Meeting a Primary Care Challenge in the United States: Chronic illness care
JoAnne M Saxe
Clinical Professor; Director, Adult Nurse Practitioner Program
Susan L Janson
Assistant Clinical Professor; Practice Director, Glide Memorial United Methodist Church Health, Services; Mary Harms/Alumnae Endowed Chair
Suzan Stringari-Murray
Associate Clinical Professor; Co-Project Director - Positive Health; HIV Advanced Practice Nurse, Education Program, University of California, United States of America
Jane E Hirsch
Associate Clinical Professor; Director, Nursing Administration Program
Catherine M Waters
A/Professor; Director, Advanced Community Health & International Nursing Program, Dept of Community Health Systems, University of California, San Francisco, United States of America
PP: 94 - 103
Abstract
Leading health care experts in the United States have stated that the greatest primary care challenge today is meeting the complex needs of patients with chronic illness/long-term conditions or impairment.
To address this challenge, there is a need for health care system redesign that requires a multidisciplinary team approach, including active participation from professional nurses. In particular, it is essential for advanced practice nurses to provide leadership in health systems design for which they are specifically trained and experienced.
In this article, the primary care challenge related to chronic illness care management is addressed. Future implications for community-based, chronic illness care delivery and the education of future health care providers with a focus on advanced practice nurses will also be discussed.
Keywords
Advanced practice nursing, advanced practice nursing education, chronic care model, chronic disease management, long-term conditions, primary care
References
Allan J, Barwick TA, Cashman S, Cawley JF, Day C, Douglass CW, Evans CH, Garr DR, Maeshiro R, McCarthy RL, Meyer SM, Riegelman R, Seifer SD, Stanley J, Swenson M, Teitelbaum HS, Timothe P, Werner KE and Wood D (2004) Clinical prevention and population health: curriculum framework for health professions, American Journal of Preventive Medicine 27: 471-6.
American Association of Colleges of Nursing (2004) American Association of Colleges of Nursing: Position Statement on the Practice Doctorate in Nursing. Washington, DC: Author accessed at http://www.aacn.nche.edu/DNP/DNPPositionStatement.htm on April 26, 2007.
Baron R, Cooke M, Janson SL and Adler J (2002) Take care to learn: UCSF diabetes management program: Partnerships for Quality Education, Robert Wood Johnson Foundation.
Bureau of Primary Health Care, Health Resources and Services Administration (2006) Health Disparities Collaboratives accessed at http://bphc.hrsa.gov/quality/Collaboratives.htm on January 28 2007.
Bureau of Primary Health Care National Health Care Collaboratives (2005) Collaborative Charter accessed at http://www.healthdisparities.net/hdc/html/library.aspx on December 29 2006.
Bureau of Primary Health Care National Health (2007) Care Collaboratives Models for Changing Practice accessed at http://www.healthdisparities.net/hdc/html/about.hdcModels.aspx on January 28 2007.
Cornish PA, Church E, Callanan T, Bethune C, Robbins C and Miller R (2003) Rural interdisciplinary mental health team building via satellite: a demonstration project, Telemedicine Journal and E-Health 9: 63-71.
Dennehy P and Saxe JM (2005) Pathways to Health: Targeting Health Disparities, Department of Health and Human Services, Health Resources and Services Administration, Division of Nursing, D11HP05197, accessed at http://nurseweb.ucsf.edu/public/targeting.htm on April 26 2007.
Dennehy P, Saxe JM, Hill K, Sweet J, Budd D, Nierman J, Greenwald J and Waters C (2006) Service demands that have influenced nursing education and training: Chronic care for a homeless population. Paper presented at the Dimensions of the NP Kaleidoscope: Education, Practice, Research & Advocacy, Orlando, Florida, accessed at http://nurseweb.ucsf.edu/public/targeting.htm on June 1 2007.
Hernandez C, Casas A, Escarrabill J, Alonso J, Puig-Junoy J, Farrero E, Vilagut G, Collvinent B, Rodriguez-Roisin R and Roca J (2003) Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients, European Respiratory Journal 21: 58-67.
Health Resources & Services Administration, Bureau of Primary Health Care, Division of Clinical Quality, Clinical Quality Improvement Branch (2005) HRSA Health Disparities Collaboratives, Executives Summary, at
http://healthdisparities.net/hdc/library/4-18-2005.6373/
HDCExecutiveSummary_July2005.pdf on February 2, 2007.
Hoffman-Goetz L and Mills SL (1997) Cultural barriers to cancer screening among African American women: a critical review of the qualitative literature, Women's Health 3: 183-201.
Institute for Healthcare Improvement (2002) HIV/AIDS Bureau Collaboratives: Improving Care for People Living with HIV/AIDS Disease, in partnership with Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, HRSA, Rockville, MD.
Institute for Healthcare Improvement (2005) Changing practice, changing lives, in Bureau of Primary Health Care, Health Resources and Services Administration (eds) Bureau of Primary Health Care Health Disparities Collaboratives Brochure, accessed at
http://www.healthdisparities.net/hdc/html/library.aspx?
documentId=8-1-2005.1501&folderOpen= on December 29 2006.
Janson S, Kroon L and Baron R (2006) Development of interdisciplinary professional education and training: Outcomes and lessons learned, Dimensions of the NP Kaleidoscope: Education, Practice, Research & Advocacy. Orlando, Florida.
Jhawar M and Wallace SP (2005) Chronic Conditions of Californians: Findings from the 2003 California Health Interview Survey, Los Angeles, University of California Los Angeles Center for Health Policy Research.
Katzelnick DJ, Von Korff M, Chung H, Provost LP and Wagner EH (2005) Applying depression-specific change concepts in a collaborative breakthrough series, Joint Commission Journal on Quality and Patient Safety 31: 386-97.
Landon BE, Hicks LS, O' Malley AJ, Lieu TA, Keegan T, McNeil BJ and Guadagnoli E (2007) Improving the management of chronic disease at community health centers, New England Journal of Medicine 356: 921-934.
Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ and Cooper C (2006) Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators, Public Library of Science Medicine 3: e438.
Mohler PJ and Mohler NB (2005) Improving chronic illness care: lessons learned in a private practice, Family Practice Management 12: 50-6.
Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, Korytkowski M, Siminerio LM, Ahmad U and Zgibor JC (2006) Translating the CCM into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention, Diabetes Care 29: 811-7.
Portillo C, Saxe JM and Stringari-Murray S (2004) Positive health: HIV Advanced Practice Nurse Education Program. Department of Health and Human Services, Health Resources and Services Administration, Division of Nursing, D09HP03285, at http://nurseweb.ucsf.edu/www/ctrhiv.htm on May 21 2007.
Proudfoot J, Infante F, Powell-Davies G, Bubner T, Beilby J and Harris M (2007) Organisational capacity and chronic disease care: An Australian general practice perspective, Australian Family Physician 38: 286-288.
Robert Wood Johnson Foundation (2006) Improving Chronic Care accessed at http://www.improvingchroniccare.org/ on December 29, 2006.
Showstack J, Lurie N, Larson EB, Rothman AA and Hassmiller SB (2004) Primary care: The next renaissance. In Showstack J, Rothman AR and Hasmiller S (eds) The Future of Primary Care, Ch 15, Jossey-Bass, San Francisco.
Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P and Sixta C (2001) Quality improvement in chronic illness care: a collaborative approach, Joint Commission Journal on Quality and Patient Safety 27: 63-80.
World Health Organization (WHO) (2005) Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions, WHO, Geneva.
eContent Home
