Category Archives: Arizona (AZ) M
Six libraries in downtown Tucson, Arizona, have some unexpected new employees: public health nurses. In what many believe to be a first-of-its-kind program, Pima County libraries teamed up with the county Health Department to start a jointly-funded “library nurse program.”
Libraries across the country often serve patrons living without shelter, health insurance, medical care or computer access, the Arizona Daily Star reports. As the need for health care and social services has grown in recent years due to a faltering economy and high unemployment, leaders in Pima County were inspired to provide more than just books to their patrons.
Now, five Pima County public health nurses divide the equivalent of one full-time public health nurse position among themselves, working weekdays at six local libraries. The nurses wear stethoscopes so they can be easily identified, but mostly provide health education and referrals to other health care resources in the area rather than actual medical care.
In addition to helping patrons get the health information they need, the program has also reduced the number of 911 calls from the libraries, “partly because nurses trained library staff to recognize when behavioral issues are escalating and to intervene appropriately,” Nurse.com reports.
“If I weren’t here, I think a lot of these individuals would fall through the cracks,” Daniel Lopez, one of the “library nurses” told Nurse.com. “I can open doors for them and they can walk on through. Overall, I think it makes for a healthier Pima County.”
In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.
A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.
Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.
Fourth in a Series: A Call to Action on Oral Health Care, Bringing Dentistry to Children Who Need It
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Kris Volcheck, D.D.S., M.B.A., a 2010 Robert Wood Johnson Foundation Community Health Leader, discusses community-specific solutions to oral health care disparities. Volcheck is director of the CASS Dental Clinic for the homeless and the Murphy Kids Dental Clinic in Phoenix, Arizona. See all the posts in this series.
Just down the street from the CASS Dental Clinic for the Homeless in Phoenix are four elementary schools, in the very impoverished Murphy school district. Although this is the urban core, it might as well be rural America. The families in these neighborhoods live on minimal incomes and don’t have transportation, making everything a long distance hike – grocery stores with fresh produce, medical centers and, not surprisingly, dentists. When basic health care is secondary to just surviving, oral health care falls by the wayside.
Last year we decided to open a dental clinic for impoverished children, as an extension of the homeless clinic we’ve had in place for more than 10 years, and in collaboration with a community funded health center already in the works. But the tough economic times meant the Murphy elementary schools we had planned to serve were unable to pay for transportation and chaperones to bring students to our clinic. And because the schools’ funding is closely tied to student performance, they were hesitant to disrupt the school day to bring children to our site.
So we refocused, and decided to bring the dental clinic straight to the children.
We now operate a portable, school-based dental clinic in the elementary schools twice a year. The Murphy Kids Dental Clinic brings oral health professionals, supplies and technology into the elementary schools to provide comprehensive dental care to children who would otherwise go without it.
The care available to underserved and vulnerable populations –in rural settings and in the middle of a city alike – lags behind those available in middle- and high-income communities. There’s a high density of dentists in high-dollar areas, but we’re scarce in the urban core.