ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, April 28, 1996 TAG: 9604300035
SECTION: NURSES PAGE: 8 EDITION: METRO
SOURCE: SARAH COX
The VA Medical Center in Salem has become a national model for a primary care program.
What distinguishes this program from other VA hospitals and private health centers, said Mary Raymer, associate chief of staff for nursing, is its primary health care teams, made up of nurse practitioners, physicians and staff nurses.
In 1992, the VA hospital started the primary care teams to move toward a more traditional family practice setting and away from specializations. With nurses involved in the primary care of patients, preventative health care and patient education became more integrated into their health care.
The hospital's goal was for nurse practitioners and advance-practice nurses to take care of patient assessment, maintenance and education, thereby delivering better care to more patients. The cost would be less, the quality would be higher.
To start off, three primary care teams were established. Now there are seven. Patients went from having no single primary health care provider to seeing the same ``group'' every time they visited the VA hospital. Seventy percent of the veterans now are seeing a primary care team, said Raymer, and their goal is to have 100 percent assigned to teams.
In addition to cost savings, the continuity of care and subsequent quality of care has been raised, said Raymer. Nurse practitioners give out their business cards, follow up with patient information, and have established a telephone triage system so patients can call in with questions.
Raymer said the number of emergency room visits has decreased. Hospital admissions are a fraction of what they were years ago. Raymer said that in 1991, the average daily census for the entire medical center was 530; in 1995 it was 340. In 1991, the outpatient visits were 142,000 for the year; in 1995 that increased to 190,000.
``It does impact health care costs and how we use our resources. Nurse practitioners have impacted this positively. Some studies have shown data that approximately 70 percent of health care problems in the outpatient setting can be appropriately handled by a nurse practitioner," Raymer said.
Raymer said nurse practitioners are trained to look at the whole person and how he or she copes with illness and wellness. Part of their job is to get patients involved in their own health care - ``it's a much more interactive role," said Raymer.
Last summer, said Raymer, the hospital established a psychiatric primary care team. The VA has five psychiatrists double-boarded in psychiatry and internal medicine, she said, and one of those became a primary care physician. Raymer said the psychiatric primary care model will be featured at the American Psychiatric Association's national meeting in May in Boston. In addition, the VA has hosted site visits from other VA hospitals interested in starting their own primary care programs.
Tim Dayton, a geriatric nurse practitioner for the VA Medical Center, said he believes nurse practitioners at the hospital are extremely involved in the health care of their patients.
``They do more than just deliver medical care. They deliver health care, which is nursing care plus medical care. I view myself as a primary care health care provider," he said. For instance, if an 80-year-old in a wheelchair came in for medical care, said Dayton, he would determine who would be dispensing the patient's medicines, who would be purchasing the medicines, and what kind of support this person has once he leaves the hospital.
``It is my concern, because he is my patient, and to look at the whole patient requires my looking at all the aspects of the patient," he said. "In looking at the whole person, I could reveal other problems that can become exacerbated down the road."
Dayton said he spends a great deal of time educating patients on the outcomes of their illnesses. The team following a patient's care provides continuity of care and develops a bond of trust between themselves and the patient. Because of this trust, the patient tends to respond more readily to medical advice, he explained.
Dayton, who said he takes great pride in trying to convey a caring attitude to patients, said nurse practitioners are basically nurses with advanced skills who provide patients with medical care and the hospital with a cost savings.
Carolyn Stanley-Tilt, a nurse practitioner on the psychiatric primary care team, said her team is already winning awards. One was recently given by the Roanoke Valley chapter of the National Alliance for the Mentally Ill. This fall, team members will be presenting their program at the American Psychiatric Association's meeting in Chicago.
Stanley-Tilt said her primary care team is focused on the mind and the body - again, a very holistic approach certainly encouraged by the presence of a nurse practitioner. She said that she and the physicians are ``colleagues and collaborators."
They look at both the medical and psychiatric problems, because ``we know that assessing the bio-psycho-social person is good because all this affects the whole person. People are whole, not just parts," said Stanley-Tilt.
She describes her primary team's function as consultive. The primary care physician refers a patient to them. They do the treatment, and make preventive care recommendations. They send this plan to the attending physician, who can then either manage the patient from there on out, or give them back to the team.
``Few slip through the cracks now," said Stanley-Tilt.
LENGTH: Medium: 99 lines ILLUSTRATION: PHOTO: TIM TREVILIAN. The psychiatric primary care team at theby CNBVAMedical Center includes (from left) Carolyn Stanley-Tilt, Sandy
Presley, Ruthie Barnett and Sue Kimrey.