“nurses…particularly effective at improvisation, invention….”
Loretta Ford Collection
1965: Duke University PA Program
Who shall provide care?????
Who Should Provide Care:
Ms. Shade is a 56 year old woman with a 4 year history of Non-Insulin Dependent Diabetes Mellitus. She has a 10 year history of smoking more than 1 pack per day. She is on a fixed income due to a past disability related to arthritis, another chronic illness. Her current weight is about 25% over the recommended limit for her height, and she also suffers from high blood pressure. On her last visit to her health care provider, her blood pressure was 149/85, her fasting blood glucose level was above normal, around 140 mg/dl, and her hemoglobin A-1C, was elevated at 9 percent. Her feet were still in pretty good shape, warm with palpable pulses bilaterally, and showed no signs of the typical changes accompanying uncontrolled diabetes. At this visit Mrs. Shade requested and received information about a weight loss and low salt diet plan, an exercise plan that was appropriate for low income people, referral for county transportation resources, referral to a community-based “Quit Smoking” program, and correct use of a recently purchased glucometer and home blood pressure set.
The American healthcare system is fragmented and difficult for many patients to navigate.
The average Medicare patient sees seven different doctors, according to the New England Journal of Medicine.
Patients with multiple chronic conditions may see up to 16 physicians annually.
It’s easy for important aspects of a patient’s medical history or personal care preferences to fall through the cracks.
A lack of care coordination leads to medical errors, higher costs, and unnecessary pain for patients and their families.