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1. Health-A Message from the President of the United States Relative to Building a National Health Strategy. 92nd Congress, 1st Session, House Document No. 92-49, February 18, 1971, p. 2. 2. Berki, S. National Health Insurance: An Idea Whose Time Has Come? In The Nation's Health: Some Issues. Ann. Amer. Acad. Poli. Soc. Sc. 399:125-144, January, 1972. 3. Blendon, R.J. The Age of Discontinuity: The Financing of Innovative Health Care Programs in Poverty Areas. Johns Hopkins Med. JI. 128:2429, January, 1971. Written for the Journal on invitation of the Editor, by Dr. Samuel Wolfe. Dr. Wolfe is Director, Comprehensive Health Programs, at Meharry Medical College, Nashville, where he also directs the Center for Health Care Research and is professor of family and community health. From 1962 to 1966, Dr. Wolfe was a Commissioner of the Saskatchewan Medical Care Insurance Commission, Canada's pioneer universal coverage medicare plan. LETTERS In their article The Outcomes and Service Impact of a Pediatric Nurse Practitioner Training ProgramNurse Practitioner Training Outcomes (AJPH March 1972), Yankauer, et al., state that 'the major objective of the BHHC-MGH Program has been to improve the delivery of health care to children." While the article is full of interesting observations and clinical impressions we are left with no hard data that the program did or did not accomplish its goal since there was no control line for comparison. Neither is there any statistical indication whether the quality of care improved or deteriorated. This is typical of the '"research" appearing on the use of primary care agents. They are full of input and mostly free of output appraisals. Litman's paper, which immediately precedes the above, illustrates the need 1for hard data research to convince the public, not to mention the practitioners, that the use of auxiliaries as primary care agents is both safe and effective in providing the right service at the right time in the right place at a cost lower than the all doctor system. I know of only one controlled output study (unpublished) of non-M.D. primary care agents, that conducted by Sister A. Tinabu and Dr. N. Cunningham at the Gbaja Street Clinic in Lagos, Nigeria, in 1968, where the first six months observation of output-what happens to the children so processed?-showed conclusively that auxiliaries, under the conditions of the experiment, made no more fatal errors than the doctors on the control line (zero for both) and the rate of improvement, same, or worse was indistinguishable, but that the children received three times as many immunizations per child from the auxiliary line as from the doctor line. There was no assessment of comparative costs. The study covers 809 children. That study convinced the Nigerian Society of Health and the Ministry of Health sufficiently to start a program to bring auxiliary based primary care to all children in the country. Similar studies are needed in this country to convince the people and the power structure. Such research is neither easy nor inexpensive (nor comfortable). As Piet Hein has noted, Problems worthy of attack prove their worth by hitting back. Robert D. Wright, M.D., Professor, Department of International Health Reply to Dr. Wright Thank you for the opportunity of reacting to Dr. Wright's comments on our article. If Dr. Wright had taken the trouble to read the introductory AJPH OCTOBER, 1972, Vol. 62, No. 10
American Journal of Public Health – American Public Health Association
Published: Oct 1, 1972
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