Practice Support Update Blog

Leslie D McDowell, DNP, ANP-BC, RN


Recent Posts

Everyone is struggling with something others know nothing about.

Jul 28, 2025 10:15:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Primary Care, Pediatrics, patient care

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portrait stressed sad young woman outdoors. City urban life style stress-1

Their behavior may become increasingly confrontational as a result.

Healthcare settings are places of intensified emotion.

How well do you and your staff respond to escalating confrontational behaviors from patients and their families?

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Q: (Excluding COVID-19), what is the world's deadliest virus?

Jul 22, 2025 9:00:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Primary Care, medicare, Vaccination, Hepatitis C, Preventive Care, sexually transmitted infections, hepatitis

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The answer is The Hepatitis Virus.

Hepatitis is also the leading cause of liver cancer!

Hepatitis Day

 

World Hepatitis Day is July 28th

What is Hepatitis? 

An inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses (A, B, C, D and E). These are of greatest concern because of the burden of illness and death they cause, and the potential for outbreaks and spread.

Different Types of Hepatitis:

A: Primarily spread when an unvaccinated person ingests food or water that is contaminated with the feces of an infected person. Does not usually cause chronic liver disease. Closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene, and oral/anal sex. An effective vaccine is available.

B: Spread when an unvaccinated person is exposed to infected blood or body fluids from an infected person, including from infected mother to child at birth. A safe and effective vaccine offers 98-100% protection. Potentially life-threatening liver infection and a major global health problem. Puts people at high risk of death from cirrhosis and liver cancer.

C: As a bloodborne virus, Hepatitis C is most commonly spread through sharing needles when injecting drugs, and through sexual contact. If appropriate practices are not followed, it can also be spread via inadequate sterilization of medical equipment in healthcare settings or transfusion of unscreened blood / blood products. There is no effective vaccine against hepatitis C.

D: Infection with this strain cannot occur in the absence of hepatitis B. This co-infection is considered the most severe form of chronic viral hepatitis due to faster progression to cancer and liver-related death. Vaccination against Hepatitis B is the only way to prevent hepatitis D infection.

E: Most commonly found in countries with limited access to essential water, sanitation, hygiene and health services. (Some outbreaks have occurred in war zones and camps for refugees or internally displaced populations.) This virus is shed in the stools of infected persons and enters the human body through the intestine. A vaccine to prevent this strain is licensed in China but is not yet available elsewhere.

Did you know.......

Medicare covers Hepatitis B Screening, Hepatitis B immunization and administration, and Hepatitis C Screening ? (It also covers HIV Screening, and since HIV is also a blood-borne virus often associated with hepatitis viruses, can be transmitted through sexual contact,  (seniors ARE sexually active), it is important to offer this as well.)

Sources:

Medicare Preventive Services Quick Reference Chart

World Hepatitis Day

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Addressing Mental Health with the Collaborative Care Model (CoCM)

Jun 11, 2025 3:30:00 PM / by Leslie D McDowell, DNP, ANP-BC, RN posted in mental health, behavioral health, Pediatrics, podcast, collaborative care

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On the most recent episode of the Northwest AHEC Healthcare Insights podcast, host Andrew Brewer speaks with Dr. Gretchen Hoyle.

Dr. Hoyle returns to provide a post-launch update of implementing a collaborative care management model (CoCM) in primary care practice in a large health system. The model provides continuity of care for chronic conditions such as ADHD, anxiety, and depression. Learn how CoCM operates and insights on transforming care practices with a behavioral care manager, data registry, EHR workflows, and billing.

According to Dr. Hoyle, "This model allows us as pediatricians to use a team based approach for pediatric patients with mental health issues." Members of the CoCM team include the primary care provider who makes a diagnosis and referral, a psychiatric consultant who provides subspecialist level expertise and advice, and the behavioral health care manager (BHCM) who interacts most closely with the patient and their family. Dr. Hoyle finds it is the BHCM that is the "hero" of the CoCM team!

Check out the latest episode of NW AHEC Healthcare Insights podcast!

 

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"It takes two to make a thing go right!"

Mar 19, 2025 10:45:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Primary Care, Quality Improvement, diabetes, hypertension, chronic kidney disease

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Two hands trying to connect puzzle pieces with sunset background

It's National Kidney Month!

Chronic kidney disease affects nearly 37 MILLION people in the country (more than 1 in 7 adults). 

Chronic kidney disease often causes no symptoms until it is more advanced.

Chronic kidney disease is progressive.

Chronic kidney disease puts people at risk for other serious health problems like heart attack, stroke and kidney failure.

One in three adults with diabetes (and one in five with hypertension) may have chronic kidney disease (CKD).

90% of people with it DO NOT KNOW THEY HAVE kidney disease!

Back to our title, "it takes two to make a thing go right": Two tests should be done to look for CKD. Fewer than half of patients at high risk for CKD are screened appropriately.

How to screen?

  • Spot urine ACR (albumin-to-creatinine ratio)

AND

  • eGFR (estimated Glomerular Filtration Rate)

 

Get started now to help make this thing go right!

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March is Colorectal Cancer Awareness Month: Early Detection SAVES LIVES

Mar 12, 2025 8:00:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in cancer, screening, colon cancer

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Happy multi generation family running towards camera in the park on sunny day

Current guidelines: begin colon cancer screening at age 45.

The United States Preventive Services Task Force (USPSTF) recommends that all people at average risk begin colon and rectal cancer screening at age 45. People at higher risk may need to be screened earlier.  

Why was the screening age lowered?

  • In the U.S., about 10% of colorectal cancer cases are diagnosed in individuals under age 50.
  • Young-onset rectal cancer incidence has increased at nearly two times the rate of young-onset colon cancer.
  • It is predicted that by 2030, colorectal cancer will be the leading cause of cancer deaths in people ages 20-49.

Colorectal cancer screening often focuses on detecting polyps. Pre-cancerous polyps usually take about 10-15 years to develop into cancer. It is vital to find them EARLY before they have a chance to grow, spread and turn deadly, and THEN cause symptoms! 

One woman's story:

"The only risk factor I had was being 55 years old. No family history of colorectal cancer, I had no symptoms, I am physically active and eat a healthy diet. I really did not want a colonoscopy, so I had Cologuard screening instead. It came back positive! My colonoscopy showed three very large, but thankfully pre-cancerous polyps. These were removed and honestly, I believe my life was saved. GET SCREENED!"

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Practical ways in everyday clinic work to practice mindfulness.

Dec 18, 2024 12:37:21 PM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Wellness, stress, mindfulness, health

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LiveOaks.sunset.gg

Let's face it. Sometimes it's just plain hard to work in health care.

Mindfulness (paying deliberate attention to the present moment) has been shown to improve cognitive performance, empathy, health and well-being.

We offer 10 simple ways to incorporate mindfulness into your day to day activities.  

Take care of yourself as you take care of others.

 

 

Mindfulness Exercises

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Rural Nursing: A Unique Specialty!

Dec 4, 2024 12:30:00 PM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Nursing, rural health

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Graham County view

Just as orthopedic nurses are skilled at caring for patients with musculoskeletal conditions, and cardiac nurses specialize in patient care of cardiovascular disease, rural nurses are skilled at knowing a little bit about everything! They balance the needs of their patients with the often-limited resources and other challenges in small and sometimes isolated areas.

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Do you know XEC? New SARS-CoV-2 Variant

Nov 26, 2024 2:00:00 PM / by Leslie D McDowell, DNP, ANP-BC, RN posted in COVID-19, public health, family medicine, Pediatric, Vaccination

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Once again, a new SARS-CoV-2 variant is likely to be the gift many did not want to receive from attending holiday gathering!

virus

You may recall in the early days of the COVID-19 pandemic, there was frequent breaking news about each latest variant of the virus (remember Delta and Omicron?). Now that the worldwide public health emergencies have expired, detecting, monitoring, and responding to new variants has become more challenging. 

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Lung Cancer Screening

Nov 25, 2024 8:30:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Primary Care, medicare, screening, Adult health, lung cancer, smoking

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autumn.path.gg

November is Lung Cancer Awareness Month. A perfect time to revisit this topic!

Tobacco use is the leading cause of preventable disease, disability, and death in the U.S., and smoking causes almost a half a million deaths per year.

Rural NC Road in Autumn. Photo used with permission

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General

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NP Week 2024: Celebrating Nurse Practitioners!

Nov 13, 2024 8:30:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN posted in Primary Care, family medicine, Pediatrics, nurse practitioners

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female pediatrician and a little boy where both are smiling

More and more patients are embracing prevention and early intervention to stay healthy and avoid health related complications. NPs encourage health promotion and a comprehensive, wellness-first approach. November 10-16, 2024 is National Nurse Practitioners (NP) Week! 

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