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Caring for Chronic Conditions in Primary Care

Caring for Chronic Conditions in Primary Care

With the Patient Protec­tion and Affordable Care Act now underway, more attention is being focused on patient-centered and coordinated care. As a result, primary care physicians (PCPs) are seeking new ways to organize care around patients. This includes providing in-office services that meet all of patients’ healthcare needs and/or taking responsibility for appropriate referrals. Within MaxHeath Family Medicine, the focus is on increasing our ability to address all patient health concerns by adding a diverse array of services. In addition to a patient clinic, our practice houses centers for allergy, physical medicine and rehabilitation, cosmetic medicine, and weight loss. It also offers centers for sports medicine, brain health, and mental health. By offering more services, we have successfully improved patient outcomes, as well as financial benefits for the practice. A Focus on Allergic Rhinitis & Asthma Efficient treatment of chronic conditions is important to cultivating patient-centered primary care. Nearly half of all Americans have a chronic condition, and the prevalence of such conditions continues to increase. For example, approximately 60 million Americans suffer from allergic rhinitis (AR), which often precedes the onset of chronic allergic asthma. To enhance care of chronic conditions, we must shift from simple chronic disease-state management toward prevention-focused care.               In an effort to address AR, my colleagues and I implemented additional AR treatment protocols by establishing an allergy center. We work with United Allergy Services to supply allergy testing and immunotherapy to patients. For those who view their symptoms as a minor inconvenience, it is important that they avoid specific allergens. However, this avoidance approach can only work...
Improving ED Communication & Patient Throughput

Improving ED Communication & Patient Throughput

Among the many Affordable Care Act initiatives rumbling through the healthcare industry, the introduction of 30 to 40 million new patients is certain to create additional stress to an already overburdened healthcare system. As a result, hospitals must find ways to increase their patient throughput and operational efficiency. Unfortunately, inefficient inpatient discharge practices continue to create unnecessarily long hospital stays. Patient throughput in the ED impacts the rest of the hospital system. ED lengths of stay generally increase when hospital occupancy levels exceed 90%, so enhanced communication and patient throughput are vital throughout the acute care setting. Although many factors can hinder patient flow, nearly 70% of clinicians cite communication as the most challenging cause of patient throughput delays. EDs: The Communication Ground Zero Communication in the ED sets the course for patient flow throughout the hospital. Safe, efficient, quality care in the ED requires frequent and effective communication. Nearly half of EDs report operating at or above capacity, and wait times and patient visits have risen steadily for the last 20 years. Initial communication with ED patients must be a top priority. As soon as patients register at the ED, they must be clearly informed of their anticipated treatment. Early communication about details, such as estimated wait times, anticipated discharge times, and availability of immediate treatments for minor symptoms, can smooth transitions of care.  Intricacies are sometimes forgotten but have a tremendous impact on patient throughput. The physical design of individual patient rooms can greatly affect throughput. When rooms are well-designed and provide optimum flexibility, patients can receive faster, more efficient care. In order to save space for...
NPs Practicing Independently? AAFP Says No

NPs Practicing Independently? AAFP Says No

The idea of advanced practice nurses directing primary care practices on their own without a physician on staff has been a hot topic of discussion lately among the healthcare and public policy communities. The rationale behind most of these proposals stems from the U.S. shortage of primary care physicians. So is substituting nurse practitioners for doctors the answer? According to an article published in the July issue of Medical Care, the number of NPs could grow by 94% by the year 2025, and they will likely provide increasingly more healthcare services as demand rises during implementation of the Affordable Care Act. The move toward nurses practicing independent of physicians is coming at a time when medical practice itself is evolving into an integrated, team-based approach that includes physicians and other health professionals, according to the AAFP. This approach is generally known as the patient-centered medical home (PCMH). Studies show the ideal practice ratio of NPs to physicians is approximately 4 to 1. PCMHs built around that ratio provide patients with a primary care doctor and the benefits of team-based care. Successfully piloted in several locations, the PCMH model facilitates improved primary care and will likely become a reality for most Americans in some form in the next decade. The medical home is a team-based approach to healthcare touted by reformers for its potential to improve quality while lowering costs. The AAFP report, released yesterday, said that although NPs are valuable members of the medical home team, they are not qualified to head the “household.” It notes that family physicians receive 11 years of college and graduate-level education, including residencies,...
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