Primary care teams must continuously innovate to optimize patient outcomes and contain costs. In the absence of symptoms, recent research has demonstrated the lack of benefit from annual medical exams. Our redesign of the annual exam incorporated two concepts: optimize technology for disease management or prevention, and utilize each care team member at the top scope of licensure. Nurse visits were used for routine monitoring and wellness appointments to encourage patient engagement. Pharmacist visits were used for a comprehensive medication review, to optimize medicine use. Additionally, the pharmacist engaged the patient and caregivers utilizing shared-decision making to ensure they understood the risks and benefits of each medicine. Social workers and care coordinators were also available for consultation. This model helps to improve the efficiency of the provider visit, and illustrates the benefit of team-based care to the patient while encouraging improved health outcomes.
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