A hospital in Philadelphia significantly reduces the incidence of Clostridium difficile infection by feeding patients yogurt twice a day when they are receiving antibiotic therapy. The bacteria in the yogurt is thought to combat the ravages of C difficile infection by maintaining the healthy bacteria in the gastrointestinal tract throughout the antibiotic treatment course.1

A wheelchair-bound patient misses 4 clinic visits. When his family nurse practitioner calls, he offers a variety of excuses and promises to make his next visit. Sensing a problem, the nurse practitioner orders a home visit by the nursing student team who learns that the patient was moved to a second-floor apartment and cannot get down the stairs. Clinic personnel intervene, and the patient is moved to a ground-floor apartment.

A primary care nurse practitioner notices that the glycated hemoglobin A_1c (HbA_1c) levels of many of her diabetic patients drop precipitously at the end of each month and then rise again. She focuses on the patients who are doing well throughout the month and discovers that none of them are on food stamps. Focused interviews of the patients with compromised HbA_1c levels reveal that their food stamps last only for 3 weeks. The nurse practitioner works with the social worker to remedy the situation, and the HbA_1c levels remain positively stable for all patients.

Simple solutions to complex problems require a special kind of thinking that avoids the mire of complexity, fixes quickly on the root cause of the problem and provides an uncomplicated solution that is often nonmedical. Offering yogurt to patients who might be at risk for C difficile infection makes perfect sense, given what we know about the benefits of probiotics. More importantly, the intervention was uncomplicated; a simple, nutritious, inexpensive food that would do no harm. Although there were skeptics who said that the results might not be statistically significant or only preliminary, subject to replication, there was a positive effect that could be replicated.

The nurse practitioner who ordered a home visit for her "no-show" patient based her decision on the patient's past pattern of faithful clinic visits. Furthermore, correlating the lowered HbA_1c levels with the pattern of food stamp availability was an exquisite insight by a nurse practitioner who took the time to examine available patient data. Simple, nonmedical solutions as the first line of defense in addressing health problems can result not only in improved health outcomes but also in decreasing unnecessary and expensive care.

It was Thoreau who said, "So simplify the problem of life, distinguish the necessary and the real. Probe the earth to see where your main roots run."2 Good advice for promoting change in the health care system.

-Gloria F. Donnelly, PhD, RN, FAAN

Editor

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