Doctors are reluctant to give nurses more authority to treat patients, according to findings in a New England Journal of Medicine study released on Wednesday. But doctors’ skepticism about nurses having expanded roles isn’t based on the facts — and it ignores the reality that nurse practitioners must take on such responsibilities if health care reform is to succeed.

The new study finds that many doctors don’t trust nurses to lead patient-centered “medical homes,” with only 17 percent of surveyed primary care physicians viewing it positively. “Medical homes” are arrangements encouraged by Obamacare in which nurses, doctors, pharmacists, and specialists work together to provide patients with better and more efficient care in a unified setting.

There is also a striking chasm between doctors and nurses on the issue of nurse practitioners’ ability to provide safe, quality patient care:

When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

Doctors also overwhelmingly disagreed with many nurses’ position that they should receive the same level of pay as doctors for performing similar services.

But this position is an untenable one in the era of Obamacare, with more than 25 million Americans expected to gain health coverage in the coming decade. Since the bulk of these Americans are expected to consume primary care — rather than specialty — services, it’s important that the U.S. medical system have enough medical workers to serve them. And there simply aren’t enough primary care doctors to tackle that burden on their own.

Instead, nurse practitioners will have to take on additional responsibilities. There’s no reason to suspect that this will compromise patient care quality — in fact, multiple studies have shown that the quality of care that nurse practitioners provide for acute primary care is on par with doctors. One randomized trial comparing nurses’ versus doctors’ ability to manage complex care regimens for HIV-positive patients receiving antiretroviral therapy also found no evidence of professional inferiority. As David Hebert, CEO of the American Association of Nurse Practitioners, told Kaiser Health News, “[N]urse practitioners have been practicing safely and providing great outcomes for decades.”

Doctors — and patients — would be well served by an expanded role for nurse practitioners. Primary care doctors tend to be concentrated in urban areas, creating a major barrier to rural and isolated communities’ access to basic medical services. But nurses are more numerous and could have greater access to such populations, making them ideal candidates for heading medical homes and seeing to the day-to-day aspects of patient care.

According to a new study published in the Journal of the American Medical Association (JAMA), young girls may get the same benefits from less doses of the HPV vaccine compared to older women. Study authors hope that the findings will result in higher rates of girls’ HPV immunization in the U.S., which the Centers for Disease Control (CDC) have deemed “unacceptably low.”

The study finds that giving girls aged nine to 13 two doses of the HPV vaccine — commonly called Gardasil — is enough to immunize them. “Nine to 13-year-old girls make a much better anti-body, a better protective response to the vaccine than 16 to 26 year olds,” said Dr. Simon Dobson, lead study author and University of British Columbia pediatrician. That could potentially convince more American parents to get their children vaccinated by making the process less cumbersome, since the HPV vaccine is usually administered over the course of three doses to older girls and women.

This latest study gives credence to federal officials’ recommendations that girls — and boys — receive the vaccination beginning at age 11 as a preventative measure. Many American parents have ignored those suggestions, pointing to the statistic that most people who are infected with HPV do not develop cancer. However, that’s a risky bet given that there is no way to know who is at risk of contracting cervical cancer from an HPV infection, and who isn’t.

A mere 30 percent of U.S. women between the ages of 19 and 26 have received one or more doses of the HPV vaccine — a percentage that some surveys indicate may fall even further. That may partly be because many parents are swayed by conspiracy theories endorsed by fear-mongering politicians that Gardasil is unsafe — a claim that has been thoroughly and repeatedly debunked by the scientific community.

Vaccines are safe and effective. Yet an “unacceptably low” number of Americans receive their vaccinations, forgoing one of the most efficient forms of preventative care in the world. Part of that is due to false notions about vaccines’ efficacy and safety that stem from political fear-mongering and conspiracy theories. But another barrier to better vaccination rates is lack of access — and on World Immunization Week (April 24-30), some public health advocates are urging lawmakers to break it down.

Pharmacy Choice and Action Now (PCAN) is launching a national campaign to convince state lawmakers to loosen regulations on pharmacists providing vaccinations. Currently, appropriately-trained pharmacists can administer shots — but only a select few of them. In a press release, PCAN explained that “all 50 states allow trained pharmacists to administer vaccinations — all qualified state pharmacists can administer the influenza vaccine and 44 states allow qualified pharmacists to administer the shingles vaccine — but pharmacists are ready and willing to do more.”

In fact, pharmacists may actually have to do more in order to facilitate the influx of newly-insured patients who will gain coverage as Obamacare is fully implemented. The success of health care reform will largely depend on increased coordination between various medical workers, as well as more responsibilities for primary care doctors, technicians, nurses, and pharmacists. Pharmacies such as Walgreens have already announced plans to get ahead of the curve and start directly providing primary and chronic care services to their customers.

Other than assisting with health care reform, opening up pharmacists’ ability to administer vaccinations would also prove a crucial preventative health resource for low-income, rural, and other secluded populations that don’t have easy access to hospitals. In turn, that could help stem the tide of preventable deaths due to non-vaccination. “More than 50,000 adults and 300 children die from vaccine-preventable diseases or from their complications each year in the U.S. alone — I think we can do better than that,” said PCAN Chair Bill Mincy in the press release. “Expanding immunization authority for pharmacists is a sure way to increase access to vaccines and keep our communities healthy. I encourage state legislators to take a look at current laws and consider ways to achieve this.”

Forget congressional quibbling in Washington. One of the most telling fights over the future of U.S. health care is actually taking place right now in Louisiana.

Last week, the Louisiana House Committee on Health and Welfare advanced HB 527 to consideration by the full House. If passed, the controversial and heavily-lobbied legislation would redefine “optometrists” — who are primary care eye doctors — as “optometric physicians,” giving them expanded authority to prescribe medications and perform minor eye surgeries that they wouldn’t have been allowed to conduct before. Unlikely though it may sound, the future of American health care largely depends on whether or not bills like this can expand access to quality care while lowering costs — or whether they will instead make common medical procedures more dangerous, and ultimately more costly.

HB 527′s most ardent opponents are a different group of eye doctors — ophthalmologists — who are specialists in eye-related surgeries. Ophthalmologists wearing lab coats branded with “Oppose 527″ testified against the bill, asserting that its passage would open up Louisiana residents to a “blatant expansion of [optometrists'] services without training.” “The problem is, the optometrists want … this designation as a physician and yet, when it comes to oversight they want to be designated as an optometrists. Well, you cannot have it both ways,” said former Louisiana congressman and ophthalmologist John Cooksey.

Optometrists disagree. “In the end, this bill is about access, access to quality eye care for all the people of Louisiana,” said James Sandefur, executive director of the Optometry Association of Louisiana. “Our patients, and especially those in the rural areas, do not have access to these procedures. This bill would give them the access they deserve.” What Sandefur doesn’t mention is that having certain surgical procedures provided by optometrists would actually also lower health care spending, since optometrists wouldn’t be billing as much for their services. And the combination of these two factors — increased access to medical care for vulnerable populations and lowering costs — are really the cornerstones of health care reform.

As more and more people gain access to insurance under Obamacare, the assumption is that they will begin to consume more health care services. That means that more medical workers will be needed to provide care for these newly-insured populations — many of which will be poor, rural, or some other combination of vulnerable and secluded. The vast majority of care consumption isn’t the expensive kind; it’s the preventative and primary care kind, like doctor’s check ups and minor outpatient procedures. That has led some to worry that there won’t be enough primary care doctors to meet the increased demand once Obamacare is in full effect, and that the U.S. health care sector will be overwhelmed.

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On Thursday morning, Walgreens became the first-ever chain retailer to announce that it would become a direct provider of primary care services, moving beyond the pharmacy’s current practice of administering vaccinations to diagnosing and treating Americans with asthma, diabetes, and high cholesterol. The decision holds particular promise for Americans suffering from chronic conditions by giving them an easily-accessible “medical home” for managing illnesses that require preventative or ongoing care — and it might just herald the future of the American health care industry.

Walgreens has been planning something along these lines for some time now. In January, the company announced that it would be launching its own take on Obamacare’s Accountable Care Organizations (ACOs) — coordinated arrangements in which normally stratified health workers collaborate to provide better patient care while lowering costs — in an effort to become “care extenders” that implement the plans drawn up by physicians. As today’s announcement proves, they were serious about that:

Walgreens officials say they will have nurse practitioners and physician assistants at more than 300 Take Care Clinics in 18 states and the District of Columbia to do tests and make diagnoses – and also write prescriptions, refer patients for additional tests and help them manage their conditions.

“We’re not trying to take over primary care, but we think we can help support physicians and transform the way care is delivered to provide more access points at a time when people need it the most,” said Heather Helle, a division vice president at Walgreens. [...]

She said physicians will help oversee Walgreens’ clinics – and the clinics can transmit test results and other information electronically to doctors’ offices. She noted that clinics could help people find doctors too. Many would have an affiliation or other link with the stores’ clinics.

Retail clinics generally appeal to consumers looking for convenience and cost savings. Costs are roughly 30 percent to 40 percent less than similar care at doctor’s offices and 80 percent cheaper than at an emergency room, according to a 2011 study published in the American Journal of Managed Care.

The cynically-minded may point out that there’s a financial motivation to all this, as Walgreens’ main revenue source is its pharmacies, where the costs of generic versions for prescription drugs are considerably higher than at independent, online, and wholesale retailers. Still, this shift would provide substantially added value to purchasing those drugs at Walgreens chains by eliminating the need for a hospital trip, and the idea of an ubiquitous source of cheap primary care should excite health reform advocates, as the planned coordination model is exactly the sort of innovation that reformers and Obamacare are hoping will take root.

American Academy of Family Physicians president Dr. Jeffrey Cain slammed Walgreens’ decision, stating that it could be risky and confusing for patients to receive care through non-doctor practitioners — but this critique completely ignores the needs and realities of U.S. health care. The fact is, increasing reliance on practitioners and physician assistants to provide primary care is absolutely critical to meeting increased patient demand as an increasing number of Americans gain coverage under Obamacare. That’s why the reform law encourages the expansion of community health clinics and these collaborations in the first place.

Having easily-accessible chain pharmacies like Walgreens to carefully monitor patients’ chronic care needs is also likely to increase patients’ compliance with their treatments. That’s huge, considering that noncompliance — especially with medication regimens — leads to $300 billion in wasteful health expenditures every year. Pharmacy-based primary care medical homes would also open up access to disadvantaged populations, like low-income Americans or Americans living in isolated rural communities.

Critical access hospitals (CAHs) are medical providers located in America’s most isolated regions, serving rural communities that do not otherwise have easily-available access to care. Since the closest alternatives to these hospitals are usually over 35 miles away, they provide an essential resource for Americans living in secluded communities — and therefore receive enhanced funding from the federal government to carry out their work. But according to a Harvard School of Public Health study, death rates at these hospitals are significantly higher than national averages — and are on the rise.

The study found that, while mortality rates in the nation’s other hospitals declined by 0.2 percent per year between 2002 and 2010, “critical access hospital death rates rose about 0.1 percent each year, reaching 13.3 percent in 2010.” Those numbers were also worse than non-CAH rural hospitals, leading head author Dr. Karen Joynt to suggest that a dearth of sophisticated medical technology and the special government treatment that CAHs receive may be contributing to higher death rates:

Joynt and her co-authors, John Orav and Dr. Ashish Jha, also of Harvard, suggested that the hospitals’ care may suffer because they don’t have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations. A previous paper by the trio found that critical access hospitals were less likely to have the ability to perform cardiac catheterizations and to have intensive care units. [...]

She also suggested that the hospitals may have been victims of their lenient treatment by the government. Since hospital officials are not required to evaluate their performances to make reports to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients.

“This is 1,000 hospitals, a quarter of the hospitals in the country, that are invisible,” she said. “We’ve created a completely separate system, and in this case it looks like that has not done patients in these hospitals any favors.”

Brock Slabach, an executive at the National Rural Health Association, cautioned against drawing sweeping conclusions from the report. “Mortality is just one small part of the picture of what qualities means,” he said. He said the association’s own research has found that rural hospitals do better in patient satisfaction surveys than do urban hospitals, and that there’s no substantial difference in other measures such as readmissions.

Slabach’s point is important to note — mortality shouldn’t be the only measure of a hospital’s or government program’s effectiveness, particularly for specialized populations in rural areas that have more specified needs than their urban counterparts. Americans living in rural areas have much higher numbers of elderly Americans than urban regions, meaning that mortality rates for rural areas will be skewed upwards to begin with. Furthermore, these populations have more children and are more likely to be poor, uninsured, under-insured, and chronically ill, meaning that preventative and ongoing primary care may ultimately be more important to the locales than more sophisticated secondary or tertiary care.

Still, the study’s findings draw attention to the reality that specialists are hard to come by in these areas. The vast majority of doctors in general — and specialists in particular — are concentrated in cities. But that doesn’t explain why non-CAH rural hospitals are apparently outperforming CAHs. And that suggests there may be something to the study authors’ point about lax reporting standards, which could be leading to a lack of nuance in the way that funding and resources are deployed to these providers.

According to a new report from the Centers for Disease Control (CDC), over 70 million of America’s 79 million “prediabetic” residents — those with relatively high blood sugar but not high enough to qualify as diabetic — knew they were at risk of developing the disease in 2012.

As Everyday Health reports, that’s particularly bad news considering that prediabetic Americans can reverse their condition through diet and exercise, preventing their blood sugar from reaching diabetic levels and sparing them from the chronic illness and its associated health care costs:

While prediabetes is often reversible with a healthy diet and exercise, the CDC said in its report, those with the condition need to know they have it or they’re unlikely to make the needed lifestyle changes. And without those lifestyle changes, research has shown that within 10 years most prediabetics develop diabetes, which can lead to a variety of serious complications, from heart disease to kidney failure to blindness.

“If we can identify it early on, we can treat it,” said Scott Drab, PharmD, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy. “We can prevent many of these patients from going on to get diabetes.”

In its report, the CDC noted that only 14 percent of Americans even know prediabetes exists — but the agency was also clear that the condition and therefore the risk of developing diabetes could be reversed or delayed in many cases by eating less, exercising and losing weight.

“Evidence-based lifestyle programs aimed at increasing physical activity, improving diet, and achieving moderate weight loss among those with prediabetes can prevent or delay type 2 diabetes,” the CDC said in the report. “Because the vast majority of persons with prediabetes are unaware of their condition, identification and improved awareness of prediabetes are critical first steps to encourage those with prediabetes to make healthy lifestyle changes.”

Some doctors recommend that all Americans get screened for prediabetes every year in order to bolster prevention efforts and stop the disease before it progresses to an unsustainable stage. That’s not surprising considering that excess sugar in diets leads to 180,000 annual deaths worldwide and that the rise in American diabetes rates is the main driver of ballooning U.S. health care costs.

Four-year-old Torrie Smith, a little girl in a low-income Colorado household, suffers from devastating dental health issues. Her plight could have been avoided with regular preventative dentist check ups, which would have been free for Torrie under Medicaid — but her mother Wendie didn’t know about the dental health benefits afforded to Torrie under the public insurance program until it was far too late.

Torrie’s issues underscore the considerable gaps in America’s dental health coverage system. Dental insurance remains elusive even for many who have employer-sponsored health coverage — some estimates peg the number of Americans forgoing dental care at over 100 million, with children and the poor being disproportionately affected. That’s particularly bad news considering that dental problems are lifelong problems, and poor dental health early on in life leads to a status quo in which over a quarter of elderly Americans over the age of 65 lose all of their teeth.

And as the Coloradoan reports, even Medicaid beneficiaries face a dearth of coverage due to low reimbursement rates for dentists accepting Medicaid patients:

State Medicaid data reported to the federal government show that less than half of the 453,000 Coloradans under age 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents under age 19 to visit a dentist, according to an I-News analysis of state records.

“Dental disease is not self-resolving,” says Diane Brunson, director of public health for the University of Colorado’s School of Dental Medicine. “It’s not like catching a cold and you put up with it for a week or 10 days and you’re fine. You have to get treatment. And it’s so much more beneficial all the way around — to the child, to their family, to taxpayers — if dental problems can be prevented.”

While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorado’s 3,500 or so dentists are considered “significant” Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorado’s 64 counties do not have a dentist who accepts Medicaid.

A large part of the problem has to do with a lack of knowledge regarding essential health care benefits, which leads to the vast majority of Americans not claiming preventative dental care that they are eligible for. “When she came along,” Wendie said of Torrie, “they gave me a (Medicaid) card and said it was for her doctor visits. They didn’t say dental or anything like that.” That’s nothing new when it comes to Americans and their preventative care benefits — only one in five Americans in high-deductible insurance plans know that much of their preventative care is free.

But as the Coloradoan’s article points out, it also has to do with Medicaid’s historically low reimbursements for doctors. Since states share a considerable amount of authority along with the federal government when it comes to determining Medicaid’s budget, the program is often an easy target for budget cuts. But those cuts carry with them a considerable human cost for some of America’s poorest residents. As ThinkProgress has consistently reported, that makes implementing Obamacare’s optional Medicaid expansion a medical imperative for the American poor — but as Torrie’s story shows, educating families about the care that they are eligible for is just as important.

Obamacare has already begun making big changes to the way that insurers and hospitals do business — and now, it’s changing the very way that medical schools train doctors. As Modern Healthcare reports, medical colleges are expanding programs to teach doctors how to coordinate care with other health care workers, focus on patients’ comprehensive, long-term care, and encouraging more general practitioners and primary care providers in anticipation of a changing medical landscape under Obamacare.

One of the most significant ways that Obamacare hopes to transform the American medical industry is by shifting it from an expensive system of private practices to a coordinated care model in which hospitals, nurses, general practitioners, and physicians work together to provide centralized and patient-focused care — what some in the industry refer to as a “medical home” — to lower costs and improve health outcomes. But this strategy’s success depends entirely on a medical workforce that understands how to coordinate care and work in teams — and medical colleges understand that:

Those trends [towards group practices] are gathering speed under Obamacare as government spurs the creation of new health care models like medical homes and accountable-care organizations, which make doctors responsible for soup-to-nuts care and patients’ health over the long term.

Schools like Weill Cornell are teaching would-be doctors how to work more effectively with other health professionals so that they may lead the changes rather than get swept up in them. They are putting a heavy premium on teamwork among doctors, nurses, nurse practitioners, social workers, health aides and physician assistants. Doctors prescribe the medicine, but it may be the nurse, the social worker or the home health aide who makes sure it gets taken. [...]

“If care is to be transformed, that can’t happen unless we transform the process of training physicians,” said Carol Aschenbrener, chief medical education officer of the American Association of Medical Colleges.

Teaching hospitals such as NYU Langone are also expanding programs for alternative degrees in public health and hospital administration in an effort to get ahead of the coordinated care curve. Weill Cornell has programs that offer students financial incentives to go into primary care, as well as classes that train doctors to get used to following patients’ treatment regimens and care over the long-term.

That’s especially good news considering the primary doctor shortage that America is potentially facing, and in light of the fact that wasteful Medicare spending is largely spurred by patients not following their treatment regimens. Coordinated, bundled care that streamlines the fragmented health care system will simplify Americans’ care and help them properly follow their treatments, lead healthier lifestyles, and thereby lower health care spending.

Taken together, recent changes in medical school training curricula are very promising for the future of American health care, and a stark reminder that Obamacare doesn’t just aim to reform private insurance — it also contains bold ideas for reforming the very way that health care is delivered in America.

In a new report, the Centers for Disease Control (CDC) proclaims that American adults are receiving vaccinations for whooping cough, shingles, and pneumonia at “unacceptably low” rates.

While the report found increases in the number of Americans receiving TDAP — tetanus, diphtheria, and pertussis — and HPV vaccines, it also concluded that there was “little improvement in coverage for the other vaccines among adults in the United States.” CDC officials told reporters that the low vaccination rates could have to do with confusion over the proper vaccination schedules:

There were “modest gains” in coverage for the Tdap (tetanus, diphtheria and pertussis) and HPV (human papilloma virus) vaccines, said CDC researcher and study co-author Dr. Carolyn Bridges during a phone call with reporters. Nearly 13% of people 19 to 64 years old reported receiving a Tdap vaccine in 2011, which was an increase of almost four percentage points from the previous year, she said; the number of adults living with an infant under a year old who received the vaccine was up around 11 points to 22%. Pertussis is particularly dangerous in infants.

Regarding HPV vaccination, adult women are advised to complete a series of three injections by age 26. Thirty percent of women ages 19 to 26 had received one or more doses of that vaccine in 2011, up from 21% in 2010. (In 2011, health officials added men up to the age of 21 to the list of people advised to get the vaccine, but the effects of that change aren’t available in the current data, which was collected in the 2011 National Health Interview Survey.) [...]

During the phone call with reporters, Bridges acknowledged that many adults might be confused about what vaccines they need; schedules vary depending on the vaccine and on a patient’s individual risk. She urged those people to ask their healthcare provider if they were due for any shots.

Even in areas where there has been improvement, vaccination rates are still woefully low — for example, just 30 percent of U.S. women receive one or more of their recommended HPV vaccines. That may partly be due to coverage gaps and a lack of proper information regarding vaccines. But it also speaks to the baffling misinformation spread by conspiracy theorists — and some Republican politicians — regarding the safety and efficacy of vaccines.

Doctors and medical experts have consistently advocated for more robust vaccination rates, and study after study has confirmed vaccination schedules’ ability to lower the spread of infectious diseases. But even during the worst flu epidemic in years, Americans remain remarkably resistant to taking their medicine.