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Caring for Chronic Conditions in Primary Care

Caring for Chronic Conditions in Primary Care
Author Information (click to view)

Jeffrey M. Bullard, MD

Medical Director
MaxHealth Family Medicine

Jeffrey M. Bullard, MD, has indicated to Physician’s Weekly that he has in the past worked as a paid speaker for Lilly and Abbott.

 

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Jeffrey M. Bullard, MD (click to view)

Jeffrey M. Bullard, MD

Medical Director
MaxHealth Family Medicine

Jeffrey M. Bullard, MD, has indicated to Physician’s Weekly that he has in the past worked as a paid speaker for Lilly and Abbott.

 

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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.

ChronicConditions-Callout

 

 

 

 

 

 

 

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 if the offending allergens have been identified. Allergy testing allows us to arm patients with information on what they’re allergic to and what to avoid. For those needing more substantial treatment, allergen immunotherapy addresses the underlying causes, helping reduce symptoms in about 85% of patients. Allergen immunotherapy has also been shown to prevent the development of new allergies and halt the progression of diseases, such as allergic asthma.

Allergy Care: Appropriate Resource Allocation

Increasing access to allergy care within primary care ultimately aligns with healthcare reform goals to deliver higher quality, affordable care to more patients. There are not many board-certified allergists and other allergy specialists, but demand for their services is projected to rise rapidly. By increasing the scope of care within our practice, we can help more patients fight chronic conditions like AR and allergic asthma. Given these benefits, the extent of care provided by PCPs will continue to expand as the healthcare industry evolves.

To learn more about Atrial Fibrillation Awareness Month, go to www.hrsonline.org. The Heart Rhythm Society also offers guides several helpful pocket guides for clinicians managing patients with atrial fibrillation. Two of these guides—“Managing the Patient With Atrial Fibrillation” and “Practical Rate and Rhythm Management of Atrial Fibrillation”—are available as free downloads.  

Readings & Resources (click to view)

Chronic conditions: a challenge for the 21st century. National Academy on an Aging Society. November 1999. Available at: www.agingsociety.org/agingsociety/pdf/chronic.pdf.

Eggleston PA, Butz A, Rand C, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95:518-524.

Polosa R, Al-Delaimy WK, Russo C, et al. Greater risk of incident asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: a retrospective cohort study. Respir Res. 2005;6:153.

Purello-D’Ambrosio F, Gangemi S, Merendino RA, et al. Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not: a retrospective study. Clin Exp Allergy. 2001;31:1295-1302.

Ryan M. Upward trend: what’s to account for the increased prevalence of allergic rhinitis? ENT Today. March 2010. Available at: www.enttoday.org/details/article/588763/Upward_Trend_Whats_to_account_for_the_increased_prevalence_of_allergic_rhinitis.html.

Viswanathan RK, Busse WW. Allergen immunotherapy in allergic respiratory diseases: from mechanisms to meta-analyses.Chest. 2012 May;141:1303-1314.

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