A Summary of the December 2009 Forum on the Future of Nursing Care in the Community (2010) / Chapter Skim
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4 Primary Care
4 Primary Care
Pages 25-34
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From page 25... ...
. The state also has invested in the Chronic Care Model that Governor Rendell described during his remarks; as he noted, this model uses nurse practitioners and primary care physicians in a medical home format to reach three-quarters of a million patients.
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From page 26... ...
One is the patchwork of funding on which they rely -- a combination of inconsistent reimbursement, federal dollars, and state and local funding. "The real issue is that the health care system has not quite caught up to the innovation of these clinics." A recent national survey found that nearly half of all major managed care organizations do not credential or contract with nurse practitioners as primary care providers (Hansen-Turton et al., 2008)
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From page 27... ...
Also, nurse practitioners cannot currently participate in some of the medical home initiatives supported by the Centers for Medicare & Medicaid Services. Very recently, however, the Joint Commission, a nationwide accrediting body for health care organizations across a variety of settings, has approved certification for a primary care home that includes nurse practitioners and physician assistants in leadership roles.
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From page 28... ...
effective in reaching the segment of the U.S. population that currently goes without regular care, with up to 60 percent of clinic patients not having a regular source of primary care (Mehrotra et al., 2008)
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From page 29... ...
It provides health care to 1.9 million American Indians and Alaska Natives around the country, mostly on reservations in rural and remote areas. Its system includes 48 hospitals; several hundred ambulatory, free-standing primary care clinics; and 34 urban clinics.
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From page 30... ...
Additionally, facilities have established programs to screen for sexually transmitted diseases, organized programs to facilitate mother-daughter interactions, and held faculty dinners at the high school and middle school levels to educate community leaders and youth on healthy lifestyles, behaviors, and risk factors. IHS includes more than 350 public health nurses prepared at the bachelor's level who are rarely found in clinics and hospitals but rather are out in the community.
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From page 31... ...
"Through her insight and keen talent for relationship building, this public health nurse and her team developed a mass vaccination campaign to avert a disaster," said Haldane. Community clinics were established and staffed with medical personnel as well as community volunteers so that they could work together to address threats in a community-based way.
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From page 32... ...
For those who wish to go to school to achieve an advanced practice degree, opportunities are "dismal," according to Haldane. The service's system is seeing continuous decline in inpatient admissions and an increasing use of primary care and public health services, yet most new nurses' education has focused on inpatient nursing.
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From page 33... ...
Hansen-Turton replied that retail clinics are not meant to be ongoing sources of primary care. However, they are designed to provide basic health care services, and emergency rooms are now being flooded with people needing attention for various types of basic health care issues that could be treated elsewhere.
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From page 34... ...
The real value proposition is multiple access to care, and certainly the retail clinics present a first level of care," said Hansen-Turton. In response to a question about how to increase the diversity of the nursing workforce and reduce barriers these candidates face in entering the nursing profession, Haldane said that many of the students who apply for scholarship programs through IHS are from remote and rural locations and are not as well prepared as other individuals.
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