Magazine article Policy & Practice

'Nurse First' Logs Long Miles in Montana

Magazine article Policy & Practice

'Nurse First' Logs Long Miles in Montana

Article excerpt

Montana is known as the Big Sky Country for its picturesque vistas, mountain ranges and never-ending blue skies. For Medicaid clients, those never-ending blue skies can represent the distance that often separates them from a doctor in this largely rural state.

But the "Nurse First" disease management and nurse advice line program--launched in January 2004 by the Montana Department of Public Health and Human Services--for about 65,000 Medicaid clients, eliminated many of the miles that can divide a patient and needed health care services.

Nurse First improves quality of life by helping clients stay healthy year round, even when winter keeps people from reaching urgent or chronic care providers. For those clients difficult to reach by phone, Montana employs community-based nurses, who travel to certain clients' homes to administer the program.

Unique solution to continuing crisis

The financial situation of the Medicaid program in Montana is no different from any other state. The mandate is to provide more health services to more clients with less funding. To deal with this issue, Montana implemented a nurse advice line for acute medical issues and disease management for chronic illnesses such as asthma, diabetes, heart failure, cancer, and chronic pain.

Disease management includes one-on-one health counseling, health education, and information about controlling chronic illnesses. The programs are delivered by registered nurses by telephone or in the community by nurses who live in the area. Nurses work to ensure that clients follow their doctor's orders, monitor their health regularly, and utilize preventive health programs.

In addition, Montana promotes using a "calling the nurse" advice line before seeing a physician, except in emergencies.

The Montana Department of Public Health and Human Services is unique in that it heavily promotes the nurse advice line with direct mail. By encouraging calls to a nurse for acute health concerns, the state ensures that the Medicaid client uses the appropriate health care services. The process helps the state save money and limited resources when minor ailments are treated at home or during a scheduled physician visit rather than in the emergency room. The converse is true as well. When severe, acute illnesses are identified early, immediate treatment can potentially save a life and lower overall treatment costs through speedy intervention. …

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