Sandy Payne When Sandy Payne was approached about starting a new house- call service for the chronically ill, she knew right away it would be a perfect fit for her skills and training. She holds a Master's degree as a nurse practitioner, and recently retired from her teaching position at the University of South Carolina School of Medicine, in the school of Family Medicine.

"Patient care is the greatest part of medical work," she says. "I love direct contact with patients, and helping them work through their problems."

She now offers that help through a new service in the Midlands called Care Improvement Plus, a national organization which set up business here a year ago. CIP had found that both doctors and patients are often frustrated at the lack of time for detailed discussion and education. Patients who have learned what their disease is and why certain procedures are important have a much greater chance of successful treatment.

Care Improvement Plus offers a free house- call to Medicare patients, from a licensed health care specialist who can evaluate the situation and answer questions. Payne visits the ill in their homes. She says her work can be summed up in four steps:

• First, she evaluates the home environment, checking for conditions which may be contributing to the problem, and offering advice on correcting those conditions.

• Second, she reviews the medications which may have been prescribed by more than one physician, so that compatibility can be determined.

• Third, she educates the patient about the illness, explaining what is happening and answering the questions that arise. She recommends such measures as diet and exercise which can enhance improvement.

• Fourth, she helps the patient develop a list of questions to take to the next doctor visit, so that improvement can be ongoing.

The principal diseases Payne sees in the course of her visits are diabetes, congestive heart failure, and end-stage renal failure. These chronic illnesses require daily attention. Effective management can help ward off severe complications such as amputation, heart or kidney failure, and death.

She finds great satisfaction in helping a patient to learn to live with the illness and prevent greater problems.

"South Carolina has a very high population of patients with limited access to primary medical care," she says. "Even those who do manage to get to a doctor regularly cannot get all their questions answered. And treatment from multiple providers can actually be counter- productive if the medications do not work together properly."

Payne has received the Nurse Practitioner of the Year Award from the American Academy of Nurse Practitioners, and has been recognized with community service awards by the American Cancer Society and the American Heart Association.

Her CIP calls are made throughout Richland, Lexington, and Saluda counties.

Care Improvement Plus can be reached in Columbia at 1-866-766-8698.