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Health Care at the Right Time and Right Place

Have you visited home lately – your medical home, that is? 

If you have seen your primary care provider (PCP) recently, then yes, you most likely have been to your medical home.  After all, your PCP is where you go to receive most of your health care needs, which is one of the key attributes of a medical home. 


The PCP is usually a family medicine physician or internal medicine physician, although obstetricians and gynecologists often serve as a PCP for their patients, just as pediatricians do for children.  In some cases, a Physician Assistant (PA) or Advanced Practice Nurse Practitioner (APRN) serve as a PCP.  PAs and APRNs see patients, diagnose and treat illnesses and prescribe medication, under the supervision of a physician.  

Of course, there are several health care options in addition to your PCP: urgent care clinics, free-standing emergency rooms and hospitals.  These facilities can be valuable resources, but it is important that patients 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 any patient can do for his or her health. 

The Medical Home

As explained above, the medical home is where you go for the majority of health care needs, including checkups, screenings and treatment for illness or injury.  There are several other factors that go into the establishment of a medical home, or as it is officially known, a Patient Centered Medical Home (PCMH). 

The Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services defines a PCMH as “not simply a place but as a model of the organization of primary care that delivers the core functions of primary health care.”   AHRQ identifies five functions and characteristics of the medical home:

  1. Comprehensive Care: A PCMH can deliver 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 – in addition to chronic care, the treatment of long-term or permanent conditions, are part of comprehensive care. 
  2. 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 in a way the patient is comfortable and with sensitivity to the patient’s culture, values and unique needs. 
  3. Coordinated Care: The PCMH coordinates all health care services for the patient, including specialty care, hospitalization and home health.  There is also an emphasis on communications between patients and their families. 
  4. Accessible Services:  A PCMH 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. 
  5. Quality and Safety:  Patient safety and high-quality care are core focuses for a PCMH.  The practice of evidence-based medicine and a focus on population health by tracking and analyzing patient data are essential. 

These core characteristics of a PCHM are well-integrated within the providers of Privia Medical Group North Texas (PMGNTX).  PMGNTX focuses on proactive team-based and evidence-based care, utilizing the latest technologies and advancements in medicine.  Having a medical home should mean something, and that’s why the patient is always the central focus and can expect unhurried, comprehensive visits that allow the time necessary to develop an individualized care plan. 

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, what’s the best option when unexpected medical needs arise? 

To answer that question, we first need to consider what constitutes a medical 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 of 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.  

Drive or Call 911? 
If you’re not sure the answer to this question, it’s best to call 911.  There are a few reasons why.
In most areas of North Texas, Emergency Medical Technicians (EMTs) will arrive quickly.  If the patient is in an emergency situation, the EMTs can often stabilize the patient.  They will also record vital signs, like blood pressure and blood oxygen levels.

If the patient definitely needs to go to the hospital, the EMTs will begin and 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.  In the patient 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. 

In rural areas where it may take a long time for EMTs to arrive, it may be better and faster for someone to drive the patient to the hospital.   

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 decade or so.  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 less of a 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 simply 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. 

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 the 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. 

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 and establish your medical home 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

American College of Emergency Physicians

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