Taking Action to Address Chronic Conditions Among Older Adults in Rural Tennessee

Rural populations face unique health challenges due to a complex mix

of economic, social, demographic and health workforce factors. They have distinctive characteristics — for example, rural areas are home to a higher proportion

of older adults — and may experience financial insecurity

 and higher rates of unhealthy behaviors, as well as shortages in the health care workforce that can make access to care

a serious challenge.

America’s Health Rankings data consistently show that adults living in rural (nonmetropolitan) areas experience higher rates of chronic conditions than their counterparts in metropolitan areas. This is especially pronounced in Tennessee, where nearly 1 in 5 rural adults (19.5%) live with multiple chronic conditions compared with 14.9% of adults living in Tennessee’s metropolitan communities and 14.4% of adults living in rural areas nationwide.

In Tennessee, River Valley Health

, formerly Cherokee Health Systems — a Federally Qualified Health Center — is tackling high rates of chronic conditions among older adults through a prescription delivery program that provides consistent access to medications, health care education and counseling.

Within River Valley Health’s service area, 32% of the population are adults age 55 and older, many of whom are likely to have increased medical and pharmaceutical needs which require multiple prescriptions. Additionally, 25% of the communities served by River Valley Health are considered rural, making in-person access to pharmacies more challenging for many patients. Further, although prescription mail order services are generally available throughout Tennessee, access can be more limited in rural parts of the state and particularly for patients without insurance. Pairing medication delivery with health care resources can help overcome many of the barriers in rural communities that can contribute to chronic conditions.

Nationally, chronic obstructive pulmonary disease (COPD) was 1.61 times more prevalent among adults living in rural areas (9.2%) relative to their counterparts living in metropolitan areas (5.7%) in 2023.

In 2023, the prevalence of cardiovascular diseases was 1.41 times higher among U.S. adults living in rural areas (11.7%) than those living in metropolitan areas (8.3%). In the same year, the prevalence of cardiovascular diseases in rural areas varied by state, with adults living in rural areas in Utah (7.0%) having the lowest rate and those in West Virginia (16.2%) having the highest.

Nationally, adults living in rural areas (14.4%) had 1.24 times higher prevalence of diabetes compared with those in metropolitan areas (11.6%) in 2023. Diabetes worsened for both adults living in rural (13.4% to 14.4%) and metropolitan areas (10.9% to 11.6%) since 2021, with the difference between geographies persisting over time.

There is also a difference in the prevalence of multiple chronic conditions — defined as having three or more chronic conditions — based on where one lives. Nationally, the prevalence of multiple chronic conditions was 1.48 times higher among adults living in rural areas (14.4%) than those living in metropolitan areas (9.7%) in 2023.

As part of our commitment to improve health outcomes, the United Health Foundation partnered with River Valley Health in 2024 to expand and enhance its prescription delivery program. The program provides older adults, especially those living in remote areas, with better access to essential medications and health care resources.

Through this partnership, a team of clinical pharmacists, certified pharmacy technicians and care coordinators deliver medications directly to patients' homes, as well as provide medication counseling and identify and address unmet social needs that impact their health.

What began as a simple idea of bringing prescriptions directly to patients’ doors has become a lifeline for more than a thousand individuals who otherwise might have gone without the care they need. The River Valley Health team has worked across departments to streamline the process, coordinate with clinicians and ensure that every delivery happens safely, accurately and on time. “We’ve seen how something as small as getting your medication without having to worry about transportation can change someone’s entire outlook,” said Dr. Stacy White, River Valley Health’s Pharmacy Director. “It’s not just convenience, it’s access and dignity.”

As the program has expanded over the past few months, the team has learned valuable lessons about logistics and connection. The results speak for themselves. Fewer medication lapses, better adherence rates and a steady stream of gratitude from patients all point to a program that’s working. Each delivery reinforces River Valley Health’s mission to remove barriers and meet patients where they are. What started as a pilot effort has evolved into a model for compassionate, community-centered care that continues to grow and inspire.

Learn more about the United Health Foundation’s grant partnerships.

America’s Health Rankings data consistently show that adults living in rural areas have higher rates of chronic conditions and risk factors than their metropolitan counterparts.

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*There are many ways to define rurality, and not all rural communities are alike. America’s Health Rankings data on chronic conditions included in this article come from the Behavioral Risk Factor Surveillance System

(BRFSS) 2023 dataset, which classifies respondents by whether they live in nonmetropolitan or metropolitan areas. Nonmetropolitan includes micropolitan and noncore communities.