Latest news with #primarycare
CNA
14 hours ago
- Business
- CNA
Health Minister Ong Ye Kung 'dismayed' at company's S$52,000 monthly rental bid for Tampines clinic
SINGAPORE: Health Minister Ong Ye Kung said he was "dismayed" at a healthcare company's S$52,188 monthly rental bid for a clinic in a Housing and Development Board (HDB) estate in Tampines. In a Facebook post on Wednesday night (Jun 4), Mr Ong said: "This must translate to higher cost of healthcare one way or another, and negate the effort of Ministry of Health, Singapore (MOH) to try to keep the cost of primary healthcare affordable. "More importantly, higher rental bids do not necessarily translate to the best healthcare that the community needs." The successful bid for the ground floor unit at Block 954C Tampines Street 96 by I-Health Medical Holdings in January has led to discussions online about rental fees and healthcare costs. The rental works out to over S$1,000 per sq m. NEW TENDER APPROACH He noted that MOH and HDB last month launched a new tender approach for general practitioner (GP) clinics at Bartley Beacon. In the new approach, quality of care will account for 70 per cent of the tender evaluation, and rental will make up 30 per cent. The unit is about 100 sq m – twice the size of normal clinics – and suited for clinics which intend to provide multi-disciplinary care and "try out new care models", he added. 'Through this Price-Quality evaluation Model (PQM), we can shift the competitive focus away from rental rates, to better care models, including preventive care, chronic disease management and mental health,' Mr Ong said. The tender for the unit at Bartley Beacon was closed on May 29. 'I understand from my MOH officers that we have received interesting proposals, with rental bid prices significantly below the Tampines site in per sqm terms. We are currently assessing the proposals,' he said. Mr Ong noted the Tampines clinic was tendered in December 2024 and awarded in March this year, before the PQM model started. 'Going forward, and given the encouraging response to the Bartley Beacon site, we will make the new PQM approach the norm, when tendering our GP clinics in our HDB heartlands,' Mr Ong said. 'It will be a meaningful shift, both in improving primary care, and ensuring greater affordability.'
Medscape
17 hours ago
- Business
- Medscape
PCP-Cardiologist Collaboration: How It Works in Real Life
Everyone agrees primary care physicians (PCPs) need to work together with cardiologists when caring for patients with heart disease, diabetes, and sometimes both conditions. Medscape Medical News asked for examples of PCP-to-cardiologist referrals that were successful — or not. Here are three success stories and one that could have turned out better. Diabetes, Hypertension, New-Onset Raynaud's…at 97 The patient arriving for a primary care visit had diabetes and a history of hypertension. He was 97 years old. But now, 'his blood pressure was a little low,' recalled Kimberly Petrick, MD, a family medicine physician at Kaiser Permanente, Santa Monica, California, who was his PCP. 'I messaged the cardiologist — we are able to actually text message our cardiologists — and said, 'His blood pressure is a little low. Which ones [medications] would you be OK with me reducing?'' Then, she discovered he had developed Raynaud's, which also needed medication. After their discussion, Petrick said to the cardiologist: 'I will create follow-up in 1 week, but can we insure he also has follow up with you?' Kimberly Petrick, MD The cardiologist agreed. 'It's that collaborative care that makes it so easy and seamless and really reduces that siloed care that isolates cardiology from primary care and a lack of communication and integration,' Petrick said. Recently, Petrick ran into the man as he arrived for a follow-up blood pressure check in the clinic with a nurse. 'The purple discoloration of his fingers had gotten better. His blood pressure had adjusted beautifully. It was all done with the adjustment of the medication in collaboration with the cardiologist.' It's crucial for PCPs and cardiologists to be aligned on the big picture, Petrick said. 'It's not just about the heart. That patient has a system of other organs. We need to make sure both of us are looking at that patient as a whole.' From Cardiac Referral to Rehab The woman was in her 50s, with long-standing uncontrolled type 2 diabetes and now, new symptoms. 'She had been complaining of intermittent chest pain and shortness of breath,' said Natalie Hamilton, MD, a Denver family medicine physician and senior instructor of family medicine at the University of Colorado Anschutz Medical Campus, Aurora, Colorado. 'She had a family history of heart disease, well, which is something I always ask about. It increases the risk of heart disease and might make me refer sooner.' She referred this patient to a cardiologist, who performed catheterization and found stents were needed. Natalie Hamilton, MD 'It seemed like a very fast process,' Hamilton said. 'We got her in quickly, and she's been doing great ever since. From that collaboration, she also got involved in cardiac rehab.' Then, 'all of a sudden we were controlling her diabetes too well,' Hamilton said. 'So, she was having some low sugars when she was doing rehab. So, we worked together optimizing her cardiac rehab so she could participate while controlling her diabetes in a safe way to prevent further complications.' One bonus to referrals, she finds, is a better understanding by patients of the importance of managing their health. 'I have many patients with diabetes and heart disease, and I find it can be abstract for patients to understand why it's important to control their diabetes. When they have concurrent heart disease and I feel like a cardiologist would be a good fit for their team, I found that it is very validating for the patient to hear from the cardiologist how important that piece [heart health] is for their diabetes. And it's something people can grasp onto easier. Most people want to protect their heart.' So that becomes good motivation, she said, for them to start dietary modifications and medications that will help both conditions. 'Don't You All Talk to Each Other?' Coordination between a PCP in one health system and a cardiologist in another isn't impossible but can be difficult, as Asha Shajahan, MD, a family medicine physician at Corewell Health, Roseville, Michigan, found out with a recent case. The patient's needs were complicated, she said. He needed a heart transplant and had addiction problems. He was already going to a cardiologist in a different health system, she recalled, so that's who she collaborated with. It was difficult to get records back and forth, and 'it was difficult to keep in touch.' Asha Shajahan, MD The patient would come in to see her, Shajahan said, and say that his other doctor wanted him to go off a particular medication — something she would have to verify by reaching out, and it was difficult for her to receive a response. 'I kept trying to get ahold of him but never got to talk to him,' she said of the cardiologist. So she read through all the medical records and the cardiologists' notes when she finally did receive them and went from there with clinical decisions. For others in a similar situation, she advised: 'Extend your phone number and contact information.' Then, they can respond or get records to you by fax if other methods aren't an option. Otherwise, others may get the same question Shajahan got, despite all her efforts. 'I remember the patient asking: 'Don't you all talk to each other?'' Tag Teaming for Smoking Cessation For the past 3 years, the patient had gotten regular reminders from his PCP and his cardiologist about the need to stop smoking. Recently, the cardiologist, Jennifer Nguyen, MD, who practices at Kaiser Permanente West Los Angeles Medical Center, Los Angeles, reached out to the PCP, using the health system's secure messaging, telling that doctor she had a recent chance to talk to him about smoking cessation and that he seemed open to the idea now. 'And I saw that patient this week in clinic and brought it up again. And because we were able to coordinate and reinforce our messaging, that patient said, 'I did it. I quit.'' Jennifer Nguyen, MD 'It's still early, but monumental.' And the patient was also open to being referred for tobacco cessation counseling. 'That felt like such an achievement,' Nguyen said. The electronic medical records used at her health system greatly help the PCP-cardiologist collaboration, said Nguyen, who is also an assistant professor of clinical medicine at Kaiser Permanente School of Medicine, Pasadena, California. 'When they leave the primary care office, I can see immediately what was ordered, what the concerns are on the notes; it's all in real time, and I can pick up from there. And that really adds to patients just being able to seamlessly go from the primary care space to the specialty space uninterrupted even though we are physically in different buildings.'
CBS News
a day ago
- Business
- CBS News
Allina Health doctors, PAs hold first-ever union picket, ask for better work-life balance in new contract
Six hundred Allina doctors, physician assistants and nurse practitioners who work in primary care are asking for a new contract with more work-life balance. They gathered in the pouring rain Tuesday morning for a first-of-its-kind protest. "We are here together as a result of many years of fighting, fighting for primary care and fighting to make things better," workers chanted. While nurses have walked the picket line for years, these picketers are doctors, PA's and nurse practitioners who are admittedly higher compensated. "We all get paid really well, its not about that. It's about having better support for our patients and support in our community and that we want a fair treatment in our contract and protections for everybody," said Dr. Chris Filetti, a pediatrician with Allina Health. WCCO The workers are asking for paid sick leave, instead of having to use vacation time. They're also asking for four hours a week to finish paperwork, instead of doing it in their off time. Additionally, they're asking for more medical assistants and nurses for support. "As a provider I hear story after story about providers who have to cut back from practice because of poor work-life balance," said Filetti. Allina's leaders say they are listening despite the unsettled contract, telling WCCO in a statement: "We continue to negotiate in good faith to reach responsible agreements that maintain competitive pay and benefits for our providers while ensuring that we can sustain our caring mission during these extremely uncertain economic times. It is important to get it right. We remain committed to reaching fair agreements that ensure we can maintain access to the high-quality care people depend on."
Medscape
a day ago
- Health
- Medscape
Recognizing and Treating Hyperprolactinemia
In this podcast, I'm going to talk about hyperprolactinemia in primary care. Let's start with a case study. Hannah is a 32-year-old lady who presents to us in primary care with a 6-month history of a bilateral watery breast discharge. She has associated irregular periods. There's no family history of breast disease, breast cancer, or any other malignancy. Of note, past medical history includes a history of Graves disease treated with radioactive iodine. In terms of her social history, she lives with her partner and their 2-year-old daughter. On examination, Hannah's breasts were symmetrical in appearance. There were no skin changes or no palpable mass in either breast. However, there was white discharge expressed from both breasts. There was no evidence of any local or distant lymphadenopathy. In terms of investigations, pregnancy test was negative, and her prolactin levels returned at 800 mIU/L. So, what is causing her high prolactin levels? Let's start with a bit of background about prolactin. Prolactin is a peptide hormone produced in the anterior pituitary gland. The main physiologic role of prolactin is to initiate and sustain lactation. Prolactin also is responsible for the proliferation and differentiation of breast tissue during pregnancy. Excessive production of prolactin can lead to subfertility and gonadal dysfunction due to suppression of gonadotropin-releasing hormone (GnRH) production from the hypothalamus. GnRH stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn stimulate the ovaries and testes to produce sex hormones. Finally, dopamine inhibits prolactin production and helps regulate prolactin levels. Prolactin levels, of course, are high during pregnancy and lactation, but levels also increase after meals, exercise, stress, sleep, nipple stimulation, and any form of chest wall injury. What are the pathologic causes of high prolactin levels? Causes include prolactin-secreting pituitary tumors or prolactinomas. Additionally, nonfunctioning or nonsecreting pituitary tumors can also lead to high prolactin levels, because they prevent the normal flow of dopamine to the pituitary gland due to compression of the pituitary stalk. Rarely, hypothalamic tumors might also be implicated, as can any form of head injury or seizure activity. A history of brain surgery or cranial radiotherapy can also lead to high prolactin levels. Other causes include kidney and liver failure and polycystic ovary syndrome. Also, certain endocrine conditions can lead to high prolactin levels, including acromegaly and hypothyroidism. Hypothyroidism is, in fact, the cause of Hannah's symptoms. Her past radioactive iodine treatment for Graves disease has now rendered her hypothyroid, which has led to elevated prolactin levels. Importantly, a range of medications we commonly prescribe in primary care can also lead to hyperprolactinemia: a range of antipsychotics, first-generation antipsychotics such as chlorpromazine and haloperidol, and second-generation antipsychotics such as aripiprazole. Most antiemetics can also lead to high prolactin levels (such as metoclopramide, haloperidol, and prochlorperazine). But, incidentally, cyclizine does not lead to high prolactin levels. The combined oral contraceptive pill can lead to hyperprolactinemia, as can many antidepressants, verapamil, opiates, cimetidine, and illicit drugs, including cocaine. Finally, commonly prescribed drugs such as omeprazole and trimethoprim can also lead to high prolactin levels. How does hyperprolactinemia present? In women, it often presents as Hannah presented, with galactorrhea and menstrual disturbance. Reduced fertility, reduced libido, acne, and hirsutism are also other presenting features. Men can also present with galactorrhea, though this is much less common. More commonly, men present with loss of libido, erectile dysfunction, and subfertility, and sometimes gynecomastia. Importantly, we must remember, both men and women can present with visual field defects: for example, a bitemporal hemianopia or a headache due to the mass effect of a pituitary macroadenoma. Furthermore, low bone mineral density and an increased risk for osteoporosis can also be associated with longstanding elevated prolactin levels. With regard to investigations, we simply need to repeat prolactin levels in the first instance because the stress of venipuncture itself can increase prolactin levels. We need to exclude pregnancy as appropriate and, importantly, review current medications, taking into account the wide range of drugs that can increase prolactin levels, as I've already outlined. In terms of further bloodwork, consider ordering a thyroid-stimulating hormone test to check thyroid function, a urea and electrolytes test to check kidney function, and a liver blood test to exclude any sort of hepatic failure, and also consider checking sex hormones: FSH, LH, and testosterone levels. When looking at those prolactin results, results of 500-700 mIU/L for females and 325-700 mIU/L for men are rarely pathological or clinically significant, which is a really useful take-home message for us in primary care. However, very high levels of prolactin, over 5000 mIU/L, are strongly suggestive of an underlying pituitary tumor. When other causes have been excluded, such as drug-induced causes, diagnosis is usually confirmed by a pituitary MRI scan. In terms of management, the main principle of management of hyperprolactinemia is to identify and treat the underlying cause, if feasible. The goals of treatment are, of course, to relieve any symptoms if present, such as galactorrhea, in Hannah's case, to prevent complications from osteoporosis or pressure effects and to restore fertility and sexual function. Treatment will very much depend on the underlying cause and will be largely driven by our secondary care colleagues, our endocrinology colleagues, and our neurosurgery colleagues. Treatment can include the use of dopamine agonists (for example, cabergoline and bromocriptine) to help regulate prolactin levels, and surgical treatment might include transsphenoidal surgery. Medscape Family Medicine © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: Kevin Fernando. Recognizing and Treating Hyperprolactinemia - Medscape - Jun 03, 2025.
CTV News
2 days ago
- Business
- CTV News
B.C. primary care review underway, part of NDP's confidence deal with Greens
B.C. Green Party for West Vancouver-Sea to Sky MLA elect Jeremy Valeriote answers questions from media after providing a statement in Victoria, Wednesday, Oct. 23, 2024. THE CANADIAN PRESS/Chad Hipolito VICTORIA — The British Columbia government has launched a review of its primary health care system, in accordance with the ruling New Democrats' confidence agreement with the Green Party. The assessment is being co-ordinated by the Ministry of Health in collaboration with the two-member Green caucus. The government says in a statement that a working group will engage with key stakeholders in the assessment of all elements of B.C.'s primary care system. Interim Green leader Jeremy Valeriote says the party expects the assessment will lead to 'real action on the deep challenges in B.C.'s health-care systems.' The confidence agreement between the New Democrats and Greens, finalized in March, outlines the basis for the two Green legislative members to support the NDP in confidence votes. The agreement seeks to stabilize Premier David Eby's slim one-seat majority, in exchange for specific actions in 12 policy areas including health care, housing, environment, electoral reform and B.C.'s response to American tariffs. This report by The Canadian Press was first published June 2, 2025.
