Practice Improvement

In an ongoing effort to improve the care we give our patients and their families, Cary Pediatrics is engaged in a number of projects to look at our practice. Some of these involve our clinical decision making and following clinical guidelines, and some with patient satisfaction.

What have we learned?

Staying on schedule

We are pleased that patients are happy with our practice, and would refer others to see us. But we have heard that our biggest barrier is time waiting in the office to be seen. We have worked with our scheduling staff to ensure that appointments that are made have enough time to discuss the concerns the parents have. We are also working on streamlining the use of our EHR to expedite orders and the gathering of information. We also could use your help: when you call to make an appointment, either a sick visit or a checkup, if you have specific questions or concerns that may require a prolonged visit with your provider, please let us know beforehand, so we can budget time, and be able to give your child as much time as they need, and help keep us on schedule.

Building relationships with a primary provider to address special needs

We also learned that we are doing a good job with having patients with special health care needs see their primary provider, to ensure consistency and continuity of care. But we also see that we can do better. We have highlighted in our scheduling programs and in our EHR a primary provider for patients with special needs. In this way, we should be able to do even better maintaining that important relationship. Below, blue means a patient saw their primary provider.

We are proud that all three of our office are performing similarly, showing we are all on the “same page” in our approach to our patients.

How are we performing?

When you are seeing your provider, you might also hear us mention things like “it is recommended that…” or “guidelines or the American Academy of Pediatrics suggest…” We do our best identifying areas of our practice that have been identified by national agencies as areas of emphasis to improve care, both in the short term and in the long term.

Examples in the past year or two include: following industry standards in vision screening in younger children; cholesterol screening in school-aged children; immunizing children, especially those with asthma against influenza; maintaining appropriate appointment schedules for children on chronic medications; tracking newborn screening to ensure complete results; keeping kids on schedule for their yearly checkups.

We also try to review the medications that we are prescribing. For example we know that cost is very important to parents when it comes to medical care. We also know that generic medications tend to cost less than brand name medications. Unfortunately prescribing generic medications is not always possible, but we want to keep the percentage of generic medications as high as possible while prescribing the best and most effective medications for the patients. Below is the percent of brand name medications we have prescribed for the month of September the past two years.

Continuously Improving

We strive to continuously improve our practice by reviewing current literature and practicing evidence based medicine.  The providers meet frequently throughout the year to discuss the latest literature to ensure that we are all practicing up to date medicine.

We also actively seek feedback from our patients at regular intervals.  Formally, we will send out surveys via email after visits for our patients to give us feedback.  Our questions on the surveys will change depending on our goals, but mostly involve making sure you were satisfied with all aspects of your visit from making the appointment, to your time with your nurse, and the time with you spent with the provider.  We use this feedback to make changes in our workflow and procedures.  Listening to our patients is one of our most important goals, so that we can provide the best care and service to our patients.

Patient Centered Medical Home (PCMH)

Cary Pediatric Center is proud to announce that in June 2017 it was recognized by the NCQA Patient-Centered Medical Home (PCMH) 2014 Program. What does this mean, and what does it mean for you as our patient?

What is a Patient Centered Medical Home?

The patient centered medical home (PCMH) is a promising model for transforming the organization and delivery of primary care. It means that you will be surrounded by a dedicated team of health professionals, working together with you, to optimize your health goals using the best evidence-based medicine and resources available for you today. Helping and empowering you to take responsibility for your health and giving you the self-management support that you need to succeed.

As your primary care provider/team we will:

• Learn about your child, your family, life situation, and health goals and preferences.  Our team will recall your health history every time you seek care and will suggest treatments that make sense for you.
• Take care of any short-term illness, long-term chronic disease, and you or your child’s all around well-being.
• Keep you or your child up-to-date on all vaccines and preventative screening tests.
• Connect you or your child with other members of your care teams (specialists, health coaches, etc.) and coordinate care with them as you or your child’s health needs change.
• Find appropriate behavioral help as needed (including specialists, support groups etc.)
• Be available to you or your child, after hours, for urgent medical needs.  Our regular business hours are: Monday through Friday 9 am – 5 pm in all three offices and Saturday 9 am – 12 pm in the Cary office only.  Should you require medical care outside of these hours, urgent needs can be directed our nurse triage through WakeMed One Call Nurse Line.  They can be reached by calling any of our regular office phone numbers.
• Notify you of test results in a timely manner.
• Communicate clearly so that all conditions and options are well-understood.
• Listen to your questions and feelings.  We will respond promptly to you, and your calls, in a way you understand.
• Help you make the best decisions for your care.
• Give you information about classes, support groups, or other services that can help you learn more about your condition and stay healthy.
• Help you understand your insurance options, should you be uninsured – all children deserve equal care to stay healthy, please contact our billing department in the Cary office for more information.

We trust you, as our patient, to:

• Know that you are a full partner with us in your care.
• When you join our practice, you will provide us with a complete medical history and inform us if you obtained care outside of the practice.  Upon your first visit, we will have you complete new patient forms so that we may obtain all previous records you or your child may have.  Should you have any questions about this process, please contact the Front Office Supervisor at any of our locations.
• Come to each visit with updates on medications, dietary supplements, or remedies you are using, and any questions that you may have.
• Keep scheduled appointments or call to reschedule as early as possible.  Scheduled visits cancelled in under 24 hours or “no-shows” will incur a $25.00 fee.
• Understand your health condition and what you can do to stay as healthy as possible.
• Work with us to develop and follow a plan that is best for your health, if you have obstacles in fulfilling this plan, please discuss them fully with our staff.
• Take medications, as prescribed.
• Contact us, after hours, only if your issue cannot wait until the next work day.
• If possible, contact us before going to the emergency room so someone who knows your medical history can care for you.
• Agree that all health care providers in our healthcare team will receive all information related to your healthcare.
• Learn about your health insurance coverage either from your insurer, or, if you have additional questions about billing, you can contact our billing department in the Cary office at 919-467-3211.
• Give us feedback to help us improve our care for you.

Forms

Well Visit Handouts

At each well visit we will provide you with a handout of important information that is specific to your child’s age and development. You will receive a hard copy with their growth documented in the office but you can also download them here in PDF format.

Post-Partum Support

Moms Supporting Moms is a community-based resource, and is a “…peer-led, judgment-free support group for women struggling with issues related to pregnancy, delivery and early motherhood.” As it says very appropriately on their website:

“The adjustment to new parenthood sometimes can be difficult. Irritability, anxiety and even sadness over changes in lifestyle can be expected as parents settle into a new routine of caring for an infant.”

If you or someone you care about is having difficulty adjusting to the changes surrounding motherhood, please reach out during your visit to our office to a provider or nurse, or call for guidance.

They can be reached at 919.454.6946 and can found on the web at Moms Supporting Moms.

Flu Season

With the flu season just around the corner, we have a few things to keep in mind.

First, and most importantly, we recommend that all children 6 months and older receive the flu vaccine. This is the best and most effective way to prevent your children from getting the flu. If you haven’t already, please call one of our offices to schedule a nurse visit to receive the flu vaccine. Bear with us as our supplies of the flu vaccine are changing daily.

Tamiflu

At this time of year, we receive lots of letters from urgent care clinics in the area stating that a child has been diagnosed with the flu and been given Tamiflu, usually appropriately, but sometimes inappropriately. Tamiflu is ONLY indicated in children 2 weeks and older who have been symptomatic for LESS THAN 48 hours. When given in the first 48 hours of the illness, Tamiflu has been shown to reduce symptoms by only 1-2 days. Therefore, do not expect your child to improve immediately after being given Tamiflu.   

After 48 hours, there is no evidence that Tamiflu has been shown to be effective and should’t be given unless your child is critically ill from the flu (meaning your child is in the ICU in the hospital). There are only a few, rare, reasons to give Tamiflu to children who have been exposed to influenza. We can explain those situations to you if this case should arise. 

Just like antibiotics, inappropriate use of Tamiflu can lead to increase in resistance, decreasing the effectiveness of Tamiflu. If you have more questions refer to the CDC web site or call our office.

Safety

Ear Piercing

Several of our providers now provide professional ear piercing for our patients.  We prefer to see children from two to six months, and over 8 years of age. Please call our office if you would like to schedule your child’s first ear piercing with us.

General Childcare

Please maintain regular face-to-face contact with us! No website or reference guide can replace personal professional care for your child.

Adolescent Care

As your child moves from elementary school to middle school, their body and interests change, and our parenting changes along with them. As pediatricians, the way we care for your child changes as well. We assess for risky behavior, counsel on safety and discuss a large number of developmentally appropriate topics.

Adolescent Vaccines

As your child moves to middle school, there will be a number of vaccines that we will discuss and recommend:

• Tdap
  Now required by North Carolina before middle school entry, this protects children against tetanus as well as pertussis, or “whooping cough”
• Varicella
  A second dose of this chicken pox vaccine is recommended before adolescence
• HPV/Gardasil
  Protecting against a family of viruses that causes genital warts has also been shown to greatly reduce a young woman’s chance of getting cervical cancer. It is a two dose series if given before age 14. If a patient gets their first dose at 15 or older, they will get three doses.
• Menactra
  This meningitis vaccine is becoming a required vaccine for college entry. Patients get their first dose in 7th grade and a booster before their senior year in high school.
• Hepatitis A
  This viral infection leads to vomiting and diarrhea, along with the liver infection. It can be obtained from food contaminated from an infected person or from certain other high-risk behaviors. It is a two-dose series.

Adolescent Safety

It’s never too early to talk to your child about being an adolescent and becoming a young adult. The hardest part is starting the conversation. KidsHealth.org offers some great resources for you and your children to navigate their growth together.

Please take time to check out The Center for Young Women’s Health for valuable information on hundreds of teenage issues your young woman may be facing.

There has been recent concern about a new “game” adolescents play called the choking game. Like any risky behavior, parents need to educate themselves about the signs of such behavior.

Contraception

If you are interested in discussing contraception for your child, we have many providers that are available and willing to discuss the various means of contraception.  We can prescribe oral contraceptive pills and depo injections.  As of September 2015, we have a provider in each office that is qualified to insert the Nexplanon implant.  If you have questions about any of these methods of contraception, please call our office to schedule an appointment.

Transitioning to Adult Care

Perhaps one of the most important things we can teach our children is to prepare them to be an adult.  That includes treating them like an adult in the doctors office.  This means that we will often have conversations with the teenagers in the room by themselves to help them become accustomed to talking with a doctor.  As your children get closer to 21, then we will start preparing the transition to adult medicine, increasing the child’s responsibility in their own care.  The website Got transition, has lots of resources for parents and teens to prepare them for this transition.