Women’s Health Policy in 2010Susan Wysoki, WHNP-BC, FAANP, President and CEO,

National Association of Nurse Practitioners in Women’s Health

A few years ago during discussions concerningnurse practitioner (NP) specialties and populationfoci, as they were later called, considerable discus-sion occurred about whether women were a specialpopulation. There seemed to be some consensusthat as a population, women would fall under pedi-atric when they were younger and then family,adult, or geriatric groups as they aged. I found thisa puzzling discussion, considering that, in the past10 to 15 years, the rest of the world had recognizedthat women were different with regard to theirhealth issues, well beyond differences in reproduc-tive organs. Women were finally being seen as notjust little men.

Many health issues affect women either inunique ways, as with cardiovascular disease andosteoporosis, or disproportionately, as withimmunologic disorders. Medications can affectwomen differently. Until fairly recently, however,those differences were not recognized becausewomen were not included in clinical trials. Earlystudies on aspirin showing prevention from heartattacks did not include a single woman. The lack ofclinical trials that included women caught the atten-tion of some women in Congress. As a result,offices of women’s health were established at theDepartment of Health and Human Services,National Institutes of Health, and the Food and DrugAdministration. Finally women’s health was gettingthe attention it deserved.

Even garden-variety women’s health issues requirespecial expertise. Anyone who provides women’shealth services knows that there is more to managingcontraception and hormone therapy than meets theeye. Women’s health care is complex.

Furthermore, the specialty of women’s healthNPs (WHNPs) has been around since the early1970s. A certification examination for these NPshas existed since 1980. It was as well established aspecialty as any other population. I was relievedthat in the end, the task force working on the NPspecialty categories ultimately agreed with theirwomen’s health colleagues that indeed, womenwere unique population foci.

However, I am concerned that WHNP pro-grams are decreasing throughout the country. Atlast count by the National Association of NursePractitioners in Women’s Health (NPWH), thenumber of WHNP tracks being offered has gonefrom 50+ to somewhere in the mid 30s. In med-icine, gender-based differences are now the get-ting attention they deserve, and more and moreis being learned about how very different womenand men are with regard to their health risks andneeds. We cannot afford to lose the expertise inwomen’s health that the NP profession has had,or we will be behind the curve.

I may be biased, but we need WHNPs,whether they are educated in basic WHNP tracksor specialized in the clinical area in DNP and otherprograms. If the expertise is lost, who will teachthe next generation of NPs? I encourage anyonewho picked up this special issue of JNP becauseof the women’s health content to continue tolearn more about women’s health issues.Encourage students to become WHNPs and tobe interested in research related to women’shealth. Many challenging and rewarding opportu-nities are available to NPs with a sound under-standing of women’s health. I encourage all NPsto recognize what those women in Congress didin the 1990s. Women’s health issues are very dif-ferent. Those differences are important.

As the president and CEO of NPWH, I inviteany NP who has a focus or an interest inwomen’s health to become a member, whetheryou are an FNP, ANP, PNP, GNP, or WHNP. NPWHis the organization for those NPs interested inlearning more and keeping up with trends andnew information in women’s health. It is mybelief that NPs should join those organizationsthat not only help them with their practice issues,but also those that meet their needs for clinicalinterests. Check out www.NPWH.org for moreinformation about our organization, meetings,and online activities. Join us to support the con-tinued focus for our profession in the field ofwomen’s health.

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Retail clinics aren’t just for strep throats any more;they’ll also be managing diabetes and other chronicdiseases. “It’s a new service strategy,” Sandra Ryan,CPNP, told attendees at a meeting on retail clinicssponsored by the Convenient Care Association andthe Jefferson School of Population Health.

“We’re evolving our clinic offerings,” said Ryan,chief nurse practitioner officer for Take Care HealthSystems, which operates retail clinics insideWalgreens pharmacies, “from episodic treatmentto looking at how do we get more chronic diseasemanagement, how do we do more prevention,how do we do more screening.”

Most retail clinics are located inside pharmacies orgrocery stores, although a few are freestanding.Staffed primarily by nurse practitioners, they’ve gen-erally treated acute illnesses such as colds, strepthroat, and urinary tract infections; some have alsoprovided vaccinations and sports physicals.

But that’s going to be changing, according toRyan. “We have recently done some research thatshowed people are willing to be treated for highblood pressure, asthma, and high cholesterol atretail clinics,” she noted.

Take Care has already begun its first steps in thatdirection in a few clinics, which are offering spirom-etry testing for asthma patients and HbA1c tests toscreen for diabetes. The chain also is doing hyper-tension screening and diagnosis. Once patients arediagnosed with hypertension, “We are currentlyreferring them out” for care, but the company islooking at becoming part of the hypertension man-agement team, Ryan said.

Donna Haugland, chief nursing officer atMinuteClinic, which operates retail clinics insideCVS Pharmacies, noted that about 11% ofAmericans have visited a retail clinic at least once.She added that the cost of managing diseasessuch as diabetes, which affects 23 million peoplenationwide, “far surpasses acute illnesses. Withfewer and fewer physicians going into primarycare, we need more access sites to help controlthe chronic disease problem we’re running into....We in the retail [clinic business] think we’re per-fectly positioned to help in the effort to combatchronic disease.”

“We can identify patients and get them into thehealthcare system so they can begin care,” she

continued, “and then we can bring them back andhelp educate them. As they get into the system,we can send them back to primary care and workwith primary care in an integrated healthcare sys-tem to boost standards of care.”

Ryan said chronic disease visits would workdifferently than the short acute-care visits thatmake up the majority of retail clinic businessnow. “Our model is built around 20-minute drop-in visits, so some of the restructuring [mightinvolve] more scheduled appointments,” shesaid. Since retail clinics have peaks and troughsin traffic, with busier times in the morning andafternoon, chronic disease visits, which might be30 minutes long, would need to be scheduled atless busy times.

Retail clinics first came on the scene in the mid-dle of the last decade, and there are now some1,200 of them operating in 32 states, according tothe Convenient Care Association, a retail clinictrade association founded in 2006. They appear tobe serving a patient group underserved by primarycare physicians, according to Ateev Mehrotra,MD, MPH, of the University of Pittsburgh Schoolof Medicine and colleagues, who studied nationalsurveys of visits to retail clinics, primary carephysicians, and hospital emergency departments(Health Affairs 2008;27[5]:1272-82). He and hiscolleagues found that more than 90% of retailclinic visits were for just 10 problems: upper res-piratory infections, sinusitis, bronchitis, pharyngi-tis, immunizations, otitis media, otitis externa,conjunctivitis, urinary tract infections, and screen-ing lab test or blood pressure checks. Those same10 conditions accounted for just 18% of visits toprimary care physicians, he said.

In another study still in press, Mehrotra and colleagues interviewed retail clinic patients to findout more about why they went to the clinics. Forthe uninsured patients, “one of the things that was a key driver...was the transparent pricing,” he said.

Read the rest of the article with commentsfrom physician organizations regarding retail clinics by visiting http://bit.ly/9pGCaa.

© MedPage Today, LLC. All rights reserved.http://www.medpagetoday.com Reprinted withpermission.

Retail Clinics Branch into Chronic Disease TreatmentJoyce Frieden

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1555-4155/$ see front matter© 2010 American College of Nurse Practionersdoi:10.1016/j.nurpra.2010.04.006

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The PPA is sponsored by America’s pharmaceu-tical research companies. These pharmaceuticalresearch companies work with providers, pharma-cists, other health care providers, patient advocacyorganizations, and community groups to educatepatients about the PPA. More than 1,300 leadingnational, state, and local organizations have joinedforces with the PPA.

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