A case report in a Rural Health Center

An experiment utilizing nurse practitioners in the delivery of health care in a rural Nebraska community is described. In spite of several reorganizations, over a 2 1/2-year period of study, the project failed in terms of patient utilization. Visit rates began at 300 per month and increased to a high of 825 until the community perceived that the nurse practitioner was interposed between themselves and the primary physician. Rates then dropped to 375 and the community withdrew from the project. Implications for rural health projects using ancillary personnel are discussed.