Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

There is nothing more reassuring than having a skilled professional in your community who can help you when you need medical care. Recent research has demonstrated that nurse practitioners are more likely than primary care physicians to practice in rural areas, and to treat Medicaid recipients and other vulnerable populations.

That’s why the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation and AARP, is working to remove outdated statutory barriers like the one in Nebraska that prevent advanced practice nurses from practicing to the full extent of their education and training.

The good news is that, since the Campaign began, eight states have modernized their practice laws. Right now, nurse practitioners in 21 states and the District of Columbia have full practice authority; Nebraska and Maryland becoming the first two states to pass legislation this year.

When nurse practitioners can practice to the full extent of their education and training, patients, families and communities benefit. The landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, concluded after reviewing the evidence that advanced practice nurses provide effective, high-quality care to people and can safely expand access to primary and preventive care. There is no evidence that care provided in states that require advanced practice nurses to work under a doctor’s authority is better than in states where advanced practice nurses have full practice authority.

We know that empowering nurses, physician assistants, and other clinicians to increase their skills and serve more patients is key to building a Culture of Health in every community. Another innovation that shows similar potential to transform care for rural and underserved populations  is Project ECHO, at the University of New Mexico, which maximizes sharing of best-practice medical knowledge and expertise. The ECHO approach was started to bring the best of specialty care to people in remote New Mexico communities. It links community care providers with specialist teams at university medical centers to co-manage patients who have complex, chronic conditions.

The multi-disciplinary specialist teams use low-cost, multi-point videoconferencing technology to conduct weekly virtual clinics with community providers.  During the clinics, primary care providers in multiple locations present patient cases and work with specialists to determine treatment. Specialists serve as mentors, training community providers to provide care for conditions that previously were outside their expertise, such as hepatitis C, chronic pain, rheumatoid arthritis, and HIV/AIDS. This means that specialty services are now available in communities where previously those services did not exist.

The quality of care is equal to that provided in university medical centers, as demonstrated in a New England Journal of Medicine evaluation of Project ECHO’s hepatitis C clinic. Across the United States, more university medical centers are partnering with community health centers to replicate ECHO. Global interest is mounting, too—ECHO programs currently operate in North and South America, Europe, and Asia.

Initiatives like Future of Nursing and Project ECHO are expanding opportunities for more people in more communities to get quality health care—when and where they need it—and enjoy better health, regardless of their ZIP codes. When more people have access to care, we move closer to attaining a Culture of Health.