Hypertensive patients' specialty use changed with medical home

February 3, 2014

Group Health studied how patients with treated hypertension used outpatient specialty care before, during, and after a primary-care redesign (the patient-centered medical home) was spread system-wide. David T. Liss, PhD, now a research assistant professor in medicine-general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, led the report in the Journal of General Internal Medicine.

"Redesigning care to a medical home seems to let primary-care teams do more, within their expertise, for their patients," Dr. Liss said. "Our results suggest this can avoid or prevent some specialty visits for patients with stable and a few co-occurring illnesses." He studied more than 36,000 patients with treated hypertension in Group Health's 26 medical centers.

Patients with hypertension and few other conditions had 27-28 percent fewer specialty visits in each of the three years after the medical home started being implemented, compared to beforehand, adjusting for potential confounders and including interaction effects. Those with some other illnesses had 9 percent fewer specialty visits during medical home implementation and 5 percent fewer specialty visits during the following year.

"In contrast, we found very different results for clinically complex patients burdened by multiple diseases in addition to hypertension," said Dr. Liss's coauthor Robert Reid, MD, PhD, a senior investigator at Group Health Research Institute, , and an adjunct professor at the University of Washington (UW) School of Public Health and Community Medicine. For those patients, specialty use was 3 percent and 5 percent higher, respectively, during the first and second years after the medical home was implemented.

"This suggests a need for more effective co-management and better 'handoffs' of complex patients by primary care teams and specialists in the 'medical neighborhood' that surrounds the medical home," Dr. Reid said. "We think new approaches to coordinating care between primary care teams and specialists should give priority to complex patients."

A patient-centered medical home is an increasingly common way to amplify the effects of good primary care: It's like having a family doctor who knows the patients and leads a team of professionals making the most of current knowledge and technology—including e-mail and electronic health records—to deliver first-rate, coordinated and reach out to help stay healthy. Dr. Reid has published evaluations of Group Health's implementation, linking it to emergency room use.

Explore further: Telemedicine service may expand access to acute medical care, study finds

Related Stories

Telemedicine service may expand access to acute medical care, study finds

February 3, 2014
People who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help—including prescriptions—by talking to ...

Guided care provides better quality of care for chronically ill older adults

January 17, 2013
Patients who received Guided Care, a comprehensive form of primary care for older adults with chronic health problems, rated the quality of their care much higher than patients in regular primary care, and used less home ...

Study demonstrates care managers in PCMHs increase improvements in diabetes patients

January 22, 2014
Patient centered medical homes (PCMHs) have been found to be an effective way to help care for patients with chronic diseases such as diabetes. Dr. Robert Gabbay, M.D., Ph.D., FACP, Chief Medical Officer and Senior Vice President ...

A happy patient is well connected to a doctor

November 18, 2013
A new trend in American health care is the patient-centered medical home. The approach revolves around a team of medical and health professionals who, working together, treat an individual, led by a primary-care physician ...

Childhood cancer survivors experience a gap in care

January 24, 2014
A recent study shows that many internists feel ill-equipped to care for adult patients who are childhood cancer survivors. Eugene Suh, MD, assistant professor in the division of Pediatric Hematology & Oncology at Loyola University ...

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.