Pathfinding on the Frontier

Abstract

In rural settings, referrals to specialists from primary care providers can be difficult for patients and families to follow up on, sometimes requiring that patients travel great distances. Patient care coordination has been shown to decrease the number of ED visits and hospitalizations, but little is known about its effectiveness in assisting with referrals in rural primary care. This article presents three case studies showing how a nurse care coordinator at a rural primary care practice resolved complex issues involving medications, specialists, and diagnoses.