Integrating Heart Health into Health Care

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Usually, people only come to see primary care doctors, such as ourselves, when they’re sick.

By Capt. Michael Danforth, DO, Medical Director, Directorate for Branch Clinics, and Cmdr. Sunny Ramchandani, Medical Director, Directorate for Health Care Business, Naval Medical Center San Diego

We have to stop meeting like this.

This probably isn’t something you’d normally hear your doctor say, but maybe should be. Usually, people only come to see primary care doctors, such as ourselves, when they’re sick. We help manage your chronic conditions and send you on your way. Many times, we don’t see you again until you come back with a new illness or a recurrence of the condition we already treated you for.

What patients do when they leave the clinic isn’t something that many providers put a lot of time into. But maybe we should. For patients at risk of developing heart disease, what happens outside of the clinic might be even more important than what happens within. A healthy diet, a regular exercise pattern, and a tobacco-free lifestyle can all do wonders to avert a heart attack or a stroke. In fact, if doctors could write prescriptions for these three behaviors, they would be prescribed for almost everyone.  Here’s why:

The key risk factors for heart disease – high blood pressure, high LDL cholesterol, and smoking – are found in almost half of all Americans – Half! Many years of research has taught us that atherosclerosis and hypertension, two conditions that can lead to a heart attack or stroke, are progressive. These conditions can develop in childhood or adolescence, and worsen with poor nutrition, lack of physical activity, or tobacco use. But that doesn’t have to happen.

What if we could prevent the onset of heart disease by treating our patients, not just their condition, in a way that helps them better manage their personal health behaviors after they leave our office?

Although heart disease risk factors can often be managed with medications or medical procedures, simple lifestyle changes still remain as some of the best remedies. Reducing blood cholesterol and blood pressure levels with a healthy diet, adequate exercise, and quitting smoking can have a significant impact preventing heart disease.

But as we all know patients don’t live in their doctor’s office. So how can the health care system help people enhance their health behaviors to prevent heart disease? How can we help motivate others to walk more or add a few extra servings of fruits and vegetables to their diet? It might begin with changing the way we view health care as a whole.

The current model where patients come to their doctors with an acute illness or exacerbated symptoms from a chronic condition is a reactive way of caring for patients. Typically, providers don’t worry about patients until they’re sick – when they have multiple office visits, end up in the emergency department, or get admitted to the hospital. By the time this happens, our patients often have cardiovascular disease and could be well on their way to having a heart attack or a stroke.

We have to stop meeting our patients like this. There is a better way.

What if we practiced medicine more proactively? What if we could prevent the onset of heart disease by treating our patients, not just their condition, in a way that helps them better manage their personal health behaviors after they leave our offices? Well, we can.

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The current model where patients come to their doctors with an acute illness or exacerbated symptoms from a chronic condition is a reactive way of caring for patients.

At Naval Medical Center San Diego (NMCSD), we are implementing population health strategies to move our patients from health care to health. But what is population health? It’s a way of helping an entire population by identifying certain conditions and disease risk factors in specific groups, and then working with those patients to improve their overall health. Population health moves us away from a “one-size fits all” approach and towards a better way of providing both wellness and health care services to patients. Our goal is to fully engage our primary care teams, integrate community health and wellness resources into patient care, and empower patients to make health and wellness part of their everyday life.

For our patients – active duty service members, retirees, and their family members – there are already a multitude of free or low-cost resources available to them in the communities where they live. Organizations like Navy Morale, Welfare, and Recreation (MWR) and Marine Corps Community Services (MCCS) are great examples. From state-of-the-art fitness centers to tobacco cessation and nutrition courses, the tools our patients need to improve their health are already an integral part of our military communities. It’s time that we, as health care providers, start taking full advantage of every resource at our disposal to create a culture of health. That’s where population health comes in – as a bridge to connect providers, patients, and resources.

Here in San Diego, we’ve developed an online portal that our primary care teams and patients can use to easily find health and wellness resources in the local community. The portal is a database of services on and off base that can be searched by condition or location. Just as a provider would write a prescription for a medication to help manage a patient’s hypertension, they can now also “prescribe” a healthy cooking class, a tobacco cessation program, or even yoga to help with stress management.

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In San Diego, we’ve developed an online portal that our primary care teams and patients can use to easily find health and wellness resources in the local community.

Another powerful tool that allows us to connect with our patients is through our online communication portal (currently powered by RelayHealth). This two-way communication system enables patients to reach out to their providers with questions and concerns, request lab results, and receive educational information. It also allows primary care teams to reach out to individual patients to help them better manage their health and share important disease prevention information.

As health care providers and part of the Navy Medicine team, we want to do everything we can to help our patients prevent disease and promote wellness. By using population health strategies, RelayHealth, and our online community service portal, we can help provide our patients with the resources they need to move from health care to health. Seeing providers like us in the clinic is a great start, but it’s just one step in the journey. Our hope is to see our patients out in the community enjoying healthy, vibrant lives.