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The primary care provider and the patient living in poverty

Applying the Bridges to Health and Healthcare model to NP practice

Wise, Barbara PhD, APRN, FNP-BC1; Dreussi-Smith, Terie MA Ed2

Journal of the American Association of Nurse Practitioners: April 2018 - Volume 30 - Issue 4 - p 201–207
doi: 10.1097/JXX.0000000000000036
Clinical Article

Background and purpose: There is a much recent emphasis on the social determinants of health, and poverty is the most influential of these. It is not enough merely to understand the influence of poverty on health—the primary care provider must understand how to effectively treat patients who live in poverty.

Methods: This article applies the Bridges to Health and Healthcare model for understanding poverty to primary care practice from an individual provider's perspective. The article walks the reader through the implications of generational poverty for the primary care clinician in a typical office visit from history taking to following up.

Conclusions: Most primary care practitioners approach patients from a middle-class perspective. Awareness of the challenges and different perspectives of those in generational poverty can enhance care and outcomes.

Implications for practice: The individual provider can use the understanding of driving forces, resources, language and cognition, environment, and relationships provided by the Bridges to Health and Healthcare model to benefit patients in generational poverty.

1Division of Graduate Nursing, School of Nursing, Indiana Wesleyan University, Marion, IN,

2aha! Process, Inc., Highlands, Texas

Correspondence: Barbara Wise, School of Nursing, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN 45953; Tel: 937-422-4691; E-mail:

Competing interests: Terie Dreussi-Smith is the coauthor of Bridges to Health and Healthcare. The authors report no conflicts of interest.

Authors' contributions: Barbara Wise wrote the initial draft of the article, Terie Dreussi-Smith added information and references, and the final version of the article was edited by both.

Received September 28, 2017

Received in revised form December 11, 2018

Accepted February 12, 2018

© 2018 American Association of Nurse Practitioners
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