Long Island St. Catherine of Siena Medical Center Seamlessly Links Women s Primary and Specialty Care
Primary care providers are the first point of care for women, says Deborah Blenner, MD, internal medicine pediatric physician, a Medical Director at Siena Proactive Internal Medicine and Medical Director of the Siena Proactive Internal Medicine Weight Management Program. It s essential that we be the facilitators who connect patients with our specialist colleagues. ST. CATHERINE OF SIENA MEDICAL CENTER Seamlessly Links Women s Primary and Specialty Care BY THOMAS CROCKER ST. CATHERINE OF SIENA MEDICAL CENTER is building a new service line that will cater to the healthcare needs of women at every stage of life across a variety of specialties. Underpinning this effort is one key idea: The primary care physician should be every woman s partner in prevention, as well as her point of entry to specialty care. SUCCESSES, CHALLENGES AND OPPORTUNITIES Preventive care has led to profound improvement in women s lives in the past few decades. Thanks in large part to screening, breast cancer death rates have been declining for nearly 30 years, the number of women dying from cervical cancer has decreased by more than 50 percent during the past 40 years and the colorectal cancer death rate has been falling for decades, according to the American Cancer Society. Significant challenges remain, however. According to the CDC, 13 percent of American women are in fair or poor health, nearly 40 percent are obese, and approximately 33 percent age 20 and older have hypertension. An important factor in improving these troubling statistics is persuading women who make 80 percent of healthcare decisions for their families, according to the Department of Labor to reorder their priorities. Women juggle so much as caregivers and professionals that they often don t care for themselves, says Deborah Blenner, MD, internal medicine pediatric physician and a Medical Director with Siena Proactive Internal Medicine. Other factors may conspire to prevent their attending to preventive health, such as fear of learning of a potential health problem, financial obstacles including copays and high deductibles and transportation. If any provider notices a woman isn t getting recommended
preventive care, he or she should direct the patient to a primary care physician [PCP]. In PCPs interactions with women, Natalia Flores, MD, FACOG, OB-GYN at St. Catherine of Siena Medical Center, sees an opportunity to expand the reach and effectiveness of preventive care. Often, women seek medical attention only when they re pregnant, have irregular menstrual cycles, or have questions about breast or cervical health, Dr. Flores says. PCPs discuss everything from preventive health screenings and weight management to hygiene and sexual health topics women might not otherwise discuss with anyone else. These consultations are teachable moments for clinicians. We need to optimize our interactions with patients so they can share what they learn with their network of friends and family. We know women drive health care, says June J. Lee, MD, MBA, Medical Director of the Breast Health Program at St. Catherine of Siena Medical Center. By taking care of women, PCPs are in an important position to drive health care not only for their patients, but for their patients families and friends, as well. RELIEVING THE BURDEN OF OBESITY St. Catherine of Siena Medical Center is creating a women s health service line that will better connect the dots along the continuum of women s care. This service line will combine the warm, personal, community-based care that has defined the medical center s reputation for 50 years with the physician expertise and advanced therapeutic options that are the hallmarks of its present and future. The medical center s PCPs, including the seven clinicians of Siena Proactive Internal Medicine, are playing a central role in enhancing women s health services. Each clinician brings different areas of interest to the practice, such as sleep medicine, geriatrics, adolescent health and in Dr. Blenner s case, weight management. This is a particularly important issue for women during perimenopause, when hormone fluctuations contribute to obesity that is linked to a variety of comorbidities. Last fall, Dr. Blenner established the Siena Proactive Internal Medicine Weight Management Program, a four-month Personal, Compassionate Care for Mothers and Babies SOME OF THE most important healthcare services women can receive are tied to what is potentially one of the most medically complex times of life: giving birth. Maternity services at St. Catherine of Siena Medical Center are designed to optimize the labor, delivery and postpartum experience for mothers and infants. The labor and delivery and postpartum units feature a 1:1 nurse-topatient ratio, and the nurses, more than any other factor, set the tone for the patient experience. We have nurses on the labor and delivery and postpartum units who have decades of irreplaceable experience, says Natalia Flores, MD, FACOG, OB-GYN at St. Catherine of Siena Medical Center. They are eager to learn and eager to teach. All of our nurses, for example, are required to obtain electronic fetal monitoring certification. Our nurses do this job because they love it, and this really comes through in the labor and delivery experience our patients have. So many of my patients come here to deliver after having given birth elsewhere and are completely overwhelmed by the intimacy of the experience and how supported they feel. START-TO-FINISH SUPPORT For many expectant mothers, the birthing experience at St. Catherine of Siena Medical Center begins with an hour-long information session and tour of the maternity unit followed by a prenatal breastfeeding class. After giving birth, new mothers can receive lactation support from a registered nurse who is a certified breastfeeding counselor. We are on the path to becoming a Baby-Friendly Hospital as part of the World Health Organization and United Nations Children s Fund s Baby-Friendly Hospital Initiative; we should receive the designation by Spring 2017, Dr. Flores says. Baby-Friendly Hospitals recognize the importance of breastfeeding and take steps to support it. All of our labor and delivery nurses are involved in lactation support. In accordance with Baby-Friendly principles, we follow a family-centered model of care in which we don t separate mothers and newborns after birth. This model has been shown to improve bonding and nursing. In 2012, St. Catherine of Siena Medical Center remodeled the fiveroom labor and delivery unit, as well as the postpartum unit, to enhance patient comfort. Each of the private postpartum rooms features a bathroom with shower. Women who experience postpartum depression can participate in Mothers Circle of Hope, a free postpartum support group that gives them a sense of community and helps them access outside resources. TREATING MEDICALLY COMPLEX INFANTS The Maternity Center features an eight-bed Level 2 NICU that allows providers to care for infants born at 30 weeks of gestation or later. An on-site neonatologist is available around the clock. This backup is invaluable when a delivery occurs and the obstetrician is concerned about a possible complication, Dr. Flores says. The NICU is always open for families and remains flexible and adaptable in the face of patients needs. For example, if a mother is discharged from the postpartum unit but her baby remains in the NICU, she may continue boarding in the unit so she can be close to her baby.
Dense breasts require additional screening tools, such as ultrasound and MRI, as a mammogram s efficacy is limited in such cases. June J. Lee, MD, MBA, Medical Director of the Breast Health Program at St. Catherine of Siena Medical Center, discusses treatment options with a patient. St. Catherine of Siena Medical Center is a hidden gem. There are a lot of wonderful clinicians here who are practicing cutting-edge medicine, and because this is a community-based medical center, patients receive attentive, personal care. nonsurgical program that can be an alternative or supplement to bariatric surgery. Staff members involved in the program recognize that many women have tried multiple ways to lose weight and may arrive frustrated. Obesity is a multifactorial disease, says Dr. Blenner, the program s Medical Director. An issue that prevents one individual from losing weight might not be present in another. A full analysis by an obesity specialist at the beginning of the program helps the team design a weight-loss strategy that best suits each patient. We pay special attention to the weight-related issues that are unique to women. We can analyze women s hormone levels, for example, to determine whether certain hormones need to be replaced. Our program also examines women s metabolism to find out if it s fast or slow. Each strategy typically includes a nutrition evaluation and ongoing guidance, a behavioral health assessment, a personalized total fitness plan created by a personal trainer, and FDA-approved weight-loss medications, if necessary. Patients meet with members of the team regularly throughout the program. Individuals may lose 15 to 50 pounds during the program, based on results observed thus far. The lifestyle changes we teach patients to make can help them lose weight throughout the four months of the program and sustain weight loss over the long term, Dr. Blenner says. This has led some patients to lose more than 100 pounds eight months to a year after starting the program. WHERE PREVENTION, DIAGNOSIS AND TREATMENT MEET PCPs are the first point of care for women, Dr. Blenner says. It s essential that we be the facilitators who connect patients with our specialist colleagues. JUNE J. LEE, MD, MBA, MEDICAL DIRECTOR OF THE BREAST HEALTH PROGRAM AT ST. CATHERINE OF SIENA MEDICAL CENTER At St. Catherine of Siena Medical Center, when a woman needs specialty services, a system of guided care embedded in the medical center s culture and protocols makes the transition smooth. Evidence of this system is pervasive, from the Epic EHR, which allows disparate clinicians to access patients medical information quickly and seamlessly, to the collegiality among clinicians that facilitates communication. In our system of physicians, it s so easy to pick up the phone and speak with another PCP if, for example, I have a question about the newest medication to treat hypertension or the best way to manage a condition I don t see often, Dr. Flores says. Recently, I spoke with a colorectal surgeon about a patient she was concerned about, and I also consulted a breast surgeon about a patient of mine. When I have conversations such as these and share what the specialists say with my patients, they know I m taking care of them. If they subsequently follow up with specialists, my colleagues already know them because we ve communicated, and I know my patients are going to get the care they need. It s easy in this community setting to get to know the people who care for my patients, which is great. That kind of gets lost in larger systems. Clinicians such as Drs. Flores and Lee practice at the intersection of primary and specialty care. They may be involved in both screening for and guiding treatment of diseases such as breast and cervical cancer. St. Catherine of Siena Medical Center
provides a wide array of services to support these clinicians who straddle the primary and specialty care realms. In obstetrics and gynecology, for example, clinicians use the da Vinci Surgical System to perform robotic-assisted, laparoscopic hysterectomies, colectomies and endometriosis procedures. The medical center s maternity services include a five-bed labor and delivery unit, which was renovated in recent years, and a Level 2 NICU. See Personal, Compassionate Care for Mothers and Babies (on page 7) for more information about maternity services. Another vital component of women s care at St. Catherine of Siena Medical Center is breast health services. The Breast Center, an American College of Radiology Breast Imaging Center of Excellence, provides a wide array of imaging and biopsy services, including screening mammography, breast ultrasound, stereotactic breast biopsy, ultrasound-guided core biopsy and breast MRI, among others. This summer, the state of New York demonstrated its commitment to leading the nation in improving access to breast cancer screening by enacting a law that requires more than 200 hospitals and clinics statewide to provide at least four hours of extended screening time per week. St. Catherine of Siena Medical Center has been a proponent of and leader in early detection of breast cancer, Dr. Lee says. We offer extended mammography hours for weekdays and weekends and are looking to expand them even further. If an imaging test returns an abnormal result, a breast health nurse navigator helps guide the patient through the biopsy, diagnosis and therapeutic process and acts as an educational Barbara Neuhaus, NP; Camille Rowe, practice manager; Dr. Lee; Sara Wood, MA; and Gabrielle Paulicelli, LPN resource and source of psychosocial support. Oncoplastic breast surgery and other reconstructive options are available to help patients achieve a more natural-looking breast following lumpectomy or mastectomy. The world has become a small place, and the treatments for some of the more common malignant diseases, including breast cancer, that are available at many well-known institutions are now offered in community settings such as ours, Dr. Lee says. On the other hand, we provide some services that are quite advanced and are not found everywhere outside of major centers services Natalia Flores, MD, FACOG, OB-GYN at St. Catherine of Siena Medical Center, and Vicky Shulman, RN, assess a mother in labor and delivery prior to a bedside ultrasound.
including deep inferior epigastric artery perforator [DIEP] flap breast reconstruction. In this procedure, the surgeon extracts excess skin and tissue and attached blood vessels from the patient s lower abdomen, reattaches the vessels to those in the chest, and reconstructs the breast using the skin and tissue. Many big-city centers offer this procedure, Dr. Lee says. We ve handled well over 100 cases in the past few years with excellent results and a minimal complication rate. Support during and after breast cancer treatment is an important part of the journey for every patient, as well. St. Catherine of Siena Medical Center helps patients find the educational and emotional assistance they need through support groups and relationships with organizations such as the American Cancer Society and the Babylon Breast Cancer Coalition. CREATING A COMPREHENSIVE WOMEN S HEALTH DESTINATION The components of the St. Catherine of Siena Medical Center women s health service line reflect the variety of medical concerns women may face throughout life. In addition to primary care, weight management, breast health and OB-GYN care, the service line includes: + + Bariatric surgery + + Cardiovascular surgery + + Colorectal surgery + + Orthopedic surgery, with emphases on osteoporosis and fall prevention + + Urogynecology Maternity Director Neila Hernandez, NP; Dr. Flores; and Denise Gebhart, RN, ANCC in the NICU Female physicians are available to provide many of these services, including colorectal surgery, to patients who may be more comfortable receiving care from a woman. In addition, women who require hospitalization will soon be able to enjoy the comfort of gender-specific care. Next year, St. Catherine of Siena Medical Center plans to begin renovating 4 South, one of its inpatient units, to house private suites for female medical/ surgical patients. When it comes to women s health care, Dr. Flores envisions a bright future for St. Catherine of Siena Medical Center. We have high-quality services, excellent clinicians and an outstanding reputation that s only going to grow, she says. All of the clinicians we ve added over the past few years have brought fresh ideas and momentum to the medical center, and that s going to translate into even better care for our patients during the next five years. To learn more about women s health services at St. Catherine of Siena Medical Center, visit stcatherines.chsli.org. n Women are the backbone of our society. It is wonderful to be part of building a service line that will offer them the care they need from adolescence to menopause. Recently, I spoke with a colorectal surgeon about a patient she was concerned about, and I also consulted a breast surgeon about a patient of mine, Dr. Blenner says. When I have conversations such as these and share what the specialists say with my patients, they know I m taking care of them. DEBORAH BLENNER, MD, INTERNAL MEDICINE PEDIATRIC PHYSICIAN, A MEDICAL DIRECTOR AT SIENA PROACTIVE INTERNAL MEDICINE AND MEDICAL DIRECTOR OF THE SIENA PROACTIVE INTERNAL MEDICINE WEIGHT MANAGEMENT PROGRAM REPRINTED FROM MD NEWS LONG ISLAND