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Are Nurses an Answer to New Primary Care Needs?Are Nurses an Answer to New Primary Care Needs?

Sandeep Jauhar, MD, PhD; and David Battinelli, MD
[+] Article, Author, and Disclosure Information

From Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1408.

Requests for Single Reprints: Sandeep Jauhar, MD, PhD, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11040; e-mail, SJauhar@NSHS.edu.

Current Author Addresses: Drs. Jauhar and Battinelli: Department of Cardiology, Long Island Jewish Medical Center, New Hyde Park, NY 11040.

Ann Intern Med. 2014;161(2):153-154. doi:10.7326/M14-1308
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In this issue, Shaw and colleagues describe how nurse-managed protocols can have a positive effect on the outpatient management of adults with chronic conditions. The editorialists discuss the study and its findings, as well as causes of the shortage of primary care physicians despite an increasing need for their services.

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Nurse Managed Protocols - expanding team-based care and needed for future healthcare
Posted on July 17, 2014
Ryan J. Shaw, PhD
Duke Univeristy
Conflict of Interest: None Declared
This editorial by Jauhar and Battinelli provides a welcome and thorough response to our findings. The authors make a note that in our findings the question of whether nurse-managed protocols works for complex or unstable patients remains an open question. We believe that this actually reaffirms multi-disciplinary primary care and that there is the opportunity for greater collaboration between team members for complex unstable patients. It is important to note that nurse-managed protocols are frequently used in inpatient settings, where for example, a physician prescribes a medication that a registered nurse further manages on a sliding scale using a well-defined protocol. This style of team based approach to care could have significant benefit if further expanded in the outpatient setting where many patients with chronic illness need frequent and long-term management. Moreover, with the advent of mobile health technologies, there will be greater levels of monitoring and tracking of important biometric information in real-time. There will be automated transmission of this data to the clinic and patients will receive automated personalized feedback. Nurses can become an integral part of managing this abundance of real-time data and by following prescribed protocols intervene with patients when they need it most, and collaborate effectively with primary care physicians in new models of team-based care.
And the soution is...
Posted on July 27, 2014
michael kelley md
Conflict of Interest: None Declared
As stated in the editorial, there is a critical shortage of primary care doctors due to completely inadequate primary care doctor salaries. And not surprisingly, America can't seem to get med school graduates to choose primary care. So the solution is obvious; make nurses and nurse practitioners primary care doctors. No wait a minute.. That doesn't make much sense at all. How about we pay primary care docs enough to actually attract more docs to primary care? How about we acknowledge that primary care actually takes brains and training and skill. How about we realize that good skilled primary care will make US healthcare better and cheaper. Now that sounds like a good solution!
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