Primary care today: Putting patients first

As technological and other changes in American society have sparked innovation across the healthcare field, primary care has kept pace, continually adapting to best respond to patient and community needs. The typical primary care practice today follows a consumer-driven model, offering enhanced convenience and transparency with a greater emphasis on prevention. It’s an approach that has the potential to benefit all patients, regardless of their age, and one that Dartmouth-Hitchcock primary care providers have wholeheartedly embraced.

An aging population, combined with a surge in the number of insured patients and deductible insurance plans that can make specialty care unaffordable even for patients who have insurance, has led patients to increasingly seek services from primary care providers. With 30 outpatient Dartmouth-Hitchcock clinic locations throughout southern and northern New Hampshire, and many Dartmouth-Hitchcock providers accepting new patients, Granite Staters have access to quality care close to home.

In addition, patients who receive care today benefit from the knowledge of a group of providers, rather than just an individual doctor, and “there is a focus on prevention regardless of what the visit is for,” says Lora Council, MD, MPH, a family practice physician at Dartmouth-Hitchcock Nashua. For example, the medical assistant who rooms the patient and in the past might simply have gathered a quick set of vitals will now often discuss the provider’s recommended preventive care with the patient, and review the patient’s record to ensure the patient is up-to-date on needed immunizations or screening procedures such as colonoscopies or mammograms.

And at Dartmouth-Hitchock, patient records are electronic, enabling seamless care and greater accuracy. In the primary care setting, “computers help the provider give the best care,” Council says. Twenty years ago, she says, care providers relied on paper notes and memory to keep track of everything that needed to be done for each patient, but now computers help track that ever expanding set of information, along with the best, most current evidence regarding treatments.

Electronic records keep patients as well as providers in sync and informed. Dartmouth-Hitchcock enables patients to log on to a portal to see their doctor’s visit notes, and email their doctor’s office with questions. “It really makes a big difference,” Council says. “It’s another way to engage patients.” Giving patients access to their doctor’s notes means patients have a handy reminder of appointment specifics, enabling them to review important details and advice from their provider so that they do not have to try to recall everything the doctor said during the appointment.

And for providers, state-of-the-art electronic records make up-to-the minute patient information accessible at the touch of the button. “When we see somebody in our system,” Council says, “we have access to all their records, so I can see what the specialist did, or if I’m in Nashua I can see the bloodwork the patient had done in Manchester, or the x-ray they had up in Lebanon. I can see all that and it’s useful for the clinician.” Information for groups of patients can be compiled and warehoused to enable doctors “to look at the whole population and figure out the population’s needs,” Council adds, and primary care practices can use electronic registries to track chronic and follow-up care that patients need, making it easier for providers to contact patients and schedule appointments. “We’re able to be more proactive than we used to be,” Council notes.

And in contrast to the past, when patient and doctor would typically go their separate ways after a visit and “it was pretty much up to the patient to do what the doctor recommended or not,” Council says, now there is often more post-appointment support. A diabetic patient might join a support group to learn diabetes-management tips, for example, and an overweight patient can enroll in a hospital-sponsored weight-loss class. Patients with complex medical needs might receive follow-up calls from a nurse, or information from a nurse who acts as their care coordinator. “Patients can really form a relationship with that nurse in addition to their provider,” Council says, and the nurse can provide valuable assistance in navigating the sometimes confusing world of healthcare.

Dartmouth-Hitchcock also offers progressive “telehealth” care options in addition to in-person visits, which provide convenience for patients and ease patient access to expert care. A patient with sinusitis symptoms, for example, might complete an online questionnaire that asks questions typically covered during an initial face-to-face visit, such as: How many days have you been sick? Do you have a fever? Are you vomiting? Do you have any pain? A qualified care team member — perhaps a physician’s assistant or nurse — can review the information gathered through the questionnaire and determine the next course of action. Perhaps a visit will be in order, perhaps detailed self-care advice will be provided, or the patient might be advised to take prescription medication, which the primary care office can electronically and immediately order from the patient’s preferred pharmacy.

Primary care providers at Dartmouth-Hitchcock can also offer e-consults, which enable providers in some instances to electronically forward a thorough patient history and lab imaging to a specialist rather than send the patient to the specialist. “The specialist can recommend ways to manage the condition or what to do next and [can say] whether they even need to see the patient,” Council explains, potentially saving the patient from a long drive to the specialist and the cost of an in-person visit.

Fortunately, the growing number of people seeking primary care has led to more and better prevention; health problems can be noticed and acted upon early. “There’s pretty good evidence that the more primary care there is for a given population,” Council says, “the less utilization of healthcare resources there is,” saving everyone in the community money and time. “Even mortality is affected,” she adds, as increased access to care saves lives.

Amidst an ever-evolving primary care experience, however, some things remain constant, such as the patient’s relationship with the provider and the rest of the primary care team. Today’s increased patient access to an integrated group of care providers means that when a patient comes in for care, he or she may see a primary care physician, but the patient and clinician may collectively decide that for this patient's optimal medical needs, he or she needs to see other members of the team, such as a behavioral health specialist. The primary care clinician will always be involved with a patient's care, but in some circumstances will play the role of the quarterback, directing the expertise of the entire care team to meet the patient's needs at that time.

To find a primary care provider at Dartmouth-Hitchcock, call 1-800-653-0776 or visit https://www.dartmouth-hitchcock.org/imagine/primary-care.html.

Categories: Features