SLIPPERY ROCK — Health care and access to it continues to be a topic of discussion on the presidential campaign trail.

In Pennsylvania, Gov. Ed Rendell's Prescription for Pennsylvania initiative calls for making health care more accessible to all residents.

Three Pennsylvania universities — Clarion, Edinboro and Slippery Rock — believe they know part of the solution: more and better use of nurse practitioners.

The universities are part of a program that has been educating nurse practitioners since 1995.

The family nurse practitioner program prepares graduates to provide primary health care, focusing on detecting disease early in its most treatable stages, diagnosing and treating common acute illnesses, and helping patients manage chronic conditions such as hypertension and diabetes.

While in the program, students benefit from close affiliation with seasoned nurse practitioners and physicians who provide clinical supervision as the students acquire new skills.

"Primary care has really become the province of nurse practitioners, and they are the ones who can reduce coverage gaps in our state and country," said Joyce Penrose, professor of nursing at SRU. "We know that in rural and underserved communities, access to health care can be a problem. The reason our program is so important is because we recruit nurse practitioner students from rural and urban communities, educate them and place them back in their own communities. They become part of the solution."

Nurse practitioners are critical to the delivery of primary care services, Penrose said, because their nursing backgrounds prepare them for work with an aging population.

"Forty-eight out of Pennsylvania's 67 counties are considered rural," Penrose said. "It is difficult to attract physicians to these sparsely populated areas where the elderly and poor predominate."

According to the Pennsylvania Rural Health Association, fewer than 12 percent of Pennsylvania's 16,838 primary care physicians practice in rural areas. Of those, 25 percent are nearing retirement age.

Meanwhile, there are 6,045 certified nurse practitioners in the state — more than ever before.

Family physician Michael McDonald, who practices in Slippery Rock and employs graduates of the universities' program, said nurse practitioners have become "the right arm of health care," especially as more doctors move into specialty practice.

"Physicians are still the face of health care, but nurse practitioners certainly fill a need when an area is underserved by physicians," he said. "If we didn't have nurse practitioners, we wouldn't see as many patients because some patients like nurse practitioners better. They are good physician extenders."

McDonald said they give acute care for uncompleted medical problems and can handle 95 percent of the cases they encounter.

"They see the ones that are not life threatening," McDonald said. "If someone has chest pains, he will see the doctor. If a baby has a high fever, the baby will be seen by the doctor."

McDonald, who has practiced in Slippery Rock for 15 years, admires the collaborative program. He has hired two graduates.

"The program provides a good knowledge base," he said, "Then they come here and learn the practice habits."

Dr. John Reefer, director of the Office of Organizational Excellence for Butler Health System, said he expects nurse practitioners to fill specialty rules, such as neonatal, intensive care and stroke units.

In July, Rendell signed a law that expanded the authority of certified nurse practitioners. Penrose said the law's provisions provide for a much better use of nurse practitioners and will help fill provider voids and give relief to overburdened doctors.

The law allows nurse practitioners to order home health and hospice care, make physical therapy and dietary referrals, do disability assessments, conduct methadone treatment evaluations and order medical equipment.

They can also issue homebound school certifications and make respiratory and occupational therapy referrals, on top of being given the authority to write prescriptions.

Gordon Ovenshine is the senior public relations writer for Slippery Rock University.