Lessons from Around the World at the APHA Annual Meeting
Michelle L. Odlum, BSN, MPH, EdD, is postdoctoral research scientist at Columbia University School of Nursing in nursing informatics. She has more than ten years of experience as a disparities researcher working on a variety of research, evaluation, and health promotion initiatives affecting vulnerable populations. Odlum is a recent recipient of the Robert Wood Johnson Foundation’s (RWJF) New Connections Junior Investigator award.
At this time when our nation’s health care reform is promoting new approaches to primary care, an exploration of health care models from around the globe is essential. With my interest in the transformative role of nursing care, I decided to attend the scientific session [at the American Public Health Association’s annual meeting] entitled: Think Global, Act Local: Best Practices Around the World. Panelists presented on a variety of interesting care models from Europe to Central America.
As we explore initiatives to improve care coordination, it was interesting to hear Erin Maughan, RN, PhD, APHN-BC, an RWJF Executive Nurse Fellow, talk about Scotland’s care coordination approach to children’s health. Maughan discussed home visitors, who provide care to children from birth to five years of age. An important aspect of the relationship forged with children and families is to allow for early identification of developmental needs, thus allowing for timely utilization of resources and services to address these needs. Interestingly, to support effective care outcomes for children with chronic illnesses over the age of five, each family is assigned a district nurse who is a chronic disease specialist.
Scotland has also coordinated health forms utilized by police, schools, and health care facilities; this is a team-centered approach for identifying and working with at-risk children. Scotland’s pediatric care model demonstrates the effective utilization of public health nurses and the implementation of inter-agency care coordination. We, as a nation, can certainly benefit from further understanding of these approaches.
The Affordable Care Act refers to integrative health care. However, holistic approaches for improved health outcomes, as part of health care reform, have not been defined. In her discussion of the Russian health care system, Luba Louise Ivanov, RN, PhD, spoke of the holistic approaches implemented in care. In fact, holistic health is a part of nursing and physician training programs. Russian nurses administer herbal treatments, and provide massage therapy and acupuncture to patients. The Russian health care model consists of home visits by nurses and physicians. Home care includes respite care to support home living for the chronically ill, who would otherwise be placed in long term care facilities. Respite care is similar to the health reform initiative—Medicare Independence at Home Demonstration, which will reimburse physicians and nurse practitioners for at-home primary care. Valuable lessons can be learned from the Russian approach for our successful implementation of home-based and integrative health care initiatives.
Care coordination is further enhanced by the ability of consumers to securely obtain personal health information to share with providers and to support effective self care regimes. In the panelists’ presentations, it was fascinating to hear that health care consumers in Russia and Guatemala are responsible for their personal health records. In these care models, medical records are kept at home and brought to provider visits. We can certainly benefit from understanding how this approach enhances care and makes for informed health care consumers.
Health care reform is an evolving process and lessons learned from global approaches that align with our vision can both support and enhance U.S. efforts for health care equity.