Welcome to The PEAK!

The PEAK, or “Patient Education And Knowledge,” is the monthly newsletter for Free Range Direct Primary Care. This newsletter will hopefully provide you with evidence-based medical knowledge as well as updates regarding the practice.

Practice Updates

NEW PATIENTS: I am continuing to accepting new patients! Currently, I can see them in 1-2 days for a new patient appointment. If you know of anyone in need of a primary care doctor, please send them my way!

REVIEWS: I would love if you can provide a 5-star Google review for my practice! You may do so by visiting here, https://g.page/r/CXhfHK-SrDl6EAE/review. Please let me know if I can improve on anything. Thank you!

APPOINTMENTS: If you are in need of an appointment, please schedule here. You may also call or email and I can get you on the schedule.

MEDICATION REFILLS: Please text/call (434-337-5934) or email (drjohnson@frdpc.com) with medication refill requests. I will get them to your pharmacy as soon as possible.

In this issue…

• Common fall allergens and how to best combat them?
• October is National Breast Cancer Awareness Month
• Fall is Open Enrollment Season - Where Does DPC Fit In?  

Common Fall Allergens And How To Best Combat Them

Common fall allergens include ragweed pollen, mold spores, and dust mites. Effective management of these allergens involves a combination of pharmacologic and non-pharmacologic strategies. Below are some simple things you can do to help you better enjoy your fall outside without pesky allergens.

Intranasal corticosteroids are the first-line treatment for allergic rhinitis due to their superior efficacy in reducing inflammation and symptoms. The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) strongly recommends these agents for patients whose symptoms affect their quality of life. Examples include fluticasone, triamcinolone, and budesonide.^[1]

Oral second-generation antihistamines are recommended for patients with primary complaints of sneezing and itching. These agents, such as cetirizine, fexofenadine, and loratadine, are effective and have a lower risk of sedation compared to first-generation antihistamines.^[1]

Combination therapy with intranasal corticosteroids and intranasal antihistamines (e.g., azelastine) can be considered for patients with inadequate response to monotherapy. This approach has been shown to provide greater symptomatic relief.^[2]

Immunotherapy is an option for patients who do not respond adequately to pharmacologic therapy. Both subcutaneous and sublingual immunotherapy can be effective, particularly for those with specific allergen sensitivities confirmed by IgE testing.^[2]

Environmental controls are also crucial. The Joint Task Force on Practice Parameters (American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology) suggests measures such as using air filtration systems, bed covers, and acaricides to reduce indoor allergen exposure. Additionally, staying indoors during high pollen counts, using air conditioning with HEPA filters, and keeping windows closed can help limit exposure to outdoor allergens.^[2]

These strategies, grounded in clinical guidelines and evidence, provide a comprehensive approach to managing fall allergies effectively.

References

Clinical Practice Guideline: Allergic Rhinitis. Seidman MD, Gurgel RK, Lin SY, et al. Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2015;152(1 Suppl):S1-43. doi:10.1177/0194599814561600.

Rhinitis 2020: A practice Parameter Update. Dykewicz MS, Wallace DV, Amrol DJ, et al. The Journal of Allergy and Clinical Immunology. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007.

https://www.givelively.org/updates/four-nonprofits-in-honor-of-breast-cancer-awareness-month

October is National Breast Cancer Awareness Month

The key to reducing morbidity and mortality from breast cancer is early detection. Understanding the recommendations for screening are crucial but can be confusing. It is important to talk about this with you doctor so that you can make the best decision for your health. The current breast cancer screening guidelines vary among different organizations, reflecting differences in the balance of benefits and harms of screening, as well as the importance of shared decision-making.

The American College of Physicians (ACP) recommends that average-risk women aged 50 to 74 years undergo biennial mammography. For women aged 40 to 49 years, the ACP suggests that the decision to start screening should be individualized based on patient preferences and values, given the close balance between benefits and harms in this age group.

The American Cancer Society (ACS) recommends that women aged 45 to 54 years should undergo annual mammography, while women aged 55 years and older should transition to biennial screening, with the option to continue annual screening. Women aged 40 to 44 years should have the choice to start annual mammography.

The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50 to 74 years. For women aged 40 to 49 years, the decision to start biennial screening should be individualized, taking into account the patient's values regarding the potential benefits and harms.

The World Health Organization (WHO) recommends mammography screening for women aged 50 to 69 years, emphasizing the importance of shared decision-making. For women aged 40 to 49 years, WHO suggests screening only in the context of rigorous research and shared decision-making strategies.

The Canadian Task Force on Preventive Health Care (CTFPHC) conditionally recommends against routine screening for women aged 40 to 49 years without a first-degree family history of breast cancer, but acknowledges that some women may wish to be screened and advises shared decision-making in these cases. For women aged 50 to 69 years, biennial screening is recommended.

These guidelines highlight the importance of individualized decision-making, particularly for women in their 40s, and reflect a consensus that biennial screening is appropriate for women aged 50 to 74 years.

American College of Physicians

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

Published April 2019

In addition to the guidelines previously mentioned, the American College of Radiology (ACR) recommends annual mammography starting at age 40 for average-risk women, emphasizing that this approach saves the most lives by detecting cancer early. The American College of Obstetricians and Gynecologists (ACOG) also supports offering mammography starting at age 40, with a strong emphasis on shared decision-making to tailor screening to individual patient preferences and risk factors.

The National Comprehensive Cancer Network (NCCN) advises annual mammography beginning at age 40 for average-risk women, aligning closely with the ACR and ACOG recommendations. The World Health Organization (WHO) suggests mammography screening for women aged 50 to 69 years, with a focus on shared decision-making for women aged 40 to 49 years, similar to the USPSTF guidelines.

The Canadian Task Force on Preventive Health Care (CTFPHC) conditionally recommends against routine screening for women aged 40 to 49 years without a first-degree family history of breast cancer, but advises biennial screening for women aged 50 to 69 years. This recommendation underscores the importance of individualized decision-making for younger women.

Overall, while there is a consensus on the benefits of mammography for women aged 50 to 74 years, recommendations for women in their 40s vary, highlighting the need for personalized screening strategies based on patient values and risk factors.

References

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Qaseem A, Lin JS, Mustafa RA, et al. Annals of Internal Medicine. 2019;170(8):547-560. doi:10.7326/M18-2147.

Harmonizing Breast Cancer Screening Recommendations: Metrics and Accountability. Lee CS, Moy L, Friedewald SM, Sickles EA, Monticciolo DL. AJR. American Journal of Roentgenology. 2018;210(2):241-245. doi:10.2214/AJR.17.18704.

Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. Owens DK, Davidson KW, Krist AH, et al. Jama. 2019;321(23):2326-2336. doi:10.1001/jama.2019.6587.

Informed Choices: How DPC Compares to Insurance in Open Enrollment Season

By: Rachel Rombough of Direct Primary Care of Burleson (adapted)

Traditional health insurance programs currently offer open enrollment for patients. During this special enrollment period, you can enroll for 2025 health coverage without a qualifying life event, such as loss of coverage or marriage. Many people believe that they can only receive affordable healthcare services with insurance coverage, however, direct primary care serves as a fantastic alternative. This guide explains what direct primary care is, how it compares to traditional insurance, and everything you should consider before making a decision.

What Is Direct Primary Care?

Direct primary care, or DPC, eliminates the need for third-party insurance companies. Patients will instead pay a premium, either as a monthly or annual fee, directly to the healthcare provider. In exchange, they can receive the following services:

Urgent care services

Physical wellness exams

Chronic disease management

Allergy testing

Women's health services

In-office procedures

Patients can receive treatment for a majority of common ailments through a DPC provider. Unfortunately it excludes any emergency medical care or surgery.

DPC vs. Insurance

If you're reluctant to renew your insurance coverage or change plans during open enrollment, you could find that switching to DPC better suits your needs. The key differences come down to the total cost but also the coverage. You need to determine which program checks off all the boxes for you.

Pros and Cons of Insurance 

When you carry health insurance, you hold a contract with a provider. In exchange for a monthly premium, your policy covers everything from preventative care and prescription drugs to hospitalizations and surgeries. 

However, the structure of modern health insurance comes with several drawbacks. The monthly payments might not fit your budget, and you'll have to either wait for the next open enrollment or endure a qualifying life event to change your policy. You may not be able to see your doctor when you get sick or injured due to limited availability.

Pros and Cons of DPC

With direct primary care, you can receive coverage on a contract basis. Your membership fee tends to be more predictable than insurance and since payment goes directly to your doctor, there are less administrative hassles. There are no surprise bills and you get personalized care.

Another pro to DPC is that it is accessible and you can have direct access to your provider and cut out the middle man hassles of insurance. You don’t need to wait for answers or worry about not feeling heard.

One notable drawback is that DPC doesn't usually include coverage for hospital stays or surgeries.

How to Make the Right Decision for You

Choosing direct primary care over traditional insurance appeals to a growing number of Americans. However, the decision ultimately comes down to your needs.

Do you have a serious medical condition that frequently puts you in the hospital? Insurance supplemented with DPC that includes this type of care might be a better option. On the other hand if you benefit from preventative care and routine care, DPC is a great option.

Free Range Direct Primary Care – Providing Superior Care to Charlottesville, VA

If you don't have insurance coverage, there's no need to wait for open enrollment to see a provider. Free Range Direct Primary Care treats a range of common conditions and can keep you healthy with affordable, personalized services. Contact our clinic in Charlottesville, VA at (434) 337-5934 to learn more about becoming a member or to schedule an appointment.

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