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Robert Schwartz, MD, is the associate medical director of Dartmouth-Hitchcock, Putnam Physicians and medical director of SVMC Northshire Campus.

Primary Care Offices Offer More Than Ever

By Dr. Robert SchwartzPrint Story | Email Story

As little as five or 10 years ago, you visited your doctor at your primary care office for your yearly physical and when you were ill. You might need to visit three or four other offices to get all of the care you needed.

But times are changing. Many primary care offices are offering patients more types of care more conveniently than ever. Knowing about all of the services your primary care practice offers can help you take better care of yourself and your family.

The shift in primary care started several years ago with the concept of the medical home. When patients first hear the term "medical home," they are often confused. "Do you mean nursing home?" they think. The term "medical home" is actually short for "patient-centered medical home." The distinction was created by the National Committee for Quality Assurance, a private nonprofit that exists to improve the quality of health care. It emphasizes team care with improved communication and coordination among team members. It has been shown to improve the quality of care and patient's satisfaction with their care.

One of the obvious benefits to patients is that more types of care are available under one roof, including access to a nurse case manager, registered dietitian, a diabetes educator, and to a behavioral health or substance abuse counselor, for instance. Rather than having to go to a different office in an unfamiliar location for a nutritional assessment, for example, you can go to your primary care office, where you may be more comfortable. In our area, we also have transitional care nurses who visit patients in their home after being discharged from the hospital.

Just a few years later, more primary care offices have come to recognize that, sometimes, patients need to be seen promptly or without an appointment. As a result, more practices are offering appointment-free care for community members. This is an important service that makes it far easier for people to get the care they need when they need it.

More and more, practices — especially those in small towns located a distance from a population center — are offering even more services. They assign specialists — like orthopedic surgeons, cardiologists and physical therapists — to work one or two days a week in clinics that previously offered primary care alone. Patients who may have needed to drive 30 to 40 minutes to see their cardiologist can now drive just 10 minutes. This also makes it easier for primary care providers and specialists to collaborate in the care of patients.

 And among the most exciting trends is teleHealth, which uses a secure high-definition audio-video link to connect patients to the specialists they need right in their primary care office. Locally, patients are already able to access board-certified emergency medicine physicians from their primary care office via telemedicine. We expect that patients will continue to see increases in the availability of specialists in the primary care setting and may, one day in the near future, be able to avoid traveling even for the most specialized care.

The organizations working to provide health care understand that health is based on being able to get the right care in the right place at the right time. Medical homes, providing additional services, are a great way to accomplish that goal. I encourage you to explore all of the services available through your primary care practice. You may be surprised to find not one provider but a whole team to provide you with the care you need more conveniently than ever.

Robert Schwartz, MD, is the associate medical director of Dartmouth-Hitchcock, Putnam Physicians and medical director of SVMC Northshire Campus. Northshire, along with the rest of SVMC's primary care practices, is an NCQA Patient-Centered Medical Home. SVMC Northshire Campus also provides orthopedics, cardiology, and physical therapy conveniently in Manchester, Vt. To find a primary care provider, call the Southwestern Vermont Medical Center find-a-doctor line at 802-447-5007.





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Protecting Children and Others During a Measles Outbreak

Dr. Marie George

Once a common childhood disease, measles was almost an expected part of growing up. But it wasn't without consequence. Worldwide, up to 2.6 million people died annually from measles every year up until a vaccine was introduced in 1963.

In recent years, some parents have refused to vaccinate their children based on misinformation about side effects of the vaccine.  As a result, the number of unvaccinated children, teens and adults in our communities is on the rise. While those making the choice to not vaccinate believe they're making this decision solely on behalf of themselves or their children, they're actually impacting the health of others. Sometimes with deadly consequences.

How is it spread? Who is at risk?

The measles virus is highly contagious and spreads easily. Spread by close personal contact, coughing, or sneezing, the virus can remain active in the air or on a surface for up to two hours after it has been transmitted.

That means that any unvaccinated individual — including infants and those with compromised immune systems — can get sick when entering a space where an infected person was even hours before. Infected individuals can then go on to spread the illness days before they show any signs of the disease.

How to protect those at risk

Measles vaccines are by far the best possible protection you can give your child. Two doses are 97 percent effective and the potential side effects are rare and not nearly as scary as suggested by a lot of popular media. If they appear at all, side effects are usually a sore arm, a rash, or maybe a slight fever. Claims that the vaccine causes autism have been undeniably proven to be false.

As for when to get your child vaccinated, the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the American Academy of Family Physicians all recommend children receive the measles vaccine at age 12 to 15 months and again at 4 to 6 years old. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

How about adults?

Because the risk of death from measles is higher for adults than it is for children, teens and adults who have not been vaccinated should take steps to protect themselves. "The vaccine can be provided in two doses within 28 days of each other. This is particularly important for those planning travel overseas or to areas in the United States where outbreaks are occurring.

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