Concord Hospital community assessment highlights differences between Capital, Lakes regions

Lakes Region patients report heightened difficulty obtaining access to primary care compared to Concord Hospital patients in the state’s capital region, according to a 2023 assessment authored by the hospital system. 

The firing of three doctors from Concord Hospital-Laconia in September sparked anxieties regarding patient access to primary care throughout the Lakes Region. Since their departure, the hospital added a new provider to their internal medicine department in Laconia in November and another doctor at the primary care practice in Gilford, where a third is expected to join in the future.

A hospital spokesperson said they’ve got 10 primary care providers accepting new patients in the Lakes Region and 55 across the broader hospital system. But since September, patients have reported difficulty in gaining access to primary care appointments, and a community health needs assessment in 2023 highlighted the need and desire among patients for better primary care provision, particularly in the Lakes Region.

The assessment of community health needs, approved by the hospital’s board of trustees in September 2023, was conducted in collaboration with health service organizations including Community Action Program, Granite United Way's Capital Area Public Health Network, Lakes Region Mental Health Center, the Partnership for Public Health and others, and sought to solicit input from consumers regarding their local health care systems. Concord Hospital Health System conducts such a study every three years, Vice President of Population Health Betsey Rhynhart explained in an emailed response Tuesday.

By the numbers

The study included the residents of 49 municipalities comprising the Concord and Lakes Region service areas, where about 250,000 people live. Residents were surveyed through direct mail, social media, email and website links, and community leaders and service providers were surveyed via direct email. The study also surveyed all hospital employees, included 11 in-person discussion groups, and consulted demographics and available health status indicators. 

The focus of the study was toward issues including the availability of mental health services, cost of health care services including medications and insurance, availability of primary care and specialty services, navigation of the health care system and a shortage in the workforce, availability and affordability of dental services, alcohol and drug use, elder support and socio-economic conditions.

Concord and the Lakes Region accounts for about 18% of the state population, according to census data, and grew by about 3.5% since 2020, outpacing the state rate of growth of 2%. The region is home to proportionally more seniors than the state average, Center Harbor being an outlier with 47% of its residents being 65 years old or older. In Laconia, 20% of residents were under 18 years old and 21% were 65 or older.

Laconia residents had a median annual income of about $64,000, and 10% lived under the federal poverty level. Almost half of households with children were single-parent, and 19% were disabled. The median income in Franklin, for comparison, was under $62,000, 5% of residents lived under the federal poverty level, and 40% of households with children were single-parent.

Respondent priorities

Among community respondents to the survey, the ability to access primary care services was the third-highest priority issue they faced in health care. The cost of health care services was the top response, followed by the cost of health insurance.

One respondent pointed to long wait times for an appointment and doctors themselves being strained by a high number of patients. 

“More primary care and mental health care providers and ability to see same without undue hurdles (such as long waits, insurance company prior approval hassles) and would love ability to see these providers without feeling rushed or that you are placing a burden on them when they are already overburdened,” the response reads.

Among the four distinct regions surveyed — Concord central, greater Concord, greater Laconia and greater Franklin — only respondents in greater Laconia opined the ability to access primary care services as their top health care need. Every other region said the cost of health care services was the most significant barrier. In greater Laconia, the cost of health insurance was the second-highest priority and the cost of health care services was the third.

Community leaders, on the other hand, more often pointed to other problems aside from accessing primary care services. Adult and youth mental health service access were the top concerns expressed by those respondents, along with prevention and treatment of alcohol and drug misuse or addiction. It’s worth pointing out, however, 9 of 10 “top issues” were common among both groups of respondents, albeit with a difference in the level of emphasis.

“There is a lack of available options for mental health problems in adults and especially children. With everything going on in schools from Covid-19 to school shootings across our nation, there are more children than ever that are in need of mental health options. Wait times at emergency departments or urgent care facilities is a huge deterrent for people seeking medical care and as such they are putting off being seen until the symptoms are more critical,” wrote a respondent who works in the emergency medical services field.

In general, respondents reported difficulty accessing primary care, but dental care for adults was the No. 1 response to a question asking if the respondent or someone in their household had experienced difficulty in accessing services over the prior year. Those responses did not vary by the income level, with all income levels responding at about the same rate. And 65% of respondents said accessing adult dental care was difficult due to cost, while 66% said accessing primary care was difficult primarily because of wait times. About half of those respondents also pointed to a lack of new patient availability and one third to a given service not being available.

Measuring progress, planning for the future

Input from the assessment was used to create a health improvement plan for 2024-26 which was intended to serve as a “road map” for the broader hospital health system. Leadership notes their “foundational goals” are to reduce health disparities, improve health equity and apply a diversity, equity and inclusion lens and trauma-informed principles to the Community Health Improvement Plan work.

The CHIP points to access to care, cost of care, behavioral health and increasing community engagement as being the four priorities for the hospital. Toward their aim of improving equitable access and assistance with navigation to high quality and safe primary care, behavioral and oral health services, the report suggests continuing to recruit for new primary care providers, assuring all primary care practices are open for new patients and developing a new orthopedics practice.

That report points specifically to developing and optimizing clinical access to meet the community’s needs, including the rebuilding of the Lakes Region’s primary care base. 

“As stated in our CHIP, our approach to community health improvement includes strategies and activities for population-based health promotion and disease prevention, building and supporting community capacity, and focusing on removing barriers to care for underserved [populations],” Rhynhart wrote. “While Concord Hospital can lead many of these strategies and activities, we recognize that this work requires the collective effort of our community.”

Over the first year, hospital administrators point to specific attainments which show improvement in increasing access to patients. They served about 1,900 low-income, underinsured and uninsured through Laconia Dental Clinic, an increase of 350 over the previous year, and almost 1,000 patients through financial and prescription assistance programs. They expanded their community health coordination support for connecting patients to additional community resources. 

Collaborations with Lakes Region Mental Health Center continue efforts to spearhead initiatives to transition behavioral health patients to community support. They organized a “Walk for Recovery” at Concord Hospital-Franklin to raise awareness of substance use disorder and funding for treatment at the CH Recovery Clinic. In September, that event drew 235 participants and raised over $40,000, and they’ve organized other events to highlight mental health and awareness and support for health care workers.

They’ve also focused on engagement with the communities they serve, Rhynhart wrote. They launched a hypertension initiative which distributed over 200 blood pressure monitoring kits, launched a multi-media vaccine awareness campaign, continued an existing diabetes initiative in primary care sites, completed over 14,000 screenings for housing needs, food insecurity, utilities, transportation and interpersonal safety. This month, they plan to launch a food security initiative in Franklin and Laconia in collaboration with the NH Food Bank for patients who are screened for food insecurity.