Posted by: Witch Doctor | April 15, 2008

The Dr Nurse – the birth of CAPNA



A primary care practice was opened in the autumn of 1997 with a ribbon cutting ceremony.

This was no ordinary practice. It symbolised a milestone in the development of a movement that had been started by Dr Mary Mundinger about seventeen years earlier.

New York was the home town of CAPNA, the first primary care practice in the USA staffed by nurses who would be reimbursed by insurance companies at the same rate as physicians.

This was long before the Dr Nurse appeared on the scene. The clinics were staffed by the equivalent of our advanced nurse practitioners.

It is not clear whether at this stage there was nursing autonomy. There seems to have been a partnership with Columbia University Physicians.

Mary Mundinger took centre court.

“Among the services CAPNA offers are flexible office hours including evenings and weekends, in-home or office follow-up care, primary care delivered by an advanced-practice nurse, and preventive health care. Advanced practice nurses (APNs) have master’s degrees in a primary care specialty, such as family practice, and are credentialed by the state to diagnose and treat illness and prescribe medications. They also have hospital admitting privileges. APNs do not replace physicians, but rather work in collaboration with physicians.

Those arguments worked, resulting in CAPNA becoming a reality. The next step, following the practice launch, is to evaluate the program so that a model can be established for the rest of the nation. Corporate and foundation sponsors for that evaluation include the Kellogg Foundation, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the Commonwealth Fund. In addition, the insurance company Oxford has agreed to participate by giving a matched cohort of patients to make comparisons regarding patient satisfaction, cost, and quality.

“Most patients we’ve seen have a lot of concerns about their health,” says Dr. Mundinger. “They are in search of a provider who can give them more time and can help them manage multiple health issues.” She says, for example, a CAPNA provider may especially appeal to a patient with diabetes and high blood pressure, for whom careful health management is essential.”

I sense some insinuations in that last paragraph.

Nothing explicit.

Just insinuations.

Do you sense them too, My black Cat?

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





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  1. yes it appears the AP nurse wants to fill the void that the specialization of physicians has left, that of the primary care giver. well hippocrates was more of a nurse than a doctor anyway..

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