To Your Health
From coordinated care for the whole family to better fitting shoulder implants, industry advances are helping providers improve patients’ care.
Home sweet medical home
When you know someone’s parents or siblings, doesn’t it help you understand that person better? That’s the thinking at Prairie Clinic in Sauk City, which, since its beginnings in 1956, has worked to provide lifelong care—preventive, acute, chronic and end of life—for families. It’s added internal medicine, obstetrics, gynecology and other services over the years to provide comprehensive care.
“There’s a natural transition from one need to the next; when patients go from pediatrics to internists they can keep the same provider,” says the clinic’s president, Maribeth Baker, M.D. “I might develop a relationship with a woman during her nine months of pregnancy and then watch her baby grow up.”
In some families Baker cares for four generations. “There’s an awful lot I understand about how the families function. It gives a wonderful insight into people and their health—you can’t isolate a person from the family surrounding them,” she reflects.
The clinic embraces advances in technology and technique to help optimize care for families. “Because we’re generalists we can take advantage of a wide range of advances that impact medicine,” says Baker.
Now Prairie Clinic is exploring the patient-centered medical home (PCMH) concept, to see if it could help the clinic adopt further efficiencies. The approach isn’t new, but is now gaining traction as health care providers strive to stem burgeoning costs and enhance health outcomes.
PCMH is a team-based model of care led by a patient’s personal physician, whose practice provides for all of a patient’s health care needs or arranges care with other qualified professionals. “It emphasizes preventive care and coordinating all of a patient’s care from one place,” explains Baker.
That helps ensure all providers are fully informed about the care a patient is receiving, which helps eliminate potential gaps, redundancies or things like harmful interactions between medications. “You work through multiple modalities to provide integrated long-term care and to minimize excess medical care, using physician’s assistants, nurses, home visits and group visits,” Baker says.
PCMH emphasizes communication with providers and patients, which fits with Prairie Clinic’s approach. “The vast majority of what I do in a day as a family physician isn’t at all technological,” says Baker. “It’s sitting face to face and listening to what patients have to say. And that’s as old as the stars.”
When patients do need lab tests or other procedures, Prairie Clinic completes some onsite, including X-ray, ultrasound, electrocardiogram and bone density scans. It sends others to an outside lab. And it refers patients to specialists for care as needed. “We have relationships with other area care groups to make it a smooth transition when patients need that specialty care,” Baker says.
Better shoulder surgeries
Primary care physicians refer many of the patients that are seen at the Meriter Orthopedic Clinic. “When a patient is seen by an orthopedic specialist they may get additional diagnostic imaging to determine whether injections, further therapy or surgery is indicated,” says Amy Franta, M.D., an orthopedic surgeon. “Surgery is always the last option.”
Treating shoulders and elbows accounts for roughly 80 to 90 percent of Franta’s practice. According to the 2008 census of American Academy of Orthopedic Surgeons, shoulder specialists performed twice as many surgical repairs of the shoulder as did general orthopedic surgeons. “Specializing allows you to take a complex field and really understand it,” explains Franta.
Shoulder injuries result from a variety of causes. “Most shoulder problems fall into three categories,” Franta notes. “Disorders of the rotator cuff, or the muscles and tendons around the shoulder, can be a mix of accidental and overuse injuries. Shoulder instability [a loose shoulder joint or a dislocation] is mostly due to trauma. And there’s arthritis-type wear and tear.”
Franta sees rotator cuff problems most frequently. The biggest advance in surgical repair of the rotator cuff and shoulder instability is the switch from open surgeries to minimally invasive arthroscopic procedures. The surgeon inserts a camera through very small incisions to see while examining and repairing an injury. “It’s getting so much better; the results we’re seeing now mimic those we used to see only from open surgeries,” she says.
Arthroscopic procedures can preserve the shoulder’s normal muscle attachments and potentially speed recovery. “In the past, when we did open surgery for instability of the shoulder, we had to detach one of the shoulder muscles in front, and sometimes it wouldn’t heal. Now we don’t have to worry about that muscle healing after surgery,” says Franta.
For patients with arthritis, shoulder replacements have changed significantly. Over the last five to 10 years surgeons have started to use more anatomic implants. “They’re no longer one size fits all, so they better recreate the patient’s anatomy. It helps improve the implants’ long-term functioning,” Franta explains.
Shoulder resurfacing, rather than traditional replacement, is another more recent development. “It preserves more of the bone, which is especially ideal for younger patients that might need future surgery,” says Franta.
Another advance that’s gotten a lot of press is the reverse shoulder replacement. “It’s designed for patients who have torn
their rotator cuffs and have also developed arthritis, which leads to arthropathy—patients lose the ability to raise their arms over their heads,” Franta says. “With this procedure, on the side of the joint where the ball normally would be, we put a socket. On the socket side we put a ball. It changes the biomechanics and lets us give patients, with very little function, the ability to raise their arms.”
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