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Ronnie Polaneczky | Nurses make a difference

Posted on Mon, Nov. 13, 2003

Practitioners could ease doctor shortage

polaner@phillynews.com

THE real nursing in East Falls isn't about the strike at Medical College of Pennsylvania Hospital.

It's about the nurse practitioners running the Falls Family Practice and Counseling Network at Abbottsford, across Henry Avenue.

Nestled within the Abbottsford public-housing development, the happy vibe of the medical office is in wild contrast to the anger, bitterness and dissatisfaction that characterizes the picket line of MCP's strikers.

"What we do here is what we got into nursing for," says Donna Torrisi, RN, the certified nurse practitioner who founded the center in 1992. "It's the most satisfying work we've ever done."

The reason? They're in charge.

Abbottsford's four practitioners are registered nurses with advanced degrees, years of hospital-based clinical experience and training in pharmacology. They do everything primary-care physicians do - diagnose, treat, prescribe, refer - without any of the malpractice woes driving many family docs out of business.

But with all of the one-on-one contact that patients crave - and family docs sorely miss.

Other than that, the Abbottsford center feels no different from any other big, modern primary-care office, its narrow halls and bright offices bustling with a staff of 19.

On the day I visited, patients were being treated for everything from asthma to chest pain, and on-site counselors were seeing patients referred for stress and other issues. Wellness programs were being conducted on the second floor, and a van was constantly dispatched to fetch patients who had no way to get to the center.

"Goodbye, baby," said one patient to Torrisi as they hugged after an appointment. "I love you."

"You, too," said Torrisi, walking the woman to the front door.

That Torrisi even had time to walk a patient to the door would make some family doctors, and hospital nurses, weep with envy.

Nurse-managed health centers have been around for about 25 years, established by academic institutions or community nonprofits in poor areas with little access to quality care. More than 100 sites are spread across 30 states, serving 1 million people, all under the umbrella of the National Nursing Centers Consortium.

Pennsylvania has the mother lode - 25, with 12 in Philly alone, four of them run as a network by Torrisi, a national pioneer in the nurse-managed movement. Because Pennsylvania law defines nurse practitioners as primary-care providers, there's no need for physician oversight (to prescribe, though, practitioners here must have a collaboration agreement with a doctor).

Perhaps because of the population they have served, nurse-managed centers have unfairly borne a kind of downscale "clinic" label at odds with the impressive results of the care they provide. According to the NNCC, the low-income patients at nurse-managed health centers see their practitioners more often than similar patients using more traditional family practice models - and use ER's 15 percent less.

Their hospital maternity stays are shorter, their prescription costs lower, and their preventive health-care programs for kids more effective.

"We are managing very well the care of complicated patients with challenging lives, and we're saving the system a lot of money," says NNCC Executive Director Tine Hansen-Turton.

The centers are financed by a patchwork of Medicaid, managed-care dollars, city, state and federal funds and private grants and contracts. The NNCC also raises funds for other programs, including lead-poisioning prevention, asthma management, smoking cessation and others credited with helping the centers deliver such good results.

In fact, their success begs the question: Since Pennsylvania is losing so many primary-care docs, creating new and scary gaps in medical access, couldn't this excellent model of health-care delivery be adapted for use in the mainstream?

In fact, movement is afoot to do just that. Locally, Keystone Mercy Health Plan has recently dubbed the region's centers "preferred providers," the first in an industry that has been slow to acknowledge their success. Others may follow, given new Medicaid and Medicare regulations forbidding reimbursement discrimination on the basis of provider type.

But the biggest boon may come from patients themselves, many of whom already see nurse practitioners in their primary-care physician offices - and appreciate the extra time they receive.

"The role of nurses has always been silent," says Hansen-Turton, "so it may take time for people to understand just how important they are in maintaining excellent health-care delivery."

Given what's happening at MCP, I'd say we've already gotten the idea.

Send e-mail to polaner@phillynews.com. For recent columns, go to http://go.philly.com/polaneczky.


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