College of Nursing clinic a model of nurse-managed health care

For Barbara Fraser, M.S.N., A.R.N.P., a University of Florida College of Nursing clinical assistant professor and family nurse practitioner at Archer Family Health Care, patient care is about more than providing care to the ill; it also involves providing tools that help people stay healthy.

Archer Family Health Care, which opened in early 2001 as the College of Nursing’s first nurse-owned and operated health-care practice, offers a full range of family health-care services. The practice fills a major gap in the medically underserved western half of Alachua County and the surrounding region.

Clinical and support staff provide health care for patients who have had little, if any, preventive health care and have used local emergency departments for the treatment of acute and episodic illnesses.

“Many of our patients had not seen a health-care practitioner for anywhere from five to 20 years,” Fraser said. “Some of them had serious medical conditions like diabetes or heart disease and had not taken their medications for some time. Some had not even had the most routine of health examinations in years.”

Susie Peterson, a patient at Archer Family Health Care, appreciates the difference between the Archer practice and some other health-care providers she has visited. Peterson, 50, has suffered two heart attacks and has diabetes. Despite her health problems, no one—until Fraser—had ever taken the time to sit down with her and discuss her overall health.

“I felt so comfortable there from the beginning,” Peterson said. “Barbara really took the time to get to know me as a person, so it was easier to discuss health issues. She was really listening instead of trying to rush me out of her office.”

In November, when Peterson experienced flare-ups in her sugar levels, Fraser arranged for a UF pharmacy student to help Peterson develop a diet plan to balance her sugar levels. Fraser and Peterson also worked to adjust her medications to correct the problem. Since then, her blood sugar level has remained normal.

“Barbara and I discussed the extent of the problem and my medical history, and she worked with me to set up a health plan that was easy to follow,” Peterson said.

Primary health care is provided by Fraser, who works at the practice full time, and Susan Schaffer, Ph.D., A.R.N.P., a family nurse practitioner and assistant professor of nursing, who practices one day a week. Debra Davis, M.N., A.R.N.P., a psychiatric nurse practitioner and clinical assistant professor of nursing, provides mental health services one and a half days a week. Nursing faculty members also serve as preceptors for master’s-prepared nurse practitioner students, who gain clinical experience at the practice.

James Taylor, Pharm.D., a clinical assistant professor in the UF College of Pharmacy, is at the practice one day a week for clinical medication management of patients with conditions such as diabetes and hypertension. Taylor also helps patients obtain medications through the pharmaceutical companies’ Patient in Need program.

Mack Tyner, M.D., a clinical assistant professor at the UF College of Medicine, is the practice’s consulting physician. Archer is part of a 16-county area of North Central Florida with the state’s highest rates for nine out of 10 leading causes of death, according to the North Central Florida Health Planning Council. Until the practice opened up, the city had been without a health-care facility for more than five years.

While the practice has assisted this underserved portion of Alachua County, its reputation has attracted patients from as far away as Levy, Gilchrist and Putnam counties, and some from as far as Cedar Key to the west and Keystone Heights to the east.

To date, the Archer practice has more than 1,300 patients on its books, and Fraser’s schedule is full. In addition to patient appointments, she fields many phone calls from patients with health-care questions.

“We look at the whole patient and examine what things may be hindering their goals to optimal health, such as problems at home or on the job,” Fraser said. “This may mean working with social services to find a temporary home for some patients, or helping to place some in vocational rehabilitation to assist in furthering their education or job training. It’s a holistic approach. We realize that problems like these may prevent people from visiting health-care providers and taking charge of their health.”

In addition to counseling individual patients, Davis leads a psychological support group that provides group counseling for women with various needs.

“It means a lot to our patients to have a direct relationship with us,” Fraser said. “The time that we spend discussing their problems—health and otherwise—is very important to them.”

Fraser and her team provide most health-care services, including diagnosis and treatment of illness and injury, written medication prescriptions, physical check-ups and immunizations, and health-care advice and education. Fraser also has a working relationship with area hospitals including Shands at UF and Shands at AGH for referrals and diagnostic testing, and works with area agencies and programs, such as the WeCare Network for patients who cannot afford specialists’ testing and fees.

“With this practice, the College of Nursing makes a statement that nurse practitioners can effectively manage the care of patients and benefit our communities,” Fraser said. “These patients rely on us and trust us with their health, and we take that responsibility very seriously,”

The practice is supported by a Florida Department of Health contract, funds from the Alachua County Commission, some patient revenue and college faculty practice funds. A sliding fee scale is used for low-income families without health insurance. All of the College of Nursing’s goals for Archer Family Health Care have been met or exceeded, and in the coming year, efforts will focus on relocating the practice to a larger facility.

“Archer Family Health Care allows our college to demonstrate the effectiveness of preventive health care, teach students about interdisciplinary care delivery, and make real our commitment to assist underserved families and individuals,” said Dean Kathleen Ann Long, Ph.D., R.N.C.S., F.A.A.N.