New Primary Care Focus Helps Patients Take Better Care of Themselves
By Carolyn M.
March 5, 2013
Starting new behaviors to
improve our health can be a challenge. Too often, our health care
system doesn’t help us learn the skills we need to stay healthy.
Take the example of Alex, a 60-year-old
man who just learned he has Type 2 diabetes.
He must watch his diet and get
regular exercise. He will need to visit his doctor to prevent
problems with his eyes, feet, and kidneys, which can be affected by
this disease. Alex will also need to check his blood sugar levels
and he may need daily pills or shots.
Alex wants to do the right things to
stay healthy. That’s good news, because research shows that people
who are involved in their health care are more likely to feel
But Alex didn’t understand the
instructions for his care until he had to put them into practice
each day. He didn’t ask questions -- or get answers -- for several months.
He didn’t know whom to contact.
This happens often. It’s a major
reason why patients have a hard time managing their health
It’s also why more health care
organizations, especially primary care offices, offer
self-management support programs.
Self-management, or self-care,
programs help patients by --
- Involving the whole care team in
planning, carrying out, and following up on patient visits.
- Planning patient visits that
focus on preventing problems and working to stay healthy, rather
than responding to problems after they occur.
- Working with patients to achieve
their health goals.
- Providing information that is
easy to understand and use.
- Making referrals to
community-based programs to follow an exercise plan, quit
smoking, or take other healthy steps.
- Connecting with patients by
email, phone, text messages, and mailings to help them stay
healthy and achieve their goals.
Self-care support programs are
becoming more popular because they represent some of the key goals
patient-centered medical homes.
A medical home may sound like a house
or building. But it’s actually a national movement to redefine and
improve how primary care services are delivered. Members of a
medical home can include doctors, nurses, social workers,
pharmacists, and physical therapists. Working together, they help
coordinate their patients’ care in health clinics, hospitals, and
Medical homes can make primary care
more accessible, so more health issues can be addressed and managed.
This can reduce the risk that a medical problem will get worse and
require a hospital visit.
A medical home also can help
coordinate other services. For example, Alex may need to a see a
doctor who specializes in diabetes care. The medical team can
arrange the visit, make sure he is prepared, and share test results
with Alex and his care team.
Today, many primary care practices
are putting together the comprehensive services they need to qualify
as a medical home. As of January, nearly 5,200 practices had been
recognized as meeting the
of a medical home.
These developments can be traced to
the Affordable Care Act, which put a high priority on creating
better access and payment for primary care services. As one example,
500 Federal health clinics are part of a
demonstration project that uses medical home principles to
coordinate and improve care for up to 195,000 Medicare patients.
Private insurers also embrace the
medical home model. More than 4 million Blue Cross Blue Shield
members in 39 States are taking part in some version of a
patient-centered medical home initiative, according to
Plugin Software Help). Many other insurers have similar
An excellent short video for patients
on self-management support is available
I’m convinced that self-management
programs and medical homes will help patients like Alex -- and all of
us -- take better care of ourselves.
I’m Dr. Carolyn Clancy, and that’s my
advice on how to navigate the health care system.
Agency for Healthcare
Research and Quality
Self-Management Support: What is
Self-Management Support? (video)
Patient-Centered Medical Home:
What is the PCMH?
National Committee on Quality
Patient-Centered Medical Home
Center for Medicare &
Federally Qualified Health Centers Advanced Primary Care
Patient-Centered Primary Care
Benefits of Implementing the Primary Care Patient-Centered
Introduction to the
Patient-Centered Medical Home
Current as of March 2013
New Primary Care Focus Helps Patients Take Better Care of Themselves. March 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/030513.html