Ryan Marotta, Assistant Editor

Leeanna Harding, MS, PA-C, has been recognized both by her patients and her peers for the distinguished care she has provided throughout her tenure as a physician assistant (PA) for MinuteClinic.

“Leeanna Harding has been working in convenient care nearly 10 years. Her care has put smiles on the faces of hundreds of patients every year, and her advice has saved countless lives,” Harding’s manager, Kristene Diggins, FAANP, DNP, of MinuteClinic told Contemporary Clinic®. “Leeanna is a problem solver, and she ands many ways to support her local and national team to enhance convenient care access for both patients and future providers in the industry. She has continuously worked in some of the highest volume clinics in North Carolina and has provided efficient, high-quality care each and every time.”

Harding has earned numerous accolades for her dedication to improving health, including the Convenient Care Association’s Unsung Hero award, but she considers her defining moment as a PA to be her interaction with a certain patient who came to her complaining of a sore throat. Although the patient was adamant that he be prescribed antibiotics, Harding noticed that something was wrong and referred him to an otorhinolaryngologist, where he was diagnosed with stage 4 throat cancer.

“Fortunately, the patient is currently cancer-free, and he has since returned to the clinic to thank me for not treating his cancer with antibiotics,” Harding stated. “This experience made me a better provider by reinforcing the importance of treating patients using evidence-based medicine, as well as by boosting my confidence in my diagnostic skills."

Reflecting upon her career as a PA, Harding remains grateful for the setting at which she has worked, especially for the opportunities that it provides to her patients.

“One of the things I find most rewarding about my work at MinuteClinic is when patients appropriately choose me over the ER,” Harding explained. “I like knowing that I’m reducing the burden at the hospital by treating those UTIs and ear infections that don’t need to be seen in that type of setting. It’s more cost effective for the patient as well.”

And although Harding has experienced significant changes in her role as a retail clinic PA, she looks forward to facing any future challenges that the evolving health care landscape may bring.

“In the past 10 years that I have worked for MinuteClinic, I have seen us change and evolve to meet the health care needs of our community with increased service offerings and expansion throughout the United States,” Harding said. “I can’t wait to see where we’ll be in the next 10 years!”

Initially I wanted to become a physician because I had no idea what a PA was or that it even existed. Sometime in middle school, I was evaluated, treated, and given a prescription by a very nice PA and it made me do some research on the profession. By the end of high school, I knew that’s what I wanted to do and worked on obtaining my prerequisites to apply to college. I couldn’t be happier with my decision because being a PA allows me to practice in any field of medicine while maintaining a healthy work/life balance.

Q: What do you think is the most important quality for a health care provider to possess?

I think the key to being a successful and caring provider is having great listening skills. If you are able to take a thorough and accurate history, while engaging your patient, you can sometimes learn more than what lab work or diagnostic testing will tell you.

Q: What do you think is the most important issue in the medical field today? Why?

The absolute most important issue in health care today is access. Patients need access to affordable health insurance, as well as access to quality health care providers for treatment. I think this is one of the areas that retail health care excels because it is relatively inexpensive and patients can walk in at their convenience.

Q: What advice would you give to aspiring PAs and retail clinicians?

The best advice I can give is to rely on evidence-based medicine and your clinical skills. We work in an unusual setting where “the customer is always right.” That might not always be the case in health care, but through thorough patient education, we can decline the antibiotic request for treating a cold and our customer/patient will still leave satisfied.

Articles

Leeanna Harding, MS, PA-C, has been recognized both by her patients and her peers for the distinguished care she has provided throughout her tenure as a physician assistant for MinuteClinic. 

Provider of the Month: Leeanna Harding, MS, PA-C

Physician assistant (PA) Sonia Rupani, MS, PA-C, has demonstrated a passion for improving patient health throughout her entire life.

Rupani’s drive to help others was apparent even in her youth, when her parents observed the care she took and compassion she displayed in tending to her sister’s wounds. Later, this inclination grew into a career aspiration after she met and shadowed a local PA, Mr. Shah; upon seeing the many positive effects that her mentor had on their community, Rupani decided to follow in his footsteps as a PA.

“Like other PAs, I wanted to make a difference on the well-being of my patients, and to provide quality care to patients all ages,” Rupani told

In pursuit of her career, Rupani graduated with a BS in chemistry from the University of Mumbai before moving to the United States, where she enrolled in and completed the PA program at John H. Stroger Jr. Hospital of Cook County in Chicago, Illinois. She later earned her MS in advanced physician assistant studies from A.T. Still University in Mesa, Arizona.

After becoming a licensed PA in 2010, Rupani put her skills and knowledge into practice as a clinician for Medinet Family Care Clinic in Houston, Texas, where she conducted physical exams, developed treatment plans, and provided counseling on preventive care. After several years, Rupani moved into her current position as a PA for a Rite Aid Rediclinic in Sugarland, Texas, a setting that has enabled her to perform further responsibilities such as administering immunizations and conducting travel consultations.

Although Rupani has treated many patients throughout her career, she nevertheless remains modest in her achievements, attributing her successes as a PA to the efforts of her fellow health care professionals.

“No matter where we practice—whether at a hospital, an emergency room, an outpatient clinic, or a retail clinic&mdash;it is teamwork that makes a difference,” Rupani said. “Efficient and adept teamwork has an impact on patient care and patient outcome.”

Reflecting on her career as a PA, Rupani expressed gratitude for her opportunities to help her patients improve their health and, ultimately, emphasized the crucial role that clinicians play on the health care team.

“Although the scope of practice at the retail clinics is limited, there are no restrictions applied to your knowledge in recognizing ailments and conditions in directing your patients to an appropriate provider, if needed,” Rupani stated. “It is rewarding to know you have helped a patient achieve the right care at the right time.”

The recipe to becoming a good health care provider contains many different ingredients, including professionalism, knowledge, empathy, compassion, thoroughness, respect, honesty, responsibility, and much more. However, one paramount spice in this recipe is being a good listener. It is important we listen to our patients to understand their concerns, as this act will guide us in getting a better understanding of their condition and allow us to provide them the appropriate quality care they deserve.

Q: Is there a specific person or patient you have worked with who taught you something that will help you be a better provider?

Yes, one of my teachers, the late Dr. Gertude Novak. She was a pathologist who went back into a family medicine residency program because of her interest to learn, and she never felt embarrassed to say “I do not know.” She taught me how to care for everyone with dedication, and how to experience the satisfaction that comes from improving outcomes. Even though she is no longer with us, the knowledge and characteristics she instilled in me and her other students has remained.

The most important issue in the medical field is the limited time and attention we invest in discussing prevention. A modifiable risk factor, obesity, is a growing concern in all age groups. We need to capitalize our time in educating patients and parents about therapeutic lifestyle changes to avoid the complications such as cardiovascular disease, diabetes, cancer, and much more.

Q: What advice would you give to aspiring PAs?

Year after year, dedicated and determined PAs have played a significant role in expanding and improving health care. My advice to aspiring PAs is to continue our devotion, hard work, and enthusiasm in providing quality care to the patients to make the world a healthier place.

Physician assistant Sonia Rupani, MS, PA-C, has demonstrated a passion for improving patient health throughout her entire life.

Rite Aid RediClinicâ€™s Sonia Rupani, MS, PA-C

Ann Tracy, APRN, FNP-C, has demonstrated her commitment to patient health and education throughout her distinguished nursing career.

After earning her nursing degree from Wichita State University (WSU), she used her skills and knowledge in a variety of roles, from an infection control coordinator, to an assistant director of nursing for a long-term care organization, to a registered nurse in hospital transplant, burn intensive care, neuro intensive care, and cardiac units. However, believing that she could better serve her patients in a different capacity, Tracy later went back to WSU for her master’s and then soon became certified as a nurse practitioner (NP).

“After 20 years of my nursing career, I felt like I had more that I could give to my patients,” Tracy told Contemporary Clinic. “Pursuing my master’s degree allowed me to continue to be a nurse, but on a new level. I pull knowledge and skills from my past nursing experiences every day.”

Following her certification, Tracy worked as an NP for Mid Kansas Pediatrics in Wichita, Kansas, where she managed the acute illnesses and chronic diseases of infants, children, and adolescents. After discovering a passion for education upon co-developing the practice’s asthma education plan, she later returned to WSU once more as a clinical instructor, where she taught nursing students to apply classroom theory to hospital settings.

Tracy next took her talents to Heartspring, a Wichita-based nonprofit school for children with special needs, where she managed the primary care needs of all students with developmental disabilities. She currently works as an NP for The Little Clinic in Wichita, where she performs physicals and administers immunizations to a high volume of patients in a clinical setting.

“I learn something every day from my colleagues and patients that makes me a better provider, including different ways to think about a situation and ways to be more efficient while providing quality care,” Tracy explained. Reflecting upon her career, she’s most grateful for the opportunities she has had to help patients improve their health. “With so many choices to access health care, I feel privileged that patients chose to come see me and put their health and well-being in my hands,” Tracy said.

A: Empathy. In order to connect with your patients and help them, you need to have the ability to be sensitive and identify with their concerns. Kindness and a smile can go a long way.

Q: What do you think is the most important issue in the medical field today?

A: Providing cost-effective care to all patients. There are so many patients who either can’t afford insurance or can’t afford to access health care when they are sick.

Q: Is there a particularly interesting or funny story you would like to share from your experience as a clinician?

A: A patient put her contact lens in the day before her visit. It didn’t feel right all day and was scratching  her eye. She removed the contact, but her eye was still very irritated. During my exam, I asked about her vision, to which she replied that she could see well even without a contact in. I examined her eye, and upon telling her that she still had a contact in, she realized that she must have put 2 contacts in, but only removed one. I asked her to remove the contact and she immediately felt better. She couldn’t believe that she didn’t realize that on her own. We had a good laugh together.

Q: What advice would you give to aspiring NPs?

A: Individualize your patient care and really listen to what the patient is saying. I think we often have the misconception that sick patients all want to leave with an antibiotic. If the patient has a virus, I have found that most patients are very receptive to me if I validate their condition and tell them that I want to help them find something that will relieve their symptoms, and they appreciate me spending the time to listen to them.

The Little Clinic's  Ann Tracy, APRN, FNP-C

The US Preventive Services Task Force (USPSTF) just released final recommendations based on its recent investigation into screening for lipid disorders in children and adolescents without signs, symptoms, or a diagnosis for the conditions.

It determined that there was insufficient research to establish the benefits and risks of screening for high cholesterol in this population. Specifically, the USPSTF found no conclusive evidence that the early identification and treatment of high cholesterol in children and teens leads to long-term improved health in adults.

As a result, it recommended neither for or against lipid disorder screening in younger patients, granting this service a grade of “I.”

“By issuing an ‘I’ statement, we are calling for more research to better understand the benefits and harms of screening and treatment of lipid disorders in children and teens and on the impact these interventions may have on their cardiovascular health as adults,” said task force vice-chair David Grossman, MD, MPH, in a press release. “In the absence of evidence, health care professionals should continue to take each patient’s individual risks and circumstances in consideration, and use their best judgment when deciding whether or not to screen.”

Not all health organizations agree with the USPSTF’s assessment. The American Academy of Pediatrics and the National Heart, Lung, and Blood Institute both currently recommend that all children aged 9 to 11 years be screened for high cholesterol due to the growing prevalence of childhood obesity.

Despite the USPSTF’s inconclusiveness on cholesterol screening in younger patients, it did recommend that children aged 6 and older be screened for childhood obesity and referred for counseling on weight management

in December 2015, Target Clinics professional services manager Courtney Ballina, BSN, MSN, NP, explained that the USPSTF’s decision would likely affect reimbursement, as insurance companies are unlikely to cover services that it doesn’t support. She added, however, that retail clinics can still play a crucial role in combating lipid disorders in kids and teens by counseling patients and parents about the health risks of high cholesterol and childhood obesity.

“Oftentimes, the retail clinician is uniquely positioned to do some hands-on training—actually walking into the aisles of the store to teach how to read a food label or make some healthy recommendations for snacks,” Ballina previously told

. “It would be great to further develop our partnerships with primary care providers and pediatricians to offer these kinds of supportive services once they have actually diagnosed a child with high cholesterol.”

The USPSTF’s full recommendation statement was published in

The US Preventive Services Task Force just released final recommendations based on its recent investigation into screening for lipid disorders in children and adolescents without signs, symptoms, or a diagnosis for the conditions.

More Study Needed on Cholesterol Screening in Children

Cautious retail clinicians may consider routinely testing all patients for genital herpes, but they might want to hold off on screening those who don’t exhibit symptoms.

The US Preventive Services Task Force (USPSTF) recently released a public draft of its forthcoming guidelines on serologic screening for genital herpes infection. After analyzing data on 18 previous studies of serologic herpes tests, it observed that herpes blood tests had a relatively high rate of false-positive results and were associated with potential psychosocial harms, such as distress and anxiety.

The USPSTF added that routine screening appeared to offer almost no benefit to patients, as the early detection and treatment of genital herpes made little difference in outcomes. There’s currently no cure for genital herpes, so treatment focuses on alleviating its symptoms, which can include bleeding between periods, blisters, discharge, and burning.

“Because there’s no cure, there isn’t much doctors and nurses can do for people who don’t have symptoms,” said USPSTF member Maureen Phipps, MD, in a press release.

Based on its findings, the task force ultimately recommended against routine serological screening for herpes in asymptomatic adolescents and adults, giving the use of the test in this population the lowest grade of “D.” However, it nevertheless advised clinicians and other health care providers to screen patients for other sexually transmitted infections (STIs) like chlamydia, gonorrhea, syphilis and HIV, as well as to counsel patients at high risk for developing these diseases. It also encouraged patients to consult their providers immediately if they experience any signs of herpes or another STI.

“People should be aware of the signs and symptoms of genital herpes and should talk to their doctor or nurse if they are concerned,” stated task force member Ann Kurth, PhD. “This is especially true for women who are pregnant because there are things clinicians can do to help women who have genital herpes protect their babies during delivery.”

The USPSTF acknowledged several limitations to its research, noting that most of the studies it evaluated were conducted in African countries, where the rate of herpes is higher than that of the United States. It also explained that the benefits of behavioral counseling interventions or preventive antiviral medication in asymptomatic patients has yet to be established.

Approximately 1 in 6 individuals 14 to 49 years in the United States has contracted genital herpes, according to the CDC.

Cautious retail clinicians may consider routinely testing all patients for genital herpes, but they might want to hold off on screening those who donâ€™t exhibit symptoms.

Routine Herpes Screening Not Recommended in Asymptomatic Patients

Retail clinicians on the lookout for signs of depression in their younger patients should be aware that the screening questionnaires used to identify the condition could lead to a misdiagnosis in children and adolescents.

set out to evaluate the accuracy of the screening tools currently used to diagnose depression. To do so, researchers from McGill University evaluated 17 studies in which the results of screening questionnaires were compared with results from diagnostic interviews that determined whether the children or adolescents were truly depressed.

After assessing the methodology and results of these 17 studies, the researchers found that many were too small to definitively establish the accuracy of depression screening tools. Additionally, they determined that most of the studies failed to meet expected standards.

However, the researchers also determined that there was inadequate evidence to recommend any particular cut-off score for a depression diagnosis for this population among any of the questionnaires used.

“There was not a single tool with even moderate evidence of sufficient accuracy to effectively identify depressed children and adolescents without also incorrectly picking up many non-depressed children and adolescents,” said lead author Michelle Roseman, PhD, in a press release.

Based on the observed shortcomings of the screening tools, the study authors expressed concern and suggested that their use could possibly cause healthy children and teenagers to be misdiagnosed with depression.

“Our study shows that if depression screening were carried out using existing screening tools, many nondepressed children and adolescents would be mistakenly identified as depressed,” stated senior author Brett Thombs, PhD, in a press release. “This could lead to the unnecessary prescription of potentially harmful psychiatric medications and negative messages about the mental health of some children who do not have mental health disorders.”

Additionally, Dr. Thombs noted that determining which diagnosed patients are truly depressed may require the use of an extensive number of resources.

“These resources would then not be available to provide treatment to large numbers of children and adolescents who are known to have severe mental health problems, but who do not receive adequate care,” he explained.

The researchers concluded that large, well-designed studies that present results across a range of cut-off scores are required to properly assess the accuracy of depression screening tools in children and teens.

In the meantime, clinicians should keep in mind that depression symptoms aren’t always one-size-fits-all—especially among children and adolescents. Therefore, it’s highly important for clinicians to review a patient’s medical records and treatment history and to collaborate with the primary care physician when determining the appropriateness of a depression treatment regimen for a given patient.