November 01, 2016
By Greg Peters
Silver City Health Center, the University of Kansas School of Nursing's nurse-run safety net clinic in the heart of the Argentine neighborhood of Kansas City, Kansas, is celebrating 10 years of providing affordable health care to residents in Wyandotte County. As part of its continued growth, this fall Silver City Health Center expanded services to include geriatric primary care and pre- and post-natal care through the KU School of Nursing's nurse-midwifery program.
"Our goal is to be the patient-centered medical home for many in our community," said clinic director JoAnn Peterson, DNP, APRN, FNP-BC. "These expanded services will help us reach our ultimate goal of improving the health and enhancing the quality of life for underserved and vulnerable citizens of Wyandotte County."
Silver City Health Center is the primary faculty practice clinic for the School of Nursing and the School of Health Professions. One of the biggest benefits of the clinic being aligned so closely with the school is the facility has access to several highly qualified and skilled nurse practitioners in a variety of specialties. All of the faculty providers at Silver City are preceptors for graduate nursing students and some also work with students in medicine and pharmacy. Each year, Silver City's health practitioners see between 1,200 and 1,400 patients during approximately 4,000 office visits.
Peterson explained that the catalyst to expand clinical services is really two-fold. First, because the School of Nursing has such a strong variety of specialties it made sense to add services that would allow faculty to work in their focus areas. Second, clinic leaders matched the needs of the community with potential revenue-providing streams to help make the the clinic more financially stable while adding value to its patients.
"We recognize that we were referring pregnant patients elsewhere because we did not offer prenatal care," Peterson said. "We also found that many of the families in our area include several generations, and geriatric primary care services are limited."
The Nurse-Midwifery Clinic, which opened as part of Silver City Health Center Oct. 4, had its beginnings in a health clinic run by the Department of Family Medicine. Nurse-midwifery faculty members have been working for the last three years in a clinic that trains family medicine residents and that's where the notion to add midwifery services at Silver City Health Clinic started to take shape.
"We saw an opportunity to expand the nursing services at Silver City Health Center and a way to broaden the offerings for midwifery care in our area," said Cara Busenhart, Ph.D., CNM, APRN, director of KU's nurse-midwifery program.
Busenhart and Barbara Parker, MS, CNM, FNP - who is leading the midwifery efforts at Silver City Health Center - see patients from 8 a.m. to noon on Tuesdays. They provide prenatal care, postpartum care and care for newborns up to 28 days. Their primary health services for women include: well-woman services and minor gynecologic treatments; family planning services including pregnancy testing; plus testing for sexually transmitted diseases and infections.
"We want to serve the need for comprehensive women's services, not just prenatal care," Busenhart said. "Family planning and well-woman care are important aspects that we can strengthen at Silver City Health Center."
One of the biggest needs the Nurse-Midwifery Clinic hopes to meet is to provide low-cost prenatal care among underserved populations in Wyandotte County. Busenhart said many undocumented women have difficulty accessing traditional prenatal care, and women seeking assistance through Medicaid services can experience considerable delays.
Expectant mothers who are cared for by the nurse-midwives will deliver at The University of Kansas Hospital with resident physicians from the Department of Obstetrics and Gynecology. Parker and Busenhart have been working with the OB/GYN residents for the past three years at The University of Kansas Hospital, so they are familiar with the operation. Busenhart said they plan to involve KU nurse-midwifery students as much as possible.
Caring for older patients
Last spring, Carol Buller, DNP, APRN, FNP-C, GNP-C, decided to leave the geriatric practice she had been associated with for 18 years to join the faculty practice at Silver City Health Center. As a School of Nursing faculty member she had been aware of Silver City Health Center, so in July she became a member of the team and currently sees patients on Tuesdays and Thursdays.
"My passion is caring for older adults, focusing not only on the management of chronic conditions but also on helping them maintain a functional level that contributes to their quality of life," she said. I want to provide primary care for adults 65 and older," she said.
Buller has wide-ranging plans for the geriatric practice at Silver City Health Clinic. Among the things she would like to see expanded are Medicare preventive wellness visits, chronic care management, transitional care following hospitalizations, and home visits for homebound patients, those needing conversations regarding serious illnesses and acute visits for urgent symptoms.
Her hope is that KU's adult/gerontology nurse practitioner students will be able to experience some of the challenges that come with delivering care to persons who may not have access to consistent health care. She is also working on ways to include Bachelor of Science in Nursing students into the program during their population health courses.