We have a lot of options when it comes to health care. That’s a good thing, but you always want to make sure you have a home – a medical home.
Patients have several health care options in addition to their medical home: urgent care clinics, free-standing emergency rooms and hospitals. These facilities can be valuable resources, but it is important we understand the differences between them and the roles they play. Seeking the right care at the right place and time is one of the most important things we can do for our health.
The Medical Home
We all know the saying, “home is where the heart is.” Your medical home can be described as “where your wellness care is” – it’s not necessarily one physical building, but rather a network of connected health care professionals who are sharing information and working together to keep you healthy.
The head of your medical home is your primary care provider (PCP). The PCP is often a family medicine physician or an internal medicine doctor. Additionally, obstetricians and gynecologists frequently fill the role of PCP for their patients, as do pediatricians. Many PCPs will also have Physician Assistants (PAs) or Advanced Practice Nurse Practitioners (APRNs) working with them, as well.
The medical home is where you go for most health care needs, including checkups, screenings and treatment for illness or injury.
A medical home typically has the following attributes:
- Comprehensive: A medical home provides most of a patient’s health care needs through a team of providers, which could include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, social workers and nutritionists. Comprehensive care includes physical and mental health and focuses not only on “sick care,” but also on prevention and wellness. Acute care, addressing short-term illnesses or injuries, and chronic care, the treatment of long-term or permanent conditions, are part of comprehensive care.
- Patient-Centered: Essentially, this means health care should be about the patient, not the provider. Patient care should be individualized, with an emphasis on communicating so the patient is comfortable, with sensitivity to the patient’s culture, values and unique needs.
- Accessible: A medical home strives to make health care services accessible and convenient for patients. This could include extended office hours in the evenings or on weekends, around-the-clock telephone or online access and short wait times for urgent needs. Virtual appointments have contributed greatly to patient accessibility.
“These core characteristics of a medical home are well-integrated among the doctors of Privia Medical Group North Texas (PMGNTX),” says Dr. James Harvey, a primary care physician in southwest Fort Worth. “At PMGNTX, we focus on proactive team-based and evidence-based care, utilizing technologies and advancements in medicine to provide the best possible care for our patients.”
Medical Homes for Children
Fundamentally, a child’s medical home should be structured similar to that of an adult, but there are a few important nuances. The American Academy of Pediatrics (AAP) defines a pediatric medical home as one with three essential characteristics:
- Medical care should be “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”
- Care should be delivered or overseen by “well-trained physicians who provide primary care” and help facilitate most other aspects of the child’s care.
- The physician must be known to and trusted by the child and the child’s family.
Children may be cared for in multiple settings, including their pediatrician’s office, a community clinic or a school clinic, as long as several attributes of comprehensive care are met. These are some of the most important:
- Partnership with the child’s family
- Clarity: Providing clear, factual information to the family
- Primary care: Including not only treatment for sickness and injury, but preventative care, such as vaccinations, and attention to mental health.
- Continuity: Coordination between all pediatric providers and seamless transition to adult health care.
- Intervention: Interfacing with early intervention initiatives, schools and childcare programs to ensure that the individual needs of the child are met.
- Record-keeping: Maintaining centralized, comprehensive and confidential health records for the child.
Urgent vs. Emergency
Sometimes you may need to see a health care provider and it’s not possible to visit your medical home. Maybe it’s over the weekend or in the evening, or perhaps you are traveling.
With urgent care clinics, free-standing ERs and hospitals to choose from, it is good for patients to understand the best options when unexpected medical needs arise.
It is still always best to call your PCP first – at PMGNTX, our PCP’s phones are answered after hours and on weekends, and we strive to help determine if you need urgent or emergency care. Many times, we can provide reassurance and home care options that will be sufficient until the patient can get into the PCP’s office.
What is an Emergency?
The following is the American College of Emergency Physicians’ list of medical emergency warning signs for adults:
- Bleeding that will not stop
- Breathing problems (difficulty breathing, shortness of breath)
- Change in mental status (such as unusual behavior, confusion, difficulty arousing)
- Chest pain
- Choking
- Coughing up or vomiting blood
- Fainting or loss of consciousness
- Feeling of committing suicide or murder
- Head or spine injury
- Severe or persistent vomiting
- Sudden injury due to a motor vehicle accident, burns or smoke inhalation, near drowning, deep or large wound, or other injuries
- Sudden, severe pain anywhere in the body
- Sudden dizziness, weakness, or change in vision
- Swallowing a poisonous substance
- Severe abdominal pain or pressure
For children, all the above are medical emergencies, as are the following:
- Inability to stand or walk steadily
- Skin or lips that appear blue, purple or gray
- Eating and feeding difficulties
- Fever with change in behavior or severe headache/back & neck stiffness
- Any major change from normal behavior, including:
- Confusion, delirium
- Lack of responsiveness or alertness
- Excessive sleepiness or lethargy
- Irritability
- Seizure
If you or someone around you is experiencing any of the above, call 911 immediately.
Urgent Care Clinics
If your symptoms don’t include anything on the above list, an urgent care clinic may be a convenient and appropriate option for care. These clinics are generally open in the evenings and on weekends. Usually, you don’t have to have an appointment, although some clinics allow you to get on a waiting list over the phone or online. The clinic will notify you when they can see you, reducing the time you spend in the physical waiting room.
Urgent care clinics are a good option for acute situations such as minor injuries or common illnesses, such as the flu or a stomach bug. Most will have the capability to perform lab tests and x-rays. Usually, the provider treating you will be a family medicine doctor, or perhaps a PA or APRN.
If you do find yourself in need of health care services away from your medical home, it’s important to recognize the difference between an urgent care clinic and a free-standing emergency room.
Free-standing Emergency Rooms
Free-standing emergency rooms have popped up all over North Texas in the last 15 years. They’re called “free-standing” because they are not attached to a hospital, although they are often affiliated with a hospital system. Free-standing ERs are open 24/7 and can treat anything you would visit a hospital ER for, from a broken bone to a heart attack. The only exception to this is that they are not equipped to treat trauma patients. Medical trauma is defined as a serious and sudden injury that requires immediate attention.
Given the number of free-standing ERs in our region, you can often get to one faster than you can a hospital and may have a shorter wait once you arrive. On the other hand, if you’re experiencing an event that may require surgery – such as a heart attack that leads to emergency bypass surgery – the free-standing ER will get you stabilized, but then you’ll have to be transported to a hospital anyway. This is one of the reasons it is often best to call 911. Not only can the paramedics begin treating you immediately, they will also transport you to the closest, most appropriate place for care.
There have been instances of people confusing free-standing ERs with urgent care clinics and visiting these facilities for illnesses such as a cold or stomach bug. This can be a costly mistake. Insurance companies will charge a significantly higher co-pay for an ER visit than for an urgent care visit.
Hospital Emergency Rooms
A hospital ER is equipped and prepared for every type of medical emergency – and just like free-standing emergency rooms, that’s what they should be used for. An emergency room in a hospital will have surgeons on hand in the event surgery is needed and of course, they can admit a patient whose condition requires an overnight stay.
The majority of hospitals in North Texas will be in most major insurance plans’ networks. It’s a good idea to review your insurance plan and make sure the hospitals closest to your home and workplace are in your network in case you ever need to visit one. But if it’s a medical emergency, don’t worry about any of that – get to the closest facility you can, as quickly as possible.
It’s An Emergency: Drive or Call 911?
It is almost always better to call 911. Here’s why:
First off, if you are experiencing a medical emergency, you should never drive yourself.
But even if you would be driving the patient, it’s still usually better to call 911.
In most areas of North Texas, Emergency Medical Technicians (EMTs) will arrive quickly. If the patient is in an emergency situation, EMTs can often stabilize him or her. They will also record vital signs, like blood pressure and blood oxygen levels.
If the patient needs to go to the hospital, the EMTs will continue treatment in the ambulance en route. This valuable use of time is especially important if the patient is suspected of having a heart attack or stroke. If the person has sustained a head or back injury, the EMTs will be able to securely transport the patient, lessening the odds of worsening the injury on the way to the ER. The EMTs can communicate with the hospital staff en route and let them know to be prepared for the patient’s specific needs. And of course, the ambulance is equipped with lights and sirens, allowing it to navigate traffic faster.
If you are in a rural or remote area where it may take a long time for EMTs to arrive, it may be faster for someone to drive the patient to the hospital.
We All Need a Place to Call Home
It’s true what they say – everyone needs a place to call home, and that applies to the world of health care, as well. Having a medical home means you’ll not only get the treatment you need when you are ill, but you will also have a team of professionals working to keep you healthy. You’ll establish a relationship with a primary care provider and have a trusted resource to turn to when you have questions about your health and need someone to talk to about how you’re doing.
And while your medical home is the place to turn to for the great majority of your health needs, it’s a good idea to know the options close to your home for urgent care and emergencies, should the need arise.
“Having a medical home should mean something, and that’s why at Privia Medical Group North Texas, the patient is always the central focus and can expect unhurried, comprehensive visits that allow the time necessary to develop an individualized care plan,” says Dr. Harvey.
If you do not currently have a medical home, check out our list of primary care providers, located throughout North Texas. Several are accepting new patients – get in touch with one of them today.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
U.S. National Library of Medicine, National Institutes of Health
