A Nurse Practitioner's View

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it! Patient-Centered Health Care Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no- brainer . However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most o...

There are so many unknowns regarding both patients and providers with the passing of the recent monumental health care legislation. Thanks to a recent post on AJN's Off the Charts blog, they posted a link to a handy ANA chart comparing both versions of the legislation and what it means for nurses and nurse practitioners. Of course, this is subject to change somewhat based on the revisions that still need passing however, I would imagine that it will remain pretty close to this. It appears the biggest factor for NPs is the ability to lead the team of providers in Patient Centered Medical Home demonstration projects. Stay tuned for more on this white hot topic of reform......

I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care. Quite frankly, the arguments are old and tired. My goal as a clinician is to deliver the highest quality, evidence-based, and culturally competent care that I am capable of. I refuse to pit NPs versus other professions. We all have our own slightly varied philosophies and approaches to delivering care. Some may prefer the approach of a DO while some choose to see a NP or PA or MD. I believe patients have that right. However, I cannot believe the nonsense and out of context rubbish posted on the AMA's "Virtual Mentor" in a column entitled, " The Primary Care Shortage, Nurse Practitioners, and the Patient-Centered Medical Home. " Oh, where to begin! The opinion piece begins with the patronizing idea that NPs are part of the solution but not THE solution to the primary care crisis in this country. Funny, but I couldn't find a single ref...

I came across this wonderful post on Dr. Edwin Leap's blog, " Attention Doctors: People may not like you. " It is relevant for all clinicians and talks about the interactions between patients and providers, patient expectations, and the handling of these expectations. The important thing to remember is that we are providing a service to our patients. Patients come to us for our advice, opinion and to make them feel better. Some may not agree with our plan and will seek further opinion - and sometimes they certainly should. Patient's should be empowered to be actively involved in the decision making process. But oftentimes silos are created, further fragmenting care and communication. That's why I believe firmly that comprehensive care is best delivered in teams - where team members share the same focus and are aware of each other's strengths and weaknesses. There are so many patient variables to consider: culture, socio -economic status, gender, past medical...

Representative Allyson Schwartz along with nearly 100 cosponsors recently introduced House of Representatives Bill 2350, Preserving Patient Access to Primary Care Act of 2009. The legislation will improve access to primary care and increase the number of primary care providers in part by allowing the Nation's nurse practitioners to lead the Patient Centered Medical Home. Here is the full text of the Bill. This has the potential to be monumental legislation for our nation. In addition, an unprecedented number of physician (American Academy of Physicians & American Academy of Family Physicians) and nurse practitioner organizations (American College of Nurse Practitioners & National Association of Pediatric Nurse Practitioners) are supporting this bill. Though it seems that the AAFP is begrudgingly "putting up" with the inclusion of NPs as evidenced by AAFP Chairperson Jim King, M.D.: The legislation also would allow nurse-practitioner-managed practices to serve ...

Today's New York Times has an article about the Medical Home concept. These projects are becoming more popular as insurers are deciding to cover the costs. The article refers to a patient who visited his very busy physician that missed a stroke diagnosis because of a hurried exam. While mostly inexcusable, it provides a real life example of the issues occurring every single day due to the system's lack of access, communication, reimbursement, and high-quality. While the article doesn't make specific reference to NPs , Senators from New Mexico, Iowa, Alaska and Maine recently discussed expansion of Medical Home projects to include NPs , and other non-physician providers of primary care to lead medical home demonstrations. Senator Bingamin of New Mexico sums it by saying: Furthermore, nurse practitioners epitomize the delivery of high quality, cost-effective primary care that is crucial to the medical homes model. Senator Murkowski of Alaska adds: Nurse practitioners funct...

There have been 2 recent articles (one in a Boston publication and one in an upstate New York publication) about the concept of the medical home. This term is thrown around an awful lot these days and means much more than just a solo or group of primary care providers. This is a patient-centered approach to care that uses a coordinated effort by a team of health care professionals focusing on preventative health services right through hospitalizations. You can see the wikipedia definition of medical home here . Professional organizations such as the AAFP , AAP , & ACP (among others) have even adopted formal policy statements on this. One of the main reasons that this concept hasn't gone anywhere is because the coordination of this type of care (the phone call consults, e-mails, paperwork, etc) hasn't traditional been reimbursed by insurance companies. These new pilot projects are attempting to remedy that. Also encouraging is that NPs are being utilized in this model and...