do

The Duplin County Health Department provides a primary care clinic that is Monday through Friday from 8-5pm. The decision to staff and maintain these clinics within the Health Department is driven by the low number of primary care providers within the county. The clinic provides well visits, sick visits, physicals, preventative care, referrals and more. The health department strives to provide equitable access to care through the primary care clinic.

Who We Serve

The primary care clinic within the health department serves patients 18 years and older, no matter their insurance status. The health department is the only medical provider that offers a sliding fee scale, with no required co-payment.

How We Impact

Providing this service brings access to healthcare to many adults who do not have a primary care provider but also cannot afford one. Those without insurance who would otherwise be turned away are able to be seen for their health problems and referred when needed. Preventative services may help to identify, diagnose and treat health problems that may otherwise go unnoticed and be fatal to our patients. 

What We Do

The Mobile Medical Unit was purchased through county-appropriated ARPA funding in 2020. The unit is in the form of a travel trailer that can be pulled from site to site, making it available to communities that may be inaccessible to care otherwise. It features interior equipment and furniture that is conducive to appropriate medical care, such as vast counter space, several areas for patient to sit for treatment and a private exam room. Since the COVID pandemic, the Mobile Medical Unit has been heavily utilized for on-site and off-site COVID testing and vaccination clinics. 

Who We Serve

Duplin County Health Department serves all residents of Duplin County regardless of age, race, ethnicity, income, citizenship, and health insurance coverage. Our Mobile Medical Unit brings medical care to areas where the population has inadequate or no means of transportation. 

How We Impact

The Mobile Medical Unit helps with access to care barriers and allows us to meet and provide health services needed where our residents work or live. 

Current Status

Due to staff turnover and funding, we have had the Mobile Medical Unit parked in all of 2023. However, we plan to utilize the Mobile Medical Unit beginning in 2024 to extend needed services (i.e. blood pressure and glucose checks, vaccinations, testings, medical evaluations, etc.) in the community, such as in mobile home parks or at our 9 local processing plants.

What We Do

The Duplin County Health Department entered into a partnership with NC MedAssist in 2014. NC MedAssist helps us provide prescription and over-the-counter medications to the uninsured population within the county.

Who We Serve

Partnering with NC MedAssist, we serve the uninsured population of Duplin County, which is approximately 20% of the population.

How We Impact

By partnering with NC MedAssist and making prescriptions and over-the-counter medications available to the uninsured population, individuals have the resources needed to prevent and treat chronic diseases, acute illnesses, and to live healthier lives.

Progress in 2022-2023

2022:

-New staff being trained to NCMedAssist program

2023:

-Decrease in uninsured due to enhanced Affordable Care Act

Why Is This Important?

Alignment With Healthy North Carolina 2030

Tobacco Use

What We Do

QuitlineNC provides free cessation services to anyone in North Carolina that is interested in quitting any variety of tobacco products. Help is available 24/7 and is also available in many different languages. QuitlineNC has had great success in previous years and with smoking and vaping being at large in our community, we felt it was the right time to utilize QuitlineNC resources and grow the program within Duplin County. We will establish agreements with the healthcare providers and community partners in the area to refer members of the community to QuitlineNC.

Who We Serve

We serve the residents of Duplin County who utilize tobacco products.

How We Impact

By establishing agreements with healthcare providers and community partners within Duplin County, the number of referrals to QuitlineNC should increase, with the long-term goal of decreasing the number of people in the county who use tobacco products.

Progress in 2022-2023

What We Do

ECU Health Duplin Hospital offers screenings of body mass index, blood pressure and heart rate, glucose, and total cholesterol to the community regularly to help screen for potential chronic diseases that may otherwise go unnoticed. 

Who We Serve

The communities of Duplin county, both rural and urban. 

How We Impact

These screenings provide the community with ways to identify potential adverse health conditions by bringing the care to them. It helps provide secondary prevention efforts to vulnerable populations that may have barriers such as work schedules, transportation and income. 

What We Do

The Duplin Coalition for Health (DCFH) is a community health improvement partnership with representatives from local churches, businesses, communities, and human service agencies. DCFH collaboratively responds to the compelling health needs of the people of Duplin County through assessment, resource identification and development, citizen advocacy, comprehensive planning, and coordination of health intervention and prevention strategies. DCFH uses the Community Health Needs Assessment (CHNA), as a joint effort with ECU Health Duplin Hospital and the Duplin County Health Department to identify, understand, and prioritize the health concerns of the residents of Duplin County. The purpose of DCFH uses a collaborative approach to improve the community's health by leveraging the resources and knowledge of the participant organization and community members. Based on the 2021 CHNA our three health priorities is Chronic Disease Prevention, Access to Care, and Mental/Behavioral Health to be addressed by the coalition. 

Who We Serve

All people of Duplin County. 

How We Impact

By building trust and strengthening communication within community organizations and the people of Duplin County we can help decrease health disparities and barriers. 

Description

Duplin County's population is about 48,515 people. Utilization of mass media message campaigns has proven to be a great way to inform and educate the general public. The Duplin County Health Department uses all forms of media including radio, newspaper, billboards, web-based & social media platforms, and printed materials.  The information is provided in both English and Spanish, with the average reading level of the target population being a factor in all message campaigns. We have continued to use multiple different outlets to disseminate information to ensure everyone has access to the information. Promoting health events and resources in a variety of ways, we ensure that everyone has equal access to information that could impact or improve their health.

Why Is This Important?

The Duplin County Community Health Assessment survey found the top 3 rated quality of life issues identified were low-income/poverty, drugs and alcohol, and lack of community resources. 16.36 percent or 193 survey respondents identified drug and alcohol (substance abuse) as a life issue. In Duplin County, an estimated 21 percent of the population lives below the poverty level. Mental health is not always treated like physical illness in relation to availability, cost, insurance coverage, and community resources. A person’s metal health can affect their physical health, and should be treated just like every other medical problem.  The number of physicians per 10,000 population in Duplin County has decreased from 6.52 physicians in 2000, to 6.03 in 2019 and remains below the state rate of 24.3 physicians per 10,000 population.  This being said, there are not enough health care professionals for community members to reach out to when they are​ experiencing problems related to their mental health. With their being an insufficient amount of health care professionals in Duplin County, programs are going to have be established within the community to provide help or provide resources to those who need them.

Unintentional poisonings are rated as the third leading cause of injury death and of injury hospitalization in Duplin County. The Duplin County Health Department is going to address mental health and unintentional overdoses by administering Naloxone Kits, increase the number of medication drop box locations in the county, and increase the utilization of Telepsychiatry services.  

Alignment With Healthy North Carolina 2030

Drug Overdose Deaths

Suicide Rates

What We Do

North Carolina Statewide Telepsychiatry Program (NC STeP) is a community-based behavioral health program the Duplin County Health Department partners with to provide Telepsychiatry services on site. Duplin County joined NC-STeP in May 2019 to provide behavioral health services, to improve the quality of life for those not receiving necessary treatment due to an insufficient amount of behavioral health providers within the county.

Who We Serve

We serve all residents in Duplin County 18 years and older.

How We Impact

By providing Telepsychiatry services through NC-STeP within the Health Department, we are able to address and provide treatment for behavioral health issues that residents would otherwise have to travel out of county to receive.

Progress in 2022-2023

2022:

-Efforts continue as many patients return to work after COVID19, ending unemployment in many areas. Mental health responses grapple with outcomes of pandemic through their patients and programs begin returning to normalcy. 

2023:

At the beginning of 2023, the previous provider for ECU Health Telepsychiatry retired and we began working with a new provider. 

What We Do

The Duplin County Health Department distributes Naloxone kits at no charge during operating hours, Monday through Friday.  In alignment with NC State law, basic instructions and information on how to administer the medication are provided to every person who receives a kit.  Naloxone is a medication that is used to reverse the effects of opioid medications. An overdose on opioid medications can escalate to an emergency situation where lifesaving measures like Naloxone and CPR may be required. We aim to educate the public on the dangers of the misuse of opioids and provide the resources needed to help someone in this situation.

Who We Serve

We serve all residents of Duplin County that may struggle with opioid misuse or addiction, along with the families and friends of these individuals.  

How We Impact

By providing education and Naloxone Kits, we are contributing to a lifesaving measure that may give someone a second chance.

What We Do

Operation Medicine Drop uses drop boxes at designated locations within the community for people to drop off expired or unused medications. With overdose rates climbing within the state and Duplin County, providing more locations in which people can dispose of potentially harmful medications can ensure they do not end up in the wrong hands. Collaborating with the Duplin County Substance Coalition, the Duplin County Health Department has been able to spread information and increase usage of the current medication drop boxes. 

Who We Serve

We serve all residents of Duplin County, which is about 48,515 people.

How We Impact

By educating the public on the proper disposal of expired or unused medications, we reduce the risk of contamination of our water system and prevent medications from getting into the wrong hands.

What We Do

The lessons introduce and develop skills for making healthy choices, building positive friendships, developing self-efficacy, communicating effectively, and resisting peer pressure and influence. Too Good for Drugs teaches five essential character development skills to build self-efficacy, and promote healthy development, and academic success:

• Setting Reachable Goals
• Making Responsible Decisions
• Bonding with Pro-Social Others
• Identifying and Managing Emotions
• Communicating Effectively

Who We Serve

We serve all students in Duplin County in kindergarten through twelfth grade.

How We Impact

By partnering with the school system and providing a preventative education program to students in kindergarten through 12th grade, we aim to reduce the number of adolescent vaping and prevention of future substance abuse.

Progress in 2022-2023

This is a new initiative for us as a county, therefore we do not currently have any data to show for this program. We plan to start holding this program in our schools in May of 2024. 

Progress on CHIP

These priorities listed for Duplin County are addressed in the Community Health Improvement Plan (CHIP). Please click on the hyperlinks below to see the progress made for 2023:

Duplin County priorities include:

Access to Care

DCHD Child Health Clinic 

DCHD Primary Care Clinic

Mobile Medical Unit 

NC MedAssist 

Chronic Disease Prevention

QuitlineNC

Duplin Coalition for Health 

Chronic Disease Prevention Screenings

Community Outreach & Education Events

Mental Health/Illness

Telepsychiatry 

Naloxone Distribution

Operation Medicine Drop 

Too Good Program

Other programs not addressed as a priority:

Cribs for Kids - Safe Sleep Education 

Women Infants and Children- (WIC)

Breast and Cervical Cancer Control Program(BCCCP)

Care Management for At-Risk Children (CMARC) 

Care Management for High-Risk Pregnancy (CMHRP) 

Morbidity and Mortality Changes Since Last CHA

• In 2023, there were 5 flu outbreaks in Duplin County nursing homes
• Duplin County had 3 active Tuberculosis cases 
• 3 Haemophilus influenza deaths
• 5 COVID deaths

Emerging Issues Since Last CHA

• Bicillin antibiotic injection shortage for treatment of syphillis cases-giving alternative antibiotics by mouth to treat which leaves room for poor medication adherence 
• Lack of available appointments with dental providers for Medicaid-insured children
• Lack of available food, daycare, financial, housing, transportation resources due to geographic location and low funding
• Cost of housing has increased and resources for affordable rates are unavailable; overcrowding of homes
• Inflation causing groceries and gas prices to increase making it harder for low income families to afford transportation and food

New/Paused/Discontinued Initiatives Since Last CHA

New:

• "Too Good" school program: this is a program being offered through our Opioid settlement funding helping students within Duplin County schools to recognize precursors to substance abuse and to help prevent future use of drugs
• Some Duplin County CMHRP/CMARC patients have already been enrolled in NC Medicaid Tailored Care plans, offering beneficiaries with behavioral, intellectual or developmental disabilities additional specialized services
• Duplin County Coalition for Health resumes

Paused/Plans for improvement:

• Mobile Medical Unit program is currently paused while management works on a primary care mobile clinic to provide necessary care to inaccessible areas. The health department team is looking at the needed staff and supplies to bring this unit back up and running.
• Plans to increase community awareness of the Catch My Breath program and encourage more usage within the Duplin County School system. 
• Work with Operation Medicine Drop Box sites to encourage record keeping of poundages of medications being disposed of annually
• Provide more outreach and community awareness for QuitlineNC program

Progress on CHIP

These priorities listed for Duplin County are addressed in the Community Health Improvement Plan (CHIP). Please click on the hyperlinks below to see the progress made for 2022:

Duplin County priorities include:

Chronic Disease Prevention

DCHD Primary Care Clinic

DCHD Child Health Clinic 

QuitlineNC

Access to Care

Mobile Medical Unit 

NC MedAssist 

Mental Health/Illness

Telepsychiatry 

Operation Medicine Drop 

Morbidity and Mortality Changes Since Last CHA

• During 2022, Duplin County saw a rise in respiratory illnesses and experienced illness-related deaths. The county saw 2 active Tuberculosis cases, 1 Haemophilus influenzae death, and 46 COVID19 deaths. 

Emerging Issues Since Last CHA

• Increased STD rates (gonorrhea and chlamydia)
• In 2022 Duplin County along with the US experienced a national infant formula shortage due to COVID19 causing chain supply issues as well as several recalls of products. Our WIC department, pediatric offices, case management teams, grocers, and faith based organizations among many others teamed together to help the residents and their children within the county find formula.
• Long COVID symptoms continue in patients
• Respiratory illnesses such as flu & RSV increase
• Housing access and affordability

New/Paused/Discontinued Initiatives Since Last CHA

New:

• In 2022, Duplin County received over $2 million dollars in opioid settlement funding to help fight the terrible epidemic of drug overdoses within the county. The funds are to be allocated to community programs and efforts to help put an end to this terrible problem.