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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...
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,...

A Collaborative Approach to Managing Depression & Diabetes

Published studies have demonstrated that many patients with diabetes and cardiovascular disease (CVD) often have comorbid depression. In individuals with diabetes or CVD, depression has been linked to poor self-management of their physical health, an increased risk for complications, and higher morbidity. Due to feelings of helplessness and hopelessness that accompany depression, the management of these patients is often more complicated than for those who are not depressed. Compounding the problem is that complications of diabetes and CVD can exacerbate any previously existing depression. Exploring a New Depression Intervention In the December 30, 2010 New England Journal of Medicine, my colleagues and I published data from a randomized controlled trial in which we tested a primary care intervention called TEAMcare. In this intervention, nurses worked together with patients and healthcare teams to manage care using evidence-based guidelines for both depression and physical diseases together. The TEAMcare intervention involved having nurse care managers coach patients, monitor disease control and depression, and work with patients’ primary care physicians (PCPs) to make changes in medications and lifestyle when treatment goals were not reached. Nurses were supervised weekly by psychiatrists and PCPs who made recommendations about medication changes that nurses then communicated to patients’ PCPs. “Patients who received the TEAMcare intervention were significantly less depressed, and also had improvements in blood glucose, LDL cholesterol, and systolic blood pressure levels.” Working collaboratively, nurses and patients set realistic step-by-step goals for reducing depression as well as blood glucose, blood pressure, and cholesterol levels. To reach the goals set forth in the TEAMcare intervention, nurses regularly monitored patients’ mental and physical health and offered recommendations to patients’ PCPs...
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