Navigating Global Health as a Nurse Practitioner

Mark Anthony Gregorio, ANP-BC, have a Deep Dive conversation about culture shock, working in a culture that doesn’t know what NPs do, learning how to expand your formulary and the benefits of generosity.


Boldly going where other NPs go? I’ve met only a few nurse practitioners that have gone into global health and when I do– they tend to be CNMs. So I was thrilled when Mark Anthony Gregorio, ANP-BC (adult nurse practitioner) and I bumped into each other on Twitter.

For many, Continue reading

Paula Deen–This Lady Has Your Back

I love Paula Deen. Poor thing has been through the ringer this week, especially in the comments section on places like CNN. She “came out” and told everybody she has Type 2 Diabetes and people used this as an opportunity to rail at her about her liberal use of butter and smiles.

I love that she uses butter.

I love that she smiles.

If she were French we would ask her which red wine complemented our favorite casserole.

I love that she has worked hard and has made a living for herself—when years ago she was home bound due to a phobia that kept her from leaving the house.

I like it when people are resourceful, overcome obstacles and are successful. She could have died a poor single mom with no money for a tombstone. If she had, people could have yelled at her about that too.

Get a grip.

If you don’t want cocaine don’t do it. If you don’t want red hair—don’t go to the hairdresser and pay for it to be dyed red. If you don’t want to eat butter don’t eat it.

Never mind that Type 2 Diabetes for some is more complicated than an over indulgence of butter.

The part of public health that has always amazed me is that in many ways it gains its legitimacy on the premise that people are stupid and must be told exactly what to do and how to do it. And that no one else should be allowed to present a differing message than the prevailing public health message of the time. It’s just too distracting from their good messages.

  • We have praised the disruption in health care that brings power to the patients, consumers and advocates.
  • We want electronic medical records.
  • We want to be able to see our health records without permission.
  • We want accurate nutrition labels so that we can make adult decisions about what to buy and eat.
  • We want patient centered medical homes so that the care is about us medical system.
  • We don’t want closed managed care systems because we want the liberty to choose our providers and make educated decisions about how and where to seek care on our own.

But as I listened to the shrieking about Paula—I realized that people want those things AND to be told what to do.

Let me tell you a story.

I had the good fortune to be a nursing student and then go on to work at the same urban-ish hospital for 5 years. In that time I got to know certain “frequent flyer” patients and their families very well. One of the more infamous patients, I’ll call her Willie Rae, was admitted to the hospital because after she ate two sheet cakes-went into a little diabetic coma—on top of her heating pad (because she had hurt her back earlier) and got a 3rd degree burn. As I’m getting her settled in on the floor and asking her all the admission questions…I have to ask “Why did you eat TWO sheet cakes?”

“Girl, cause they were on sale at Kroger!” says Willie Rae.

They had been on sale. When I saw the sale sign earlier in the week I had wondered who needed to buy two sheet cakes at one time. It may have been graduation season. I don’t remember. We were in Ohio. This picture was taken just a few weeks ago in Ohio. We love to eat sweets and get a good bargain.

Anyway, Willie Rae and I had a good talk. At the end of the conversation I tried to work on behavior modification. To make a long story short—we started negotiating about future eating habits and it ends in Willie Rae agreeing to eat ONE sheet cake at a time instead of TWO.

This was a success. Truly.

Change is hard.

Change takes time and I think we set people up to fail if we don’t give people the tools or remind them of the skills they already have to be successful change agents in their own lives.

When we get all judgmental or create expectations that are so out of line with where people truly are everybody loses.

I’d much rather people cook using Paula Deen’s recipes than go to KFC every day. That means they are going to the grocery store and cooking. Halleluiah!

Her diagnosis is a mixed blessing.

She is planning on making versions of her favorite recipes with a light touch. Paula has the ears and trust of people that most public health interventions just don’t reach.

They might even trust her to use one stick of butter instead of two.

Boomers- Disruptive From Birth

Ahh Boomers. As the saying goes—They changed the world in the ‘60s and in their 60s they may do it again.

Being itinerant in nature—they view life after 65 differently than other generations. They are not interested in going to a nursing home (apparently neither are 75 year olds, per my interview) since those are for “old people.” They do not intend to medically combust and bankrupt Medicare as many policy wonks spend sleepless nights fretting about.

So what are they going to do?

Well according to Barbara Raynor, Managing Director of Boomers Leading Change in Health, lots of things.

In our first interview she introduces their organizational concept and theory of change.

You’ll get most of the goodies below in the Deep Dive which is only available via podcast on iTunes.

  • The rigorous 40 hour training that all volunteers must complete.
    • The curriculum design and how they have tweaked it over time.
  • The importance of evaluation and how JVA consulting  has helped the with that endeavor.
  • How to integrate a cadre of health care workers like health navigators and community health workers into the larger health delivery system.
  • The importance of inter-generational work.

By engaging the Boomers in meaningful work they are also providing a health service to their volunteers. They are keeping Boomers minds and bodies active– helping to keep them healthy and out of their own doctors offices (which as we have been told will cause the end of Medicare as we know it). But as good Pitchfork Optional devotees—we know that there is data to show that this approach actually decreases mild to moderate dementia.

Boomers Leading Change in Health is shaping health care delivery, decreasing costs and improving outcomes.

I guess the alphabet soup generations will have to find something else to fix.

Post-Partum Depression, Perinatal Mood Disorders And Anxiety Oh My!

Several years ago a friend of mine had a baby while we were both in nurse practitioner school. She had a typical first pregnancy, labor and delivery. I visited the family several times in the hospital and bonding appeared to be going just fine. In the few weeks that followed the birth things began to unravel. Breastfeeding was not going well, she wasn’t feeling like herself and even her husband called to appeal for help. During a light moment, we laughed about how “we of all people” trained in women’s health had no idea what to do to make things better.

And then I stopped laughing. Continue reading

Beyond The Electronic Pamphlet: Applying Useful Criteria To Mobile Health

Remember when the internet was new and an acceptable website was the equivalent of an electronic pamphlet?

Well, people have fallen in to the same trap with mobile health.

sent text messages ≠ better health outcomes

I shared with you my excitement about mobile health in last Tuesday’s post. You got to hear firsthand from a clinician entrepreneur about her journey creating EndoGoddess, a health app that concentrates on getting people to check their blood sugar.

Today I want to share with you 4 tips from Michael Tapella (via Scienticia Advisors Blog) on how to apply incredibly useful criteria to mobile health because I want you to focus only on products that change health outcomes.


The UN Foundation/mHealth Alliance and West Wireless Health Institute define mobile health broadly as the delivery of health care services using mobile communication devices such as cell phones. These applications can range from targeted text messages to promote healthy behavior all the way to wide-scale alerts about disease outbreaks.

Their definition is a good place to start but we can go further.


Apply Michael Tapella’s criteria (my order) to mHealth products that fit in the definition above.

mHealth products:

1. Should have a health-specificity

2. Should enable patient mobility and have some level of connectivity

3. Are consumer-centric and not just mobile versions  of diagnostic services (professional point of care) (except for emerging markets)

4. Should involve a record or measurement of some kind


In addition to providing a way to further identify what is inside and out of the mHealth market–these criteria are consumer/patient centered. When you apply them to the previous broad definition it helps to point us in the direction of products that have increased medical value especially in primary care. 

 Drive a funnel toward outcomes using the 4 criteria

 1. Have a health-specificity

This point makes an IRS like specification. If you work from home you can’t deduct your whole house—just your home office. Likewise–this is saying your smartphone is not the mHealth device–it’s the application on your iPhone or Android whose primary purpose is health based that is considered an mHealth product.

 2. Enable patient mobility and have some level of connectivity

Tapella defines mobility in mHealth as the ability to move freely within an undefined space while still maintaining (internet) connectivity… as opposed to the ability to move freely in a defined space like your house. He also stipulates that for a communication to be considered mHealth, data must be shared, stored, accessed, or modified. This means that telehealth and unconnected mobile consumer devices become excluded from the mHelath category.  For example, Philips makes a product called Telestation. This is a remote monitoring stationary device that is placed in a patient’s home to monitor things like blood pressure, blood sugar and comes with a scale to manage weight. It sends the data from each person’s home to a data hub. The patient can use the device and send the data from wherever they want to in the house but the device is not meant to travel outside of the home.  So even though the device is connected it isn’t mobile and therefore should be considered telehealth instead of mHealth.

 3. Are consumer-centric and not professional point of care (except for emerging markets)

This point filters products like defibrillators in malls and portable ultrasound machines. These devices are mobile but would normally be in a facility. Tapella made the caveat about emerging markets because much of what mobile health means in countries such as Uganda and Haiti is about making point of care products (which often are diagnostic in nature)– mobile.

 4. Involve a record or measurement of some kind

mHealth devices or products need to generate a longitudinal record. Otherwise you are just collecting random data points and not seeing if anything gets better or worse.

What do you think? Do you have any other criteria for mhealth? Share in the comments and let us know!

1.Tapella, Michael, (2011) Defining mHealth. Scienticia Advisors Blog. Retrieved from: Last Accessed December 11, 2011.

Blazing A Trail: Clinician Entrepreneur Makes App for Diabetes–Shares Passion For Health Innovation

I already shared with you how much I loved my conversation with Dr. Jennifer Shine Dyer last month when I previewed our chat because I couldn’t keep all the insights to myself.

It’s time for youespecially clinicians who think you are so cool and innovative to listen to our two interview sessions on the Vimeo Channel or on iTunes as a podcast.

It’s also for people who are thinking about creating a health based app or another aspect of mobile health.

Everyone wants to be innovative. Lots of people are into making health “patient centered.” Dr. Shine Dyer does both of these things AND has shown that her methods actually improve health outcomes. Continue reading