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Nurse Practitioners in Schools Found To Aid Low-Income Pupils

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School health programs that employ nurse practitioners provide valuable medical services that many children living in low-income rural and urban areas alike sorely need, a five-year study has found.

The $6.5-million "National School Health Services Program," sponsored by the Robert Wood Johnson Foundation, placed nurse practitioners in schools in 18 "medically underserved" school districts in Colorado, New York, North Dakota, and Utah to assess their impact. Each nurse was supported by a physician in the community and a trained aide.

Nurse practitioners are registered nurses who have completed additional training enabling them to diagnose and treat many complaints. Only about 1,000 of the nation's 45,000 school nurses have that training, according to an estimate cited in a report on the study.

The study found that when schools employed such nurse practitioners: children were sent home less frequently; the proportion of immunized students increased; and a significant amount of previously untreated illness was found, including such conditions as curvature of the spine, anemia, and ear infections.

Some 96 percent of these health problems were followed up and resolved, or are still being treated, according to the report.

The nurse practitioner alone handled about half of the diagnosed problems. The others were referred to community and family physicians, the report says.

'Resounding Success'

The program "was a resounding success," said Dr. Catherine DeAngelis, the study's director and deputy chairman of the department of pe-cx0

'Resounding Success'

The program "was a resounding success," said Dr. Catherine DeAngelis, the study's director and deputy chairman of the department of pe-diatrics at the Johns Hopkins Hospital in Baltimore. "This is the biggest bargain in health care today."

Ms. DeAngelis said her hope is to provide a "legitimate medical home" at the school in communities where children are not receiving adequate health care.

"I wouldn't suggest putting this program in Scarsdale, New York," she said.

'A Bargain'

Calling the program "a bargain," Ms. DeAngelis said its annual cost per-pupil is less than the expense of one visit to a hospital emergency room. The cost of the program per child ranged, depending on the school district, between $43 and $82 annually. Nationally, school districts spend an annual average of $25 per child on health.

Too many children end up in hospital emergency rooms for non-emergency care, an expensive and inefficient way to be served, Ms. DeAngelis said. Nurse practitioners in schools, diagnosing and treating minor ailments and injuries, would reduce such emergency room vists, and the costs they entail, she said.

The traditional school nurse, who often serves several schools at once, can do little for a student who is injured or feeling ill except call a parent, who often must leave work to take the child to the doctor or emergency room, she said.

The child misses school; the parent misses work; and doctors' offices and emergency rooms fill up, Ms. DeAngelis noted, arguing that "most of the time these children are not so sick that they have to leave school."

Diagnose and Treat

A nurse practitioner, on the other hand, can diagnose and treat in the school, often permitting the student to return to class without the trip to the doctor or hospital, Ms. DeAngelis said. "It will cost a heck of a lot less for whoever is paying the bill," she said.

According to the report, "medically underserved" children in the project schools were proportionately the greatest beneficiaries of the program's services.

But even children with private doctors used the program for supplemental care, "in large part for convenience," the report states, since it is difficult for working mothers and single-parents to get health care for their children during the day.

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