Reaching out

Clinic expansion brings care to more communities

Written by Story by Greg McClure

The Purdue University School of Nursing and North Central Nursing Clinics opened two new community health clinic sites in 2016, essentially doubling access to primary health care for residents in rural areas of north central Indiana.

The Family Health Clinic of Burlington began operating in January 2016 and the Family Health Center of Wolcott opened in July 2016. They joined clinics in Delphi, launched in 1995, and Monon, established in 2006.

This particular community health center model is rather unique in the Federally Qualified Health Center world, in that it is a collaborative partnership with the School of Nursing at Purdue and the nonprofit North Central Nursing Clinics organization. The clinics are nurse-led, meaning that services are provided by advanced practice nurses.

“The quality of the care provided and the economy of the model are exceptional,” says Jennifer Coddington, medical director of the clinics. “These are the only such clinics in Indiana.”

“The common thread is that the communities embrace what we are doing. In small towns it is difficult to recruit doctors. That’s why this is popular,” says Jim Layman, executive director for Purdue Nursing Clinics.

Nurse practitioners, registered nurses, medical assistants and office support staff are at all clinics. Nurse practitioners have, at minimum, a master’s degree, collaborate with physicians and are valued as primary care health care providers by patients. They diagnose, prescribe medications and order diagnostic tests as well as provide health promotion services and education.

School of Nursing faculty join full-time clinic providers at all of the sites to deliver care and many serve as preceptors for graduate pediatric, adult gerontology and family nurse practitioner students.

”The partnership between the North Central Nursing Clinics and Purdue is in concert with the University’s land-grant mission,” Layman says. “It generates opportunities for students to learn about nursing, health care and health care systems in rural settings. Students from nursing, pharmacy, nutrition, communications and engineering have learning experiences that also generate service to the clinics.”

Undergraduate and Doctor of Nursing Practice students have completed several projects to improve access, efficiency and effectiveness of health care delivery. For example, a DNP student examined the clinics’ process for encouraging patients to have colorectal cancer screenings. After implementing several recommended changes in January 2015, the compliance rate improved from 33.3 percent to 55 percent, says Suzan Overholser, director of operations at the clinics.

She says that recently an industrial engineering graduate student led an initiative, as part of a larger project, to improve patient access through a modified “open access” schedule. This has assured that acute patients could be seen when needed while maintaining high provider productivity.

There also is an economic development connection between the health clinics and the communities. “When the Remington Wolcott Community Development Corp. (White County) talked to potential business owners, they found that they wanted good education, which they had with the North White Schools, and good health care,” Layman says. “There was a void in health care in that area at the time due to the retirement of a physician. The economic development officials approached us and put together a proposal that included renovated clinical space for us to establish a new clinic site in the town of Wolcott. This was an example of a community coming together and then coming to us.”

When the clinics obtained federally qualified health center status in 2009, they employed 10.75 full-time equivalent employees, Overholser says. The clinics now employ 47 full-time equivalent employees. Overholser says Capital Link did a research project for the Indiana Primary Health Care Association in 2014 to review the economic impact of community health clinics. Using 2014 data, they estimated the clinics had a $3.5 million impact on the communities they serve just through employment.

The dramatic increase in patient visits is evidence of how they are meeting health care needs of the communities.

“In 2009 we had 5,900 one-on-one patient encounters at the clinics,” Overholser says. “At the end of last year we had over 13,000 such encounters. By the end of 2017, we project that we should have 18,000 visits. We’re growing every year because there is a great need in rural areas for health care, but there has been no improvement in the number of physicians willing to serve in rural areas.”

And that is not likely to change, Coddington says. “All of our clinics are in medically underserved areas. The number of physicians going into primary care is declining, and it is declining even more in rural areas,” she says. “Nurse practitioners are uniquely equipped to help fill that gap. They can treat patients’ acute and chronic conditions, and hopefully prevent the development of chronic diseases.”

The clinics offer local access to health care and accept many insurance plans.

“We provide a full range of services, from birth to death,” Coddington says. “We see newborns, children and adults. We have nurse practitioners who treat adult gerontology, nurse practitioners who treat women for prenatal care and women’s health services, and nurse practitioners who treat families. We also offer behavioral health services — counseling and crisis intervention.”

There also are two pharmacy fellows who oversee clinical (College of Pharmacy) student rotations at the clinic, Coddington says.

“The students work directly with patients on medication reconciliation, education, insurance prior approvals and assisting patients to access pharmaceutical assistance programs,” she says. “Each year, brand name medications valued at over $450,000 are provided to patients with limited resources who are uninsured or underinsured at no cost.”

In addition, Coddington says there is a navigator at the clinic who helps uninsured patients look for health insurance, and then helps them sign up for insurance so that they can afford health care.

One of the navigators is bilingual, and the Delphi and Monon clinics have bilingual interpreters. About half of the patients at the Monon clinic are Hispanic.

Staff members are vigilant about the quality of care provided. In 2014, the Delphi and Monon centers were the first nurse-managed clinics in Indiana to be recognized by the National Committee for Quality Assurance as Patient-Centered Medical Homes (PCMH).

The clinics received a PCMH Level 2 recognition that is valid for three years. The designation is a model that uses evidence-based, patient-centered processes focused on care coordination and communication to transform primary care into what patients want it to be, Layman says. Research has shown that medical homes can result in higher quality and lower costs and improve patients’ and providers’ reported experiences of care.