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Patient-Centered Medical Home

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It takes a village in Manhattan

village

Dr. Fred N. Pelzman, internist, writes in MedPage Today about trying to replicate some of the virtues of small-t0wn America in an urban setting to make the patient-centered medical home concept work.

”We seem to have plenty of doctors, plenty of nurse practitioners, plenty of nurses, plenty of medical technicians….  but they need more care coordinat0rs.”

”{F}or our 1,000 highest-risk, most complicated patients that need care coordination, it seems like they live in 1,000 different neighborhoods, and so the daunting process arises of building up a network of support in each of these different places.”

”{W}hat we need in each person’s neighborhood are those smaller, more individualized, high-touch resources that are much more likely to do good for the patient than whatever we do for them in the office. It could be a local community center, a place where the patient can go and spend time during the day, a place to get a healthy meal, a low-cost gym or a group that they can begin to exercise with, a pharmacist who knows them, or a support network of people who can keep an eye on them.”

”Without this, the patient-centered medical home is doomed to failure…”

 


Home, sweet PCMH

sweethome

The American Journal of Managed Care  last month  published the results of a  pilot study about a patient-centered medical home (PCMH) in a busy and urban primary-care practice that showed better patient outcomes and without workflow disruptions.

Medical Economics says the study found providers and patients both liked the practice, which showed such nice outcomes as  increased life expectancy (12 months versus 6.7 months for those in the control group) and  greater success in stop-smoking efforts.

”The study’s authors say the program was beneficial and not difficult to implement, despite fears over the length of time office visits in the PCMH would require.”

Less happily —  and in a contradiction”? —   the study’s authors said that  “It is increasingly appreciated that while primary care should become more personalized and patient-centered, time constraints may oppose these goals.”

”The study notes that clinic staff can obtain vital signs and conduct routine interviewing, while another team member can resolve appointment and logistical issues, resulting in a 60-minute visit  {for a patient} divided between four or five different roles within the clinic.”


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