Nurse Practitioners

The Baltimore City Health Department plans to target Northwest Baltimore neighborhoods with a new mobile lab aimed at combating AIDS and other sexually transmitted diseases by offering free testing and information.The van was paid for in part by an $800,000 grant from the U.S. Centers for Disease Control to the Ujima Outreach Program, a nonprofit organization founded in 1991 to offer mobile health care to people in communities with a high incidence of sexually transmitted diseases. Among the neighborhoods the van will visit are Forest Park, Rosemont and Walbrook.

Maryland Personal Physicians Inc. (MPPI), a company that owns the practices of about 85 doctors and nurse practitioners, filed for bankruptcy reorganization yesterday.That is another setback for the large doctor groups that were formed a few years ago in an attempt to bargain better deals with managed-care insurers. Locally and nationally, several physician groups have filed for bankruptcy or disbanded in the past year.Robert A. Edwards, president of MPPI, said his group will reorganize and try to "emerge from this process a stronger and more focused organization."

Homebound patients can get house callsWe are writing in response to Myra Welsh's Oct. 31 letter to the editor to let her and other readers know that there are programs that have nurse practitioners and doctors who will visit homebound patients.In the Geriatric Nurse Practitioner House Call program at Bon Secours Hospital, a nurse practitioner visits homebound patients and provides primary care for them just as a physician would.Nurse practitioners are licensed in Maryland to perform physical exams, order tests and prescribe medicine.

If the docs can't solve the health-care crisis, how about a larger role for the nurses?Or -- why not move even faster to those ''managed care'' systems that deliver health care with an emphasis on preventive and primary health care? With pre-negotiated fees for patients' total care, the incentives suddenly turn against costly high-tech medical procedures.Another new strategy: If we're finding it morally wrong to deny health coverage to millions of Americans, especially the working poor, how about using states' buying power to offer the doctors and hospitals a deal they can't refuse?

Going to the nurse's office at Hillendale Elementary School may not be as much fun as it used to be.Youngsters will still get kind words and prompt care, but they also might get a shot or give up a little blood. They'll even be able to go there for regular checkups and attention to chronic ailments.All this medical attention takes place in Hillendale's new "wellness center," the first of its kind in a Maryland elementary school -- although Baltimore County and other jurisdictions have put the centers in high schools.

Faced with a chronic shortage of family doctors, whom will Americans call in the next few years if they develop an ulcer, get an infection or come down with the flu? If Janet Selway gets her way, they'll have the choice of calling their family nurse.In her Cockeysville office, Ms. Selway sees patients with strains and sprains, conducts physical exams, orders lab work and X-rays, diagnoses common health problems, writes prescriptions -- most of the routine things that a general practice physician might do in the course of a hectic day.But she isn't a doctor.

Nurses valued members of medical teamsI must take exception to Dr. Brian D. Briscoe's letter of July 17 regarding the qualifications of nurse practitioners.I have gone to nurse-midwives for the births of both my children and received excellent, expert care. Through nine months I saw an obstetrician only once -- as required -- and my nurse practitioners delivered healthy babies.My daughter was recently diagnosed with diabetes, and after we left the hospital we called the nurse associated with the hospital's diabetes clinic for daily insulin regulation.

Almost two years after the federal government called for the universal screening of babies for lead poisoning, a survey has found that 44 percent of family doctors in Baltimore and Baltimore County have failed to do the tests.Additionally, the survey found that many family practitioners were failing to ask parents key questions that could determine whether their children are at risk for inhaling or ingesting dangerous amounts of lead. The toxic metal can dull intelligence, cause behavioral problems and stunt growth and hearing.

THE United States has a shortage of primary-care physicians.This limits the options for improving access to cost-effective health care.Nurses are a national resource with the potential to meet this challenge.Since the late 1960s, federal policy has promoted two strategies increase primary care. The first included federal support for establishing a new physician specialty in family practice.It has not yet been successful. Between 1970 and 1990, the proportion of doctors in primary-care actually declined and the rate of decline is accelerating.

A Physician's Letter Was Demeaning to NursesI was distressed by the inaccuracies in Dr. Brian Briscoe's July 17 letter against nurse practitioners.Dr. Briscoe began his letter with the promise not to demean or undermine the role of the nurse practitioner, then proceeded to do just that for eight paragraphs.Our overburdened health care system is dependent on safe, effective, non-traditional methods of health care delivery for quality care and cost containment. The role of the nurse practitioner is one of these innovations.

Team approach best for primary care The article "Nurse practitioners pick up the slack in providing primary care" (Aug. 9) makes an important point about building our primary care workforce. However, it should be expanded to mention the importance of team care in providing high quality primary care. Nurse practitioners and physicians ideally function in a close professional relationship, communicating frequently such that each can bring his or her own insights to a clinical issue. Nurses, physician assistants, administrative staff and other health professionals are often members individually or in various combinations of a primary care team.

Like so many primary-care providers strapped for time, Tricia Angulo-Bartlett crams as much as she can into a 15-minute patient visit. At one last week, she counseled Amy Tucker about her coming surgery, evaluated her chronic sinusitis and scribbled a few prescriptions, taking time to explain the side effects and directions of each one. Along the way, she managed to ask about Tucker's twin boys. Then Angulo-Bartlett was off to dictate her notes and on to the next patient. She'll see 26 in a typical day. Such is the life of a busy nurse practitioner, a group of providers that is increasingly helping deliver primary care amid a national shortage of family doctors.

Liability limits save access to care Proven medical liability reforms, including a cap on noneconomic damages, are working to keep Maryland physicians caring for patients while still allowing injured patients access to the court system. In fact, as the column from the president of the Maryland trial lawyers association suggests, about the only people complaining are trial lawyers ("Time to treat malpractice victims fairly," Feb. 27). In states without such reforms, many cases result in runaway jury awards for noneconomic damages.

Reimbursement cuts add to strain on doctors I appreciate Dr. Peter Beilenson's generally sympathetic column regarding the plight of primary care medicine in Maryland ("A growing medical menace," Commentary, Dec. 5). But with all due respect, does anyone actually believe that Medicare and private insurance companies will increase their reimbursement rates for any physicians in the coming year? Most of my medical colleagues are expecting rate cuts of 10 percent to 20 percent in 2009, which will make maintaining a medical practice virtually impossible for many of us. Boutique medicine is not for everyone.

Tougher oversight for walk-in clinics Most of the primary care colleagues I speak to about after-hours centers and walk-in clinics are concerned about the implications for medical practice of the practices discussed in Jay Hancock's column "Convenient mall walk-in clinics fill an unmet need" (Sept. 13). The increasing fragmentation of medical care, the emphasis on quick diagnoses and the private practice model for primary care medicine are all worrisome trends that profoundly affect the quality of care.

Doctors with Columbia's MedStar Health soon will provide urgent care services at area Rite Aid stores, through a partnership the organizations plan to announce today. Starting this summer, MedStar PromptCare clinics will roll out in four drugstores, two in the Baltimore region and two in the Washington area. The companies hope to add 12 more programs nationwide after studying results of the pilot program. "Health care has been late to having a consumer focus, and consumers are increasingly demanding service in a variety of settings that are much more convenient," said Eric R. Wagner, a senior vice president of managed care for MedStar, a nonprofit.

The number of walk-in health clinics in supermarkets, big box retailers and drugstores has nearly tripled in the past year, leading physicians to wring their hands over quality-of-care issues and bemoan the increased competition for medical services. But physicians at the Greater Baltimore Medical Center have taken a different tack: If you can't beat 'em, join 'em. GBMC, a Towson hospital, agreed to allow physicians it employs to act as off-site medical directors of four such clinics, all newly opened within Target Corp.

With a new vaccine on the market to prevent it and multimillion-dollar advertising campaigns highlighting it, the cervical-cancer-causing human papillomavirus - or HPV - might be the most talked-about sexually transmitted disease since HIV. Yet a seven-year-old test designed to detect its most dangerous strains in women still isn't used in 4 out of the 5 gynecological exams it's approved for, according to Digene Corp., the Gaithersburg company that makes the test. And the recent attention to the virus has led other women to request the test when it isn't right for them.

MinuteClinic is closing its six locations at Target outlets in the Baltimore area next month, but opening seven in nearby CVS drugstores. The shift doesn't represent a retreat for the concept of basic-care clinics in retail stores. In fact, it signals the opposite - a jockeying for position as quick clinics enter a period of rapid expansion and increased competition. "As we looked at the future, we believe strategically we will be able to grow quicker through CVS," said Michael Howe, MinuteClinic's chief executive.

Thomas Brown, 75, who turned an early infatuation with the transistor into a multibillion-dollar electronics powerhouse, died of lung cancer Thursday in Tucson, Ariz. He and friend Page Burr launched Burr-Brown Corp. in 1956 in Mr. Brown's Tucson garage for $50,000. Burr-Brown was acquired by Texas Instruments Inc. in August 2000 in a stock deal valued at $7.6 billion. Elaine Gelman, 75, a pediatric nurse practitioner who helped win greater treatment responsibilities for specially trained nurses, died in New York on Tuesday of breast cancer.