A Patient-centered Solution to the Primary Care Crisis
Using More Nurse Practitioners and Pharmacists to Treat Chronic Conditions
There is a widespread shortage of primary care clinicians that extends even into prosperous, densely populated communities. New arrivals to some retirement communities in the country can’t get a primary care appointment at all for six months. With an aging population and more chronic diseases, this is a formula for disaster. Over 80% of all healthcare costs come from people with chronic conditions. The more chronic conditions they have the more likely they are to need hospitalization or an emergency room visit. Outpatient primary care teams are the best answer to this problem but only if they use the most effective systems.
There are many solutions proposed to improve the treatment of patients with chronic diseases like diabetes, high blood pressure, heart artery disease, chronic kidney disease, and congestive heart failure. Even though they make sense, they have been mostly ineffective. “These include simply reminding patients about appointments; providing laboratory information on the patient to the physician, even when specific treatment recommendations for the individual patient were included; case management when the case manager could not make independent treatment decisions; education of physicians; and multifaceted quality improvement interventions in the practice setting.”
“The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms.”
That is a quote from an article in the leading journal Diabetes Care. That is the evidence, but it has been almost completely ignored. That is how the primary care shortage can be solved while providing the best results for both heart artery disease and diabetes. A single primary care team can treat all the cardiovascular conditions that I listed above more effectively. Similar teams are highly effective in lung diseases and allergies. They can be extended to other chronic diseases.
I have broad personal experience with teams like this. I worked with a team of pharmacists in a very large primary care practice for nearly a decade. There were three PharmDs and a resident on the team. The pharmacists were all on the University of Tennessee faculty. We had an ambulatory care residency program for pharmacists. The pharmacists had the “authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms. They did marvelous work. We managed patients with high-risk diabetes or high blood pressure for a fortune 100 company. They were very pleased with our team.
For the last two and a half years, I have been working with nurse coaches who develop lasting trusting relationships with patients who have diabetes or related conditions like heart and kidney disease. They are all trained in a best practice algorithm that clinicians call optimal medical therapy (OMT). They are critical assets for the organizations where they work.
Teams don’t need to be in the same building to be effective. Pharmacists in Nevada can practice up to 100 miles away from the collaborating physician. Nurse practitioners can practice independently in 27 states. They can function in rural or disadvantaged areas and be supported by a central hub. I am working with an organization called Health Direct Partners that has pulled together a broad array of stakeholders to offer an alternative to the current system. We can provide the algorithms, physician team members, population health tools, nurse coaching, claims negotiation, direct contracting, and billing that are required to support the nurse practitioners and pharmacists that we work with. This solution is ready to provide better primary care to your county government or school district now. All that stands between us, and better primary care services is a lack of willingness to do something different. Let’s discuss improving primary care access in your community now.
I have never seen such a broken fragmented healthcare like we have today. It truly is a healthcare nightmare. One nightmare story after another and to think we pay good money for such dangerous care. I am literally worn out from trying to help people I know navigate the system. I hear comments about cost and quality all the time.
It sounds good, but I'm not sure many GPs would approve of their monopoly on being the gateway to treatment being put open to competition!