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GreenField Health's Health Matters: November 2006
Note: As GreenField continues to pilot new
technologies to better serve you, we find ourselves on the cutting edge.
Some days this works well, and other days, well…..they don’t call it the
cutting edge for nothing. This newsletter went out via our brand new
electronic delivery system a few days ago to almost a third of our audience
while it was still in draft form. If you’re one of the lucky third, we
apologize, and invite you to read the “real thing” below. We continue to be
humbled by how much we have to learn!
Monthly Matters:
- Announcements
- The
Patient-Centered Medical Home
- Cancer Screening
and Prevention in Men
- Dealing with the
Common Cold
- Office Notes
GreenField’s Health Matters:
November 2006
Announcements
- We’d like to extend a warm welcome to our new Health Coordinators –
Angie Ashburn and Kelly Thomas. Both Angie and Kelly come to us with many
years of experience working as medical assistants, and with a strong
service ethic. We’re delighted to have them as part of the team. This
officially rounds out our team of Health Coordinators, and we want to
thank you once again for your patience with us as we have moved through
this time of transition.
- Holiday giving: If you are looking for a great gift to give someone
this holiday season, consider a gift of health. You can do this by
covering a friend or loved one’s initial Annual Fee to GreenField. It is a
perfect way to encourage someone to sign up with us, or to help someone
stick with those New Year resolutions. You can also sign someone up for
GreenField’s very successful weight management course - “Transformation at
GreenField Health.” This could be the most healthful gift you can provide
this holiday season. Give us a call if you are interested. It is simple
to arrange, and we’d be happy to manage the details for you.
The Patient-Centered Medical Home
GreenField has helped to pioneer a national movement
toward what is being called the “Patient-Centered Medical Home” or the
“Advanced Medical Home." The history of this movement is intimately
intertwined with GreenField’s own history. In 1997, while working at the
Institute for Healthcare Improvement in Boston, Dr. Chuck Kilo started what
was known as the Idealized Design of Clinical Office Practices initiative.
This work, and work by colleagues in Seattle who created the “Chronic Care
Model," established a foundation for the future design of medical practice
that is now embodied within GreenField Health.
While GreenField incorporates the elements of the
Idealized Design initiative, a wide range of challenges continue to exist.
While GreenField uses and has developed an extensive amount of information
technology for example, the tools currently available today remain limited
in their ability to perform several critical functions. In addition, our
ability to create information linkages with other practices, particularly
specialists, is limited making coordination of care less optimal. As an
example of GreenField’s determination however, we are currently working with
partners such as Kryptiq Corporation to solve this problem.
Having said this, we know that our systems at
GreenField are not perfect – far from it in fact. But acknowledging that is
a critical part of our drive to continually push our systems forward to
better serve your needs.
Nonetheless, the experiences of groups such as
GreenField Health, established on top of the foundation created by the
Idealized Design initiative and Chronic Care Model, have now emerged as a
national model for primary care services called the patient-centered, or
advanced, medical home. We are hoping that efforts to promote the attributes
of such GreenField practices will take root nationally over the next few
years.
Many of you, our GreenField customers and patients,
come to our practice because of the services that we provide. Some of you
also come because you realize that you are supporting something that is more
substantive – you come to help support this critical work that we do and the
function that we serve both locally and nationally to push care forward.
What are the attributes
that we work to deliver at GreenField and that characterize the
patient-centered medical home? The three things that we work to deliver to
you, our patients, include deep trustful relationships, impeccable service,
and highly reliable clinical care – relationship, service, and reliability…
that is our mantra.
We believe that optimal
care is provided through continuous, healing relationships with physicians
being partners in coordinating and facilitating care to help patients
navigate the complex and often confusing health care system by providing
guidance, insight and advice in language that is informative and specific to
patients’ needs. This “patient-centeredness” means that our systems are
designed around you, and designed to incorporate your wants and needs into
our care – it is why we work so hard to involve you in our decision-making.
These attributes have been our goal from our inception in 2000. We seek to
provide what is best about both the art and science of medicine –
incorporating both, neglecting neither.
Cancer Screening and Prevention in Men
The development of cancer is one of the most feared
life events. The five most commonly diagnosed non-skin cancers in men are
prostate, lung, colon, bladder, and lymphoma. We can screen for and prevent
some forms of cancer, but not all. Below we list each cancer and discuss
what screening and/or preventive measures are commonly recommended for each.
- Prostate
cancer accounts for 28.6% of cancers in men. No preventive measures are
currently available. Screening for prostate cancer is accomplished by
using both the rectal exam and the prostate specific antigen (PSA). There
is still a substantial debate as to whether active screening actually
leads to better health outcomes for men with prostate cancer. In other
words, there is still a sparse amount of data showing that picking
prostate cancer up early helps to improve either the quality of life or
the life expectancy in those who get it. The rectal exam and PSA are very
helpful in our ability to identify prostate cancer, but the success of
available treatment modalities remains limited. Prostate cancer screening,
for those who desire it, should begin at age 50. For those who are at a
higher risk such as men with a family history of prostate cancer or
African-American men, screening can begin at age 45.
-
Lung cancer accounts for
16.3% of cancer in men. While sporadic lung cancer does exist (e.g.,
lung cancer not related to cigarette smoking), the vast majority of lung
cancer is caused by smoking. If you are a smoker and are able to quit,
your risk of lung cancer goes down slowly over the subsequent years. After
about 15 years of being a non smoker, your risk is approximately equal to
that of the general population. No successful screening tests have yet
been found for the early detection of lung cancer. For example, routine
chest x-rays or CT scans in smokers have not led to improved outcomes of
lung cancer, although approaches to screening for lung cancer in high risk
individuals continue to be investigated.
- Colon and
rectal cancer account for 11.7% of cancer in men. Colonoscopy is the
primary method of colon cancer screening, although sigmoidoscopy combined
with yearly stool blood testing is also an effective way to detect and
remove early cancers and pre-cancers of the colon. Screening should begin
at age 50 although those with a strong family history of colon cancer or
polyps should be screened earlier. Cigarette smoking and alcohol also
seems to increase the risk of colon cancer. Studies have shown that a diet
high in fruits and vegetables, and regular exercise may also prevent colon
cancer.
- Bladder
cancer accounts for 6.6% of cancer in men. No screening or preventive
measures have been identified.
-
Non-Hodgkin's Lymphoma
accounts for 4.2% of cancer in men. No screening or preventive measures
have been identified.
-
Skin cancer is also
quite common in men with the primary risk being long term sun exposure.
The most common forms of skin cancer – squamous cell and basal cell skin
cancers – are rarely dangerous because they generally grow locally and are
very slow to spread to other areas unless completely ignored. Melanoma is
the most dangerous form of skin cancer as it can spread quite early to
other locations (this is called metastasize) and cause death. Fortunately,
melanoma is rare whereas sqamous and basal cell cancers are common.
Screening includes a yearly skin exam by a physician and diligence on each
individual’s part if you see something on your skin that doesn’t look
normal. Things to look out for are moles that seem to be new or growing or
that change color. Anything on the skin that continues to change should be
examined, as should chronically scaling skin lesions. Skin cancer can be
prevented by avoiding sun exposure by wearing a hat when outdoors and
using sun screen.
Dealing with the Common Cold
Cold season is rapidly
approaching. We have already begun to see increasing numbers coming in with
nasty and unpleasant colds. Colds, also called upper respiratory infections
(URI's), are infections of the nose, sinuses, and bronchial trees. Most of
these are caused by viruses that are spread when someone with the virus
touches their nose, mouth or eye and then touches your hand and you then
touch your nose, mouth or eye.
Common symptoms include body
aches, fatigue, sneezing, stuffy nose and other nasal symptoms, sinus
pressure, post-nasal drip, sore throat, and cough. The viruses that cause
the common cold cannot be easily identified or treated, but they go away on
their own. We all experience them and they can be a nuisance for up to 3-4
weeks.
The best treatment is what we call
"symptomatic" treatment. Take Tylenol, Advil, Motrin, or Aleve for the aches
and pains, decongestants such as pseudoephedrine (Sudafed) for the stuffy
nose, and an expectorant like guaifenesin for the cough. Do not take
pseudoephedrine or other decongestants if you have high blood pressure
unless your blood pressure is well controlled and you monitor it closely
during treatment. In addition, don't think that you have to stop exercising
when you get a cold. Exercise is still one of the best things that you can
do....some of us believe that exercise helps resolve these infections more
rapidly (in addition to helping prevent them in the first place). URI’s
rarely need to be treated with antibiotics, as antibiotics are not effective
against viruses.
As stated, there is no cure for the
common cold. Medicine can only make your symptoms less bothersome until your
body can fight off the virus. Here are some tips to help you feel better
when you have a cold:
-
Drink plenty of liquids like water,
fruit juices and clear soups.
-
Don't drink alcohol.
-
Gargle with warm salt water a few
times a day to relieve a sore throat. Throat sprays or lozenges may also
help relieve the pain.
-
Use salt water (saline) nose drops to
help loosen mucus and moisten the tender skin in your nose.
-
Don't smoke and avoid secondhand
smoke.
-
Many cold medicines are available
over-the-counter. The chart below will help you understand how to best use
the over-the-counter (OTC) medicines to treat your cold symptoms.
|
Day of
Onset |
Symptom |
Medicine to Use |
|
1 |
Fatigue, mild sore throat |
Pain medications which also help control fevers such as
acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs such as
ibuprofen (Advil, Motrin) or naproxen (Naprosyn, Aleve) |
|
2 |
Runny nose |
Antihistamines such as diphenhydramine (Benadryl) or
chlorpheniramine (Chlor-Trimeton) |
|
3 |
"Stopped up" nose |
Decongestants such as pseudoephedrine (Sudafed) or
phenylephrine (Sudafed PE) |
|
4 |
Dry Cough |
Cough medications containing dextromethorphan (Drixoral,
Robitussin) |
|
5&6 |
Moist, productive cough |
Expectorants containing guaifenesin (Guiatuss,
Robitussin) |
|
7 |
Voice "breaks or disappears altogether |
No medicine will help your voice come back sooner.
Resting your voice is the only thing that will help. |
|
8-21 |
Nasal congestion and cough slowly resolve |
Continue
using the medications noted above as needed to control symptoms.
Antibiotics are not helpful and do not shorten the course of symptoms.
|
When should
you seek medical attention for an upper respiratory infection? Antibiotics
may be indicated in the treatment of acute bacterial sinusitis, which can
sometimes occur in the setting of a URI. However, the diagnosis of bacterial
sinusitis is not simple. Some believe that the appearance of a thick or
colored nasal discharge indicates a progression to bacterial sinusitis and
requires treatment with antibiotics. This is not the case. Discolored nasal
discharge is a normal, self-limited phase of the common cold, and does not
necessarily indicate the presence of bacterial infection. More worrisome
signs of bacterial sinusitis include severe sinus congestion longer than 10
days after the onset of a cold, localized sinus pain, upper tooth pain and
fever.
Cough is a
common symptom seen in a viral URI, but is also seen in bacterial pneumonia.
Fever is a relatively unusual sign in acute bronchitis and, when
accompanying a cough, suggests either influenza or pneumonia. Patients with
cough, fever, shortness of breath and sputum production may have a bacterial
pneumonia and thus may benefit from examination and antibiotic treatment.
This is particularly the case if the person has a chronic lung condition
such as asthma or emphysema. In these cases, please give us a call to
schedule a visit.
Office Notes
Holiday closures
– our office will be closed Thursday, November 23 in observance of the
Thanksgiving holiday. We will be open from 9:00AM – 1:00PM on Friday,
November 24 for acute visits and shopping-induced injuries. We will be
closed Monday, December 25 in observance of the Christmas holiday, and
Monday, January 1, 2007 in observance of New Years Day. As always, one our
physicians will be on call for any urgent or emergent needs you may have.
Please do not hesitate to call the office in that event.
We have flu shots
– as we’ve mentioned in our previous Health Matters, flu shots are here.
Please give us a call when you’re ready to come by for one, and we’ll be
sure to have it ready for you. (Along with that cup of coffee.) Please
also give us a call or drop us an email if you’ve gotten your flu shot
elsewhere – we’d like to document that in your chart.
We’re getting up to speed
– we are delighted to welcome all of our new Health Coordinators – Amanda,
Angie and Kelly. We also want to thank Tiana and Lindy for their hard work
over the past couple of months as they have supported the entire practice
while we’ve been in transition. We are very happy with our new team, and
again, want to reiterate our thanks to you for your patience as we’re all
getting up to speed.
We’re thankful to have you as
patients – as we enter the holiday season, we
always take a moment to stop and reflect on the blessings we have in our
lives, and this includes having you all as patients and colleagues. We wish
you and your loved ones a blessed and peaceful holiday season.
Sincerely,
Your GreenField Health Team:
Amanda
Clark, MA, your Health Coordinator (email)
Angie Ashburn, CMA, your Health Coordinator
(email)
Beth
Davis, your Benefits Coordinator and Biller
(email)
Chuck Kilo, MD
(email)
Cynthia Ferrier, MD
(email)
David Shute, MD (email)
Elizabeth Hays, MD
(email)
Eric Murray, MD
(email)
Heidi Downey, your Consultant (email)
Jill Arena, your Clinic Administrator
(email)
Joel Swartzmiller, your IT Manager
(email)
Kelly Thomas, CMA, your Health Coordinator
(email)
Lea
Robinson, Administrative Assistant (email)
Lindy Thornbloom, your Health Coordinator (email)
Paula Koeller,
MD (email)
Shelly Banta, your Clinic Manager (email)
Tiana Schmitt, MA, your Health Coordinator (email)
---------------------------
GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503.292.9560
Fax: 503.292.9510
Web:
http://www.greenfieldhealth.com
questions, concerns, comments appreciated:
questions@greenfieldhealth.com
© 2003-2006 GreenField Health
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