Academic journal article Nursing and Health Care Perspectives

Nurse-Managed Primary Care in a Rural Community: Outcomes of Five Years of Practice

Academic journal article Nursing and Health Care Perspectives

Nurse-Managed Primary Care in a Rural Community: Outcomes of Five Years of Practice

Article excerpt

Nursing centers offer underserved populations affordable access to primary health care. BUT TO BUILD THEIR CASE FOR INCLUSION IN MANAGED CARE PLANS and the health care delivery systems of the future, they must document their successes.

Nursing centers are increasingly influential in the provision of primary care to a broad range of clients in the United States. Estimates of the number of existing centers vary, but more than 250 academic or privately owned practices are actively engaged in offering acceptable, affordable, and accessible primary care (Sharp, 1992). The nursing center movement has much to offer because it brings nursing care directly to communities, helping to maximize the health of diverse population groups. Indeed, in many cases, care for underserved populations is a critical element of nursing centers (Barger, 1995; Phillips & Steel, 1994).

Both established and new nursing centers are adapting to the demands of the managed care revolution. Strategies for financial survival are changing rapidly and differ from those in the fee-for-service system (Conway-Welch & Hartman-Green, 1995; Walker, 1994). The realities of market-based health care in the United States require that nursing centers document outcomes in critical areas of functioning to solidify their acceptance as viable sources for the provision of primary care. The implementation of an effective evaluation strategy is the basis from which information can be provided to managed care organizations, other health professionals, and the public. Comprehensive evaluation of nurse-managed, primary care practices takes place across broad areas of functioning, including physical facilities, human resources, financial viability, client outcomes, and, in academic centers, student and faculty achievements (Edwards, in press).

Nursing centers must document their successes for policymakers, health care financiers, the business community, other health care providers, and clients. The importance of accurate and comprehensive data about the capabilities of nursing centers cannot be overstated. Such data are the foundation on which the case for inclusion in managed care plans and the health care delivery system will be built in the future.

Selected outcomes from five years of operation of a rural, nurse managed, academic, primary care center are presented below. Results in the areas of client demographics, financial sustainability, and selected client outcomes are drawn from the comprehensive evaluation data for the center accumulated over the five-year period from 1991-1992 to 1995-1996.

Mountain City Extended Hours Health Center The Mountain City Extended Hours Health Center (MCEHHC) is a nurse-managed, academic, primary care center that is part of the College of Nursing at East Tennessee State University. The clinic, established in September 1990, came into existence at the invitation of the community of Mountain City, located in Johnson County, the most northeastern county in Tennessee.

With a population of 15,940, Johnson County is situated in the beautiful Blue Ridge Mountains, and is accessible only by winding, two-lane roads. In 1988, the small rural hospital closed, and most physicians moved their practices to a county across the mountains in North Carolina. Unemployment reached the epidemic proportion of 35 percent as businesses left the area. Concerned citizens recognized the need for an adequate health care system in order to protect and retain their population base and to attract new businesses. A community group of private citizens and county officials approached the Health Sciences Division of East Tennessee State University for assistance. Both the Department of Family Medicine and the College of Nursing accepted the invitation to practice in partnership with the rural community (Edwards, Lenz, & East-Odom, 1993).

The MCEHHC opened September 17, 1990, to provide nurse practitioner and nursing services specifically in the evenings and on weekends. …

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