International Nurses Day 2020: Case study of the week

Providing primary health care in rural, underserved areas

Contributor: Dr Elizabeth Partin, USA

The state of Kentucky in the US has been ranked 45th out of the 50 states for health care. In particular, people living in rural areas have difficulty accessing health care services due to the lack of providers and the distance they must travel. The U.S. Health and Resources Administration (HRSA) designates 110 out of 120 Kentucky counties as Health Provider Shortage Areas.

To address this issue, two nurse practitioners (NPs), Elizabeth Partin and her daughter Julie Gaskins, set up the Family First Health Care in a rural, medically underserved area in Kentucky where the closest small city is approximately a 45-minute drive. Family First Health Care provides primary health care services and employs two nurses, two nursing assistants, and two front office staff.

The clinic provides preventive care, as well as treatment for acute and chronic conditions for patients from birth to the very elderly. Ensuring that their patients receive appropriate preventive care is an important aspect of the care they provide. They perform pap smears and lab work at the clinic and refer patients for mammograms and colonoscopy screenings. The clinic manages chronic conditions such as diabetes, hypertension, congestive heart failure, hypercholesterolemia, and atrial fibrillation, as well as acute problems such as strep throat, flu, seasonal allergies, insect bites, burns, cellulitis and repair of simple lacerations. They also perform minor surgical procedures to remove skin lesions. Situated in a rural area, it is not uncommon for people to come to the clinic requiring repair of lacerations or treatment for other farm related injuries. Because its located in a health provider shortage area, the clinic provides health care to people who would have difficulty otherwise accessing care. Last year, the clinic had over 6000 visits.

When practicing in a small rural community for many years, you get to know your patients and their families. Families are important to the staff at the clinic and that is why they chose to name their clinic Family First Health Care. People come to the clinic for minor and major problems; sometimes they don’t recognise when a condition is serious. Partin says the rewards are great, when her patients tell her she saved their life or she helped them manage a problem for which they saw no solution. Patients are appreciative and professionally it is satisfying to be able to help improve the health status in your community. Although it is challenging to own a practice, as barriers to nurse practitioner practice are removed through legislation and policy shifts, more NPs are finding it possible to open practices in rural areas. This can only prove beneficial to the patients served by Family First.