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Improving Public Health: Nurses Leading Efforts to Achieve Healthier Communities

Posted: Nov. 17, 2014

Dr. Susan Dubois (third from right) is flanked by members of the Family Wellness Center’s Diabetes Team.

Elizabeth Loika, DNP, PNC-C, FNP-C, comes from a family with a history of public-health service. Her grandmother, for instance, served as a nurse with the American Red Cross on the battlefields of France during World War I and subsequently became a community health nurse. It was only natural that after retiring from the U.S. Air Force in 2003 Dr. Loika would look for a way to give back to her community.

During her search, she was stunned to find that her Florida community did not provide health care for underserved populations, and it soon became clear that this deficiency of care was causing a tremendous drain at local emergency rooms (ER). Because of a lack of financial support and leadership, and the mismanagement of resources, primary care was not meeting the community’s health care needs. Individuals experiencing asthma difficulties, for example, were generally treated in the ER without receiving prior care.

Dr. Loika recognized that comprehensive asthma care was needed and developed a program that included treatment for the exacerbation of asthma, provider evaluation, necessary medications, equipment supplies and education for self-management. It was highly successful, and she received an Award of Excellence from the state of Florida.

"Ultimately, comprehensive health care affects the entire community,” she said. “By threading public-health initiatives into primary care, we can improve health care outcomes."

It’s by taking this sort of proactive approach, she explained, that nurses can initiate preventive actions to abate hazards before they manifest as disease.

"Primary care is becoming more and more a public-health initiative. The more education provided to the public by educated nurses, the better the concepts you’re trying to communicate are understood. That’s when you see real change for the better."

As associate professor of clinical nursing and director of the UT Austin School of Nursing’s two clinics — the Family Well-ness Center (FWC)
and Children’s Well-ness Center (CWC) — Dr. Loika has her hands full implementing and overseeing a variety of community nursing health care programs for Austin’s underserved population.

These days the clinics are becoming "one-stop shops" for people with chronic illnesses and limited resources. Dr. Loika is especially proud of the comprehensive diabetes program at the FWC, which provides nurse-managed care by employing the strengths of an inter-professional team comprising an endocrinologist, nutritionist, pharmacist, medical assistants and nurses. The team sees patients one day a week, but in that time they are able to evaluate, prescribe medication, provide supplies, educate and monitor each individual in one appointment.

"Managing diabetes is a huge challenge," said Susan Dubois, MD, endocrinologist at the FWC. "A multi-disciplinary care team approach eases the burden on primary care, leading to improved outcomes in hemoglobin A1C, blood pressure, and lipid control, and more patient engagement and satisfaction."

In addition to its highly successful vaccination program for school children, the CWC is establishing a nurse-managed pediatric asthma program based on the diabetes model, and plans are underway to launch a pediatric obesity prevention program.

"We’re aligning to become more effective in seeing greater numbers of people," Dr. Loika said. "Nurses are the backbone in this realignment. Well-educated nurses have become an essential part in bringing public health and primary care together to promote healthier communities."