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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...

Immunotherapy for Autoimmune Epilepsy

A small observational study suggests that initiating immunotherapy early may improve seizure outcome in patients with medically intractable epilepsy for whom clinical and serological clues suggest an autoimmune basis. At an average of 17 months after these patients received immunotherapy, 81% reported improvements and 66% were seizure free. Abstract: Archives of Neurology, May...

Improving Survival in Kidney Cancer

When managing kidney cancer, clinicians have traditionally used a one-size-fits-all approach. However, emerging evidence is demonstrating that all kidney cancer patients are not the same. Likewise, not all localized and metastatic kidney cancers are the same. Improving survival rates in kidney cancer is paramount, and several new targeted therapies that have been introduced to the treatment armamentarium have been shown to improve survival. As these therapies continue to emerge as viable treatment options, it’s important to determine the patients who stand to benefit most from them. New Long-Term Data In the November 1, 2008 issue of Cancer, my colleagues and I had a study published in which we assessed nearly 1,500 patients treated for kidney cancer in the last 15 years. Our investigation used an integrated staging system—developed at UCLA—which brought together medical oncologists, urologists, surgeons, clinical trial experts, and scientists for collaboration. A key finding of our study was that patients with localized kidney cancer could have low-, intermediate-, or high-risk cancers, and some may have better outcomes than others depending on the aggressiveness of the disease. Patients with low-risk, localized cancer had a 5-year survival rate of 97% and a 10-year survival rate of 92%. Those at intermediate-risk had 5- and 10-year survival rates of 81% and 61%, respectively. High-risk patients had 5- and 10-year survival rates of 62% and 41%, respectively. In the past, these groups of patients may have been treated in similar manners, but it’s clear that they should be treated individually according to their risk levels. In patients with metastatic kidney cancer, our study showed that those with low-risk disease should receive aggressive...
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