Caring for the patient with Paget's disease of the bone.

Approximately 1 to 3 million Americans suffer from Paget's disease of the bone. This chronic disease often results in pain, deformity, and mobility impairments, and can dramatically impair a patient's quality of life. The primary care provider plays a pivotal role in diagnosing and managing the patient with Paget's disease. This article discusses Paget's disease diagnosis, management, pharmacologic therapy, referral, and follow-up.

Assessing medication knowledge and practices of older adults.

An assessment instrument for home health nurses to use in assessing medication knowledge and practices of older adults was developed and tested on a convenience sample of 20 adults 65 and older admitted to a local home health agency. The tool was found usable by nurses, understood by patients, and had adequate test-retest reliability. The results emphasized the need for thorough medication assessments of all home health patients and provided a tool that home care nurses can use.

Diversity in the rural poor: differences between households with and without telephones.

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits.

OBJECTIVES: A randomized controlled trial was conducted to test the effectiveness and cost effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. METHODS: In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. RESULTS: All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. CONCLUSIONS: Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones.

The early and periodic screening, diagnosis and treatment program: opportunities for nurse practitioners.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is intended to provide comprehensive preventive health care services for children and young adults from low-income families on Medicaid. Unfortunately, only a fraction of the individuals eligible for care actually receive EPSDT services, often because of a shortage of providers who offer these services. Nurse practitioners are ideally suited to offer such services and, in states where they are allowed to function independently, can receive direct Medicaid reimbursement for them. Because many nurse practitioners are unfamiliar with the EPSDT program, this article describes the key components of the program and explains how nurse practitioners can provide EPSDT services.