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Thursday Apr 02, 2015

Rx for Success: PBS Film Shines Light on Health Care Triumphs

I recently watched a documentary that put a song in my heart and left me inspired by people who decided to take control and make a difference in the world around them -- for their patients, their teams and their communities. I heard stories of family physicians doing what we do best, despite the many hurdles we all face in a fragmented system. I want you to see what is possible.

David Loxterkamp, M.D., is the son of a physician. For two decades, he was a small-town, small-practice family physician much like his father, a general practitioner, had been. About 10 years ago, however, Loxterkamp decided he needed to make a change.

"I realized medicine is too difficult to do it alone," he said. "This is a really hard, emotionally draining job. You really need someone else to help you out."

Loxterkamp assembled a team to help him care for his small community in Maine, where he still makes house calls. His practice now includes other physicians, nurses, a psychiatrist, a psychologist, a pharmacist, a physician assistant, a medical assistant and a physical therapist.

It's hard to argue with their results. The practice's ER visits have fallen 40 percent in the past four years. One-third of the patients enrolled in a smoking cessation program have actually quit, and the blood sugar level of patients with previously uncontrolled diabetes has dropped dramatically.

David Grubin also is the son of a general practitioner, but he did not follow in his father's footsteps. Grubin is a filmmaker whose documentary, Rx: The Quiet Revolution, makes its debut tonight in many markets on PBS. Grubin said his father had lost faith in the U.S. health care system by the time he retired. Physicians, his father said, didn't have enough time for their patients, and he didn't know how to change a system that valued volume over quality.

Grubin's father, however, had never met anyone like Loxterkamp, one of the four examples the film provides of physicians and systems that have found a way to succeed in a dysfunctional, fragmented health care system.

The film, which will be repeated in most markets and also can be viewed online(www.rxfilm.org), delivers a powerful message: It is possible to succeed in our flawed, fee-for-service system. Although Loxterkamp practices in a recognized patient-centered medical home, these success stories didn't depend on the kind of incentives often provided in practice transformation pilots.

For example, Grubin visited On Lok, a San Francisco-based program for the elderly(www.onlok.org), that has been around since the 1970s. Like Loxterkamp's practice, On Lok takes a team-based and patient-centered approach to care.

The innovative program provides care and social activities for the elderly during the day yet allows patients to remain in their homes at night. In addition to medical care, the program provides services like grocery shopping and cleaning to patients who likely would otherwise be in a nursing home.

According to the film, patients in the program are less likely to visit ERs and hospitals and are less likely to be readmitted than those who live in nursing homes.

With the number of Americas older than 65 expected to double in the next 20 years, such services could be in high demand in the near future. And this film could help more patients be aware of -- and expect -- high quality, patient-centered care.

Grubin's travels also took him to Alaska, where native Alaskans were so dissatisfied with an Indian Health Service program that relied on emergent care that the community took control of the local hospital and built a new system with a strong primary care foundation. Team-based care is again a central theme in this story as is telemedicine, which the system uses to connect remote communities with physicians and pharmacists.

Teams and telemedicine also play prominent roles in the success of a program in Mississippi, which has the nation's lowest median household income and the highest rate of obesity. The state, which has one of the nation's highest rates of diabetes, is trying to address these health problems with a program that provides patients a tablet-based monitoring program that allows them to provide a blood sample each morning.

The program goes beyond monitoring with physicians, nurses, dieticians, physical therapists and more providing care and counseling. As one patient told the filmmaker, "You need somebody that cares."

Clearly, Grubin has succeeded in finding such people. It is critical to point out again that these practices were created in the setting of a flawed, fee-for-service, volume-driven, fragmented and dispassionate system. Individuals, sometimes a family physician and sometimes another team member, took control of their lives and situations. They made changes, big and small, with the most important one being that they would remember to care. They have reclaimed their joy of practice by embracing the essence of team-based, patient-centered care. And now they have shared their stories in this film.

These stories give us hope and show us what is possible.

Reid Blackwelder, M.D., is Board chair of the AAFP.

Posted at 03:55PM Apr 02, 2015 by Reid Blackwelder, M.D.

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