Care coordination is vital to achieving better health outcomes, by Medshield

The choice between primary and speciality care depends on the individual's medical needs and condition.

Let's use Thandi as an example to explain this critical difference. Thandi has suffered from asthma for several years. Her doctor put her on chronic medication, which includes inhalers to manage her asthma. Despite taking her asthma treatment consistently, as advised by her doctor, Thandi has been complaining of persistent shortness of breath. She decides to visit her regular doctor.

During assessment, her doctor determines that there is fluid in her lungs and her blood pressure is very low. Thandi also tells the doctor that lately, she has been depressed and struggling to sleep. Concerned that this combination of health issues could be fatal, Thandi's doctor referred her to a pulmonologist for further evaluation and treatment.

A pulmonologist has specialised training and expertise in diagnosing, treating, and managing various conditions affecting the lungs and airways. He provides the most appropriate and effective care for complex medical needs.

Examples of speciality care areas include:

• Oncology – cancer diagnosis, treatment and prevention
  
• Nephrology – kidney disorders
  
• Orthopaedics – bone and connective tissue disorders
  
• Cardiology – heart disorders
  
• Psychiatry – mental health and substance use disorder
  
• Endocrinology – health conditions related to the body's hormones

Process: Why speciality care coordination is vital for patient health

At Medshield, we encourage our members to follow Thandi's example and utilise primary healthcare providers as the first point of call for health issues. It leads to better health outcomes. Why do we say that?

Most often, people have multiple health issues that require the care of more than one health practitioner. Typically, specialists only focus on a specific area and may not consider how it interacts with the person's other health issues.

Care coordination is essential because it ensures that an individual's health issues are considered holistically. In the case of Thandi, the pulmonologist working with her and her primary care provider updated her care plan. The updated treatment plan now includes supplemental oxygen therapy, medication for low blood pressure and a referral to a psychiatrist for depression.

Thandi's doctor and the pulmonologist maintain open communication to continue monitoring her progress, address any complications that arise, and adjust her care as needed. Had she simply gone directly to the specialist without going through her regular doctor, the pulmonologist may have focused merely on her respiratory issues and not necessarily on her depression, low blood pressure or lifestyle.

Thandi's example illustrates how members can benefit from coordination between primary care providers and specialists. Your healthcare professional will also guide you in managing your health issues and healing process, including ensuring that patients get the specialist treatment, should that need arise.

Being proactive and well-informed about your medical scheme benefits can help members make informed decisions regarding their healthcare and ensure they receive appropriate cover for their specific needs and conditions, when they need it most. At Medshield, we provide comprehensive resources and support services to ensure members get the best health outcomes.