CHARLESTON AIR FORCE BASE, S.C. –
I recently experienced a minor hidden leak in my car which allowed rain water to seep in.
I took the car to the dealer and they couldn't find the problem. When I took it back a second and third time after they supposedly "fixed" it each time, I had to explain my concerns again to a different service agent; I was exasperated. On the fourth visit, the same service agent who had helped me previously, worked on my car and required no explanation. He took his time with the car, two days in fact. His persistence and knowledge of what had been done previously and what he needed to check next were critical in solving and ultimately fixing the leak. The service agent not only knew my vehicle, but delivered excellent customer service. It was apparent to me vehicle maintenance is just like health care. Service runs most effectively and efficiently when continuity of care is maintained.
In the past 10 years, Air Force health care delivery has become fragmented. Increases in training time and deployments have taken the providers and their support staff out of the clinic more than predicted when the Primary Care Management model was put into place in the '90s. Patients are seeking care that is convenient and at little or no cost. If their provider on base is not available, they are opting to see whoever is available, on or off base, as soon as possible. Many patients are also looking for the quick fix, a pill or elixir which can get them back to their jobs, school or activities as soon as possible. We are too busy to be slowed down by illness.
Unfortunately for all of us, this convenience comes at a cost. Seeing the first available provider can mean disruption in care, duplication of efforts and allows prevention to be overlooked. Documentation of care delivered off base doesn't always make it to the medical record in a timely fashion and sometimes never makes it back to the facility at all. This can cause military health care providers to make decisions about your care without knowing all the facts.
In preparation for the 2010 implementation of the Air Force's new primary care model, the Family Health Initiative and the 437th Medical Group will be taking steps to restore continuity of care for our patients. First, we will be realigning our patient care teams. A listing of 2,500 patients will be shared by two providers, one nurse and five medical technicians. Second, we will be shifting some patients to ensure equal distribution of both the volume and complexity of our patients between our providers. Third, we will be changing our appointment booking rules.
Patients will be offered appointments with their health care team, either the physician, physician's assistant or nurse practitioner. This allows for greater continuity of your care. Your provider team will be able to see a change in your condition because they know you. You and your health care team can develop a long term care plan including preventive measures and screenings for chronic disease.
This partnership between patient and health care team should reduce the number of appointments a patient needs per year. Currently, if a patient calls for an appointment and cannot get in on base, they are given a telephone consult to speak with a nurse. This can take the better part of a day to connect the nurse and the patient, and in most cases, the patient is sent to an urgent care center. The urgent care center will run a battery of tests and often prescribe one or two medications before telling the patient to follow-up with their own provider. The medical group or TRICARE would have then paid approximately $300 for the urgent care visit, plus prescriptions, and the patient still will need a visit with their provider to follow-up. As one can quickly see, this method of doing business is costly and inefficient for both the patient and the military health care system.
Finally, we will add new programs like disease management and a nurse-run clinic. The nurse-run clinic will target active-duty personnel with mild illnesses, such as upper respiratory infections, sore throats and urinary tract infections. This will free the provider appointments up for patients with more serious acute illnesses.
Two nurses will work in conjunction with primary care teams to do disease management. Patients with chronic diseases like asthma, diabetes or high cholesterol will be tracked carefully by these nurses. Disease management nurses will coordinate with these patients for labs, education and specialty appointments on a recurring basis.
When these patients come in to see their provider, all the critical information will be available for the patient and the provider to develop a comprehensive care plan. Meticulous management of these diseases not only eliminates wasted appointments but can drastically improve the health of patients.
Change won't be easy or occur overnight, but it will be an investment with great dividends for both patients and medical staff. We look forward to working with our customers to not only improve service and continuity of care, but ultimately improve their health.