C3 Clinic for Older Patients With Multiple Conditions
With people living longer than ever, there's an increase in disorders affecting the elderly and those older are often afflicted with multiple severe conditions at once. Dr. Ryan Bartkus discusses how to best coordinate comprehensive care for all of an older person's medical issues.
Featuring:
Ryan Bartkus, MD
Dr. Bartkus hails from South Bend, IN, where his loving parents David and Carolyn still reside. He received his Medical Degree at University of Virginia in Charlottesville and then completed his family medicine residency with the University of Colorado in Denver. The call of the Midwest led him to the University of Wisconsin in Madison, where he undertook a fellowship in geriatric medicine and then stayed on for a few more years as an assistant professor in the UW Geriatric Department and the local Veterans Affairs. As a newlywed, he was drawn south to the Chicagoland area, where he took up his current employment as an attending with the Older Adult Clinic at Alexian Brothers Medical Center in Elk Grove Village, IL. He and his colleagues care for their patients in the clinic, in the hospital, at nursing facilities and in their patients’ own homes. The Comprehensive Care Clinic, or C3, was unveiled in July 2020 and aspires to provide well-coordinated team-based care to each patient’s whole person. Dr. Bartkus would like to give a shout-out to his wife Sarah and baby Samantha. Transcription:
Joey Wahler (Host): With people living longer than ever, there's an increase in disorders affecting the elderly. And those older, are often afflicted with multiple multiple severe conditions at once.
So, we're discussing how to best coordinate comprehensive care for all of an older person's medical issues. This is AMITA HealthCast, the podcast from AMITA Health. I'm Joey Wahler. Our guest, Dr. Ryan Bartkus who specializes in geriatric medicine for AMITA health at their comprehensive care clinic known as C3.
Dr. Bartkus, thanks for joining us.
Ryan Bartkus, MD (Guest): Pleasure to be with you. Thank you so much for the opportunity to speak with you.
Host: Well you have said that the C3 clinic is kind of like a command center focusing on all of an older patient's various needs. What type of person benefits most from the services there?
Dr. Bartkus: Well right now, our services are geared towards primarily the older population. Right now, our clinic is admitting patients 50 years and older. But more specifically, we're aiming for patients who have a complex medical history. So, those patients who have, for example, numerous health conditions. Conditions that we commonly see include congestive heart failure, pulmonary disease or lung disease, chronic kidney disease, diabetes and so on and so forth. Usually these patients have so many conditions or so many medications, or even so many doctors involved in their care, that becomes very difficult for them to have all their needs met at a typical primary care clinic. So, where we come in, is we act again as that command center, where we can bring these patients into our clinic and help coordinate their care, not only personally manage all of these complex conditions and how they have their interplay between one another, but also we can coordinate with all their other doctors.
We can coordinate with their family members. We can coordinate with pharmacists at their local pharmacy, et cetera, et cetera, et cetera, that we are the ones who can help the patient navigate this complex health system, and help them get the care that they require.
Host: Well, you mentioned some of the conditions that affect people as they get older. Let me hone in on a couple of them. You say by age 90, between 25 and 33% of people will suffer from some sort of dementia. How big a burden does that become both for them and for their families as well?
Dr. Bartkus: Yes. So, this is a tremendous burden on multiple levels, everywhere from, countrywide, where this is a multi-billion dollar tax on the health system, and personally, certainly our patients suffer greatly from loss of not only their cognition, which is the word we use to describe how the brain works and its various capacities, but also in their function, their ability to do things like drive a car or to prepare a meal, or to manage their own medicines or finances. So, this becomes very difficult for the patients, certainly emotionally as they start to change in what they're able to do and how they view themselves as a person, and also on their family members who see their loved one going through these struggles and also are absorbed into these struggles as well. And step in to try to help them. This can lead to a significant burden on the patient and family, as they try to navigate this loss of function for the individual and how to support them and keep them safe and happy in their own home, how to prevent falls or accidents that might really impact their quality of life. So, dementia, across the board, no matter what level you're looking at, is a major detriment to the quality of life, to the individual and family and community and to our nation.
Host: Frailty coming from lost muscle mass in older people can reduce mobility and cause falls. That's a big issue as well, right?
Dr. Bartkus: That is one of the greatest fears that many of our patients face in addition to the loss of memory is the fear of falls and heaven forbid that they fall and break a hip or break some other important bone. Cause it's very hard to recover from that, that the statistics at this point show that if someone falls and breaks a hip, that there's a 40% chance that they may not return to the same level of functional mobility that they had before.
There's a 40% chance that they may not be able to return to their previous level of living, that they might require moving into a assisted living facility or a nursing home rather than staying at home. And even the risk for mortality, for death goes up significantly with a broken hip. So, these falls and frailty and weakness, that is just one example of how it can greatly impact a patient's quality of life.
Host: One issue for people as they get older that I think maybe gets lost in the shuffle sometimes; older people often isolate themselves, socially. And with COVID-19 bringing increased isolation in general, how big a problem is getting older patients, what they need, things like medicine and doctor visits?
Dr. Bartkus: It is a tremendous problem. Even before the pandemic, the risk for our older patient population, not being able to access the resources that they need, that was a significant problem. A lot of patients at baseline, have trouble finding transportation, for example. Many of them, can not drive or have willingly given up their ability to drive. So, they have to arrange for transport. A lot of times going to a busy shopping centers, for example, can be difficult and disorienting. So, at baseline it's difficult for these patients often to access what they need. Then when you add on the pandemic on top of things that these patients rightfully so, very afraid of getting sick with this illness. That's it's definitely been shown that, COVID-19, severely impacts the older population, that they are at much greater risk for severe illness and death. So, understandably, a lot of them further self-isolate. That they move away from social engagements, meeting family and friends outside of the home.
Many of them have difficulty using online resources like Zoom, for example, that is just not as intuitive. So, it can be difficult for them to utilize resources like that. Certainly going to the grocery store, or trying to go to a health club to exercise, to maintain their strength, that becomes risky so, that they're not able to do that. And while some of these patients, have the benefit of family and friends who can come and visit with them or deliver groceries for them, or provide these needs for them, many of our patients do not have that support. Some of them are widowed or single. Some of them do not have family in the region, some of them, have close friends who must also self-isolate. So, they don't have those social opportunities. They don't have someone to fall back on who could help transport them to a doctor's visit or transport them to the grocery store or pick up, needed resources for them. So, it really has been, a major detriment, this COVID-19 pandemic for older patients and their ability to access what they require.
Host: And Doctor, another often overlooked condition for older people, often coupled with physical problems, mental issues, mental health, the need to maybe see a therapist, a psychiatrist because of depression. Obviously, as people get older, they have these physical ailments that creep up on them, as well as various people in their life dying off. There are a lot of issues that they're facing for the first time. And that can mean needing a mental professional as well as physical, right?
Dr. Bartkus: Correct. Yes. Certainly as our population ages, we see not only memory changes, but yes mood changes. The brain is a very complex organ and as we age, just like a muscle or a bone, it changes. And the chemical messages that go from one brain cell to the other, they don't always work as they should. So, that can lead to the memory changes we discussed before, but yes, also to mood changes. So, you can see more depression, more anxiety, things of that sort. And that has significant repercussions in how a patient is motivated to care for him or herself. How they handle things like pain. For example, anxiety can greatly worsen one's level of pain control. So it really impacts one's whole healthcare.
So yes, it does become important to seek timely, and adequate mental health support. A lot of primary care physicians, including myself, get a lot of training in how to address common psychiatric conditions like depression and anxiety. So, usually a good place to start is seeing your primary care physician and they can usually guide you.
They can start with common treatments, whether it is referring you to a therapist, whether it's starting a common medication for depression or anxiety, things of that sort. There are certainly situations where a patient might benefit from a specialist. So, a psychiatrist or a psychologist in which case your primary care provider can make that referral.
But yes, it is very important to address the whole person, not only physical, but the emotional and mental health, to make sure that we get the best outcomes and best optimize the patient's quality of life.
Host: And speaking of addressing the whole person as you put it, AMITA Health's C3 clinic, which we've mentioned, offers really a multidisciplinary medical team and also longer appointments when people show up, just a few of the things that separate it from a standard primary care facility, right?
Dr. Bartkus: Yes. So, certainly we are very proud of our, our C3 clinic. And I think this is a good opportunity to discuss some of the added benefits that we have. So, we certainly have the mainstays of any primary care clinic; we have our front desk staff and trained nurses, access to labs and x-rays, other studies, things of that sort.
But in addition to that, we fully acknowledge that for our particular patient population, who usually have more medical conditions, have more medications, have more needs that we need a little bit extra, a little bit more, to make sure that they have all of their needs met. So, the C3, the, the backbone of our clinic, is that we work as a multi-disciplinary team. So, not only will you get to see me, the doctor, you'll also get to see my team members as well and regularly interact with them. Specifically, we have a case manager and a social worker. Her name is Chris. She does an excellent job helping us to coordinate with all of the people involved in the patient's care team.
That we coordinate with other doctors in the health system. And also outside of the health system. We coordinate with other social workers. We coordinate with resources in the community that the patient might need, and could greatly benefit from. We also have a pharmacist whose name is Katie, and she really works closely with our patients to make sure that she knows all of the medicines they're taking, how the medications might be interacting with one another, so we can avoid side effects. And also helps us to optimize medications, to make sure that we are getting the most benefit from the ones that the patient is on. And if there are any opportunities to remove or decrease unnecessary medications. And finally, we have a dedicated medical assistant, Beth, who is our Swiss army knife, I guess you could say. She is the first line for patients to contact and she can help with anything, whether it's helping the patient work through a cold or a COVID-19 infection or helping them link into resources that they might need as well. So, our team-based approach is very helpful.
We do have longer patient appointments. For all of our followup appointments, we have an hour for each appointment rather than the usual 15 or 20 minutes, you see it in those clinics. This is to make sure that we can address all the patient's concerns as well as come back around, to follow up on their chronic conditions that we've been tracking and managing.
So, we can cover everything. We also make sure that we follow with the patient outside of clinic. We make sure that we schedule in, at least one or two phone calls in between visits. So, we can check on the patient, how are they feeling? How are they doing towards progressing in the goals that we established at the last visit?
And if they have any other concerns that might be on their mind. So, that is a lot of the services that we offer. We also make sure that the patient has a comprehensive care plan that is personalized to their needs, at the end of each visit. We write it out, so, they know exactly what we discussed and what goals we are working together to which.
Host: And so with all of that said, where is the C3 clinic located and how can someone make an appointment?
Dr. Bartkus: Excellent. So that is a very good question. So, we are located in the Alexian Brothers Medical Center, in Elk Grove Village, Illinois. The best way to contact us and to make an appointment is to call us directly. I can give you that phone number now. It is (847) 364-6724. And just to repeat that one more time, 847-364-6724. Go ahead and call our clinic and one of our friendly front desk staff will take your call. He or she will go through a very brief questionnaire with you when you first call in, just to make sure that our C3 clinic is the best option to meet your needs.
Once that's completed, we'll set you up with an appointment usually within the next couple of weeks, maybe a month, but usually we're able to get patients in pretty quickly. If you are talking to your primary care provider or specialist, and you would like them to put in a referral, we certainly do have a referral within the AMITA in the Ascension System.
So, all they need to do, your provider, is just type in C three clinical referral, and we'll pop up, that is not necessary that you have a referral from a physician, but it does expedite things a little bit, but when all else fails, you can always just give us a call at that number and we'll set you up with an appointment.
Host: And then finally Doctor, I've saved the most important thing for last. I know you wanted to give a shout out to your wife, Sarah and your baby, Samantha, right?
Dr. Bartkus: Yes, I would. Yes. So, my little seven month old baby, she's teething right now. And she's eating like a pretty voracious little creature, but she is adorable. And we love her dearly and I want to give a big shout out to my wife, Sarah, who is moving heaven and earth to take excellent care of our family.
Host: All right. So, the shout-out for Sarah and for Samantha who were doing their thing, while you're doing yours here, love it. So, folks the message here, if you're an older person suffering from one or more conditions, physical and or mental or both, AMITA Health's C3 clinic is here for you all under one roof as we've discussed. Dr. Ryan Bartkus, Sarah, baby Samantha, we thank all of you. Thanks again.
Dr. Bartkus: Much thanks to you too. I hope to see you all in clinic.
Host: Indeed. And for more information, please visit amitahealth.org/C3. That's the number three. And if you found this podcast helpful, please share it on your social media. And thank you for listening to, AMITA HealthCast, the podcast from AMITA Health. I'm Joey Wahler.
Joey Wahler (Host): With people living longer than ever, there's an increase in disorders affecting the elderly. And those older, are often afflicted with multiple multiple severe conditions at once.
So, we're discussing how to best coordinate comprehensive care for all of an older person's medical issues. This is AMITA HealthCast, the podcast from AMITA Health. I'm Joey Wahler. Our guest, Dr. Ryan Bartkus who specializes in geriatric medicine for AMITA health at their comprehensive care clinic known as C3.
Dr. Bartkus, thanks for joining us.
Ryan Bartkus, MD (Guest): Pleasure to be with you. Thank you so much for the opportunity to speak with you.
Host: Well you have said that the C3 clinic is kind of like a command center focusing on all of an older patient's various needs. What type of person benefits most from the services there?
Dr. Bartkus: Well right now, our services are geared towards primarily the older population. Right now, our clinic is admitting patients 50 years and older. But more specifically, we're aiming for patients who have a complex medical history. So, those patients who have, for example, numerous health conditions. Conditions that we commonly see include congestive heart failure, pulmonary disease or lung disease, chronic kidney disease, diabetes and so on and so forth. Usually these patients have so many conditions or so many medications, or even so many doctors involved in their care, that becomes very difficult for them to have all their needs met at a typical primary care clinic. So, where we come in, is we act again as that command center, where we can bring these patients into our clinic and help coordinate their care, not only personally manage all of these complex conditions and how they have their interplay between one another, but also we can coordinate with all their other doctors.
We can coordinate with their family members. We can coordinate with pharmacists at their local pharmacy, et cetera, et cetera, et cetera, that we are the ones who can help the patient navigate this complex health system, and help them get the care that they require.
Host: Well, you mentioned some of the conditions that affect people as they get older. Let me hone in on a couple of them. You say by age 90, between 25 and 33% of people will suffer from some sort of dementia. How big a burden does that become both for them and for their families as well?
Dr. Bartkus: Yes. So, this is a tremendous burden on multiple levels, everywhere from, countrywide, where this is a multi-billion dollar tax on the health system, and personally, certainly our patients suffer greatly from loss of not only their cognition, which is the word we use to describe how the brain works and its various capacities, but also in their function, their ability to do things like drive a car or to prepare a meal, or to manage their own medicines or finances. So, this becomes very difficult for the patients, certainly emotionally as they start to change in what they're able to do and how they view themselves as a person, and also on their family members who see their loved one going through these struggles and also are absorbed into these struggles as well. And step in to try to help them. This can lead to a significant burden on the patient and family, as they try to navigate this loss of function for the individual and how to support them and keep them safe and happy in their own home, how to prevent falls or accidents that might really impact their quality of life. So, dementia, across the board, no matter what level you're looking at, is a major detriment to the quality of life, to the individual and family and community and to our nation.
Host: Frailty coming from lost muscle mass in older people can reduce mobility and cause falls. That's a big issue as well, right?
Dr. Bartkus: That is one of the greatest fears that many of our patients face in addition to the loss of memory is the fear of falls and heaven forbid that they fall and break a hip or break some other important bone. Cause it's very hard to recover from that, that the statistics at this point show that if someone falls and breaks a hip, that there's a 40% chance that they may not return to the same level of functional mobility that they had before.
There's a 40% chance that they may not be able to return to their previous level of living, that they might require moving into a assisted living facility or a nursing home rather than staying at home. And even the risk for mortality, for death goes up significantly with a broken hip. So, these falls and frailty and weakness, that is just one example of how it can greatly impact a patient's quality of life.
Host: One issue for people as they get older that I think maybe gets lost in the shuffle sometimes; older people often isolate themselves, socially. And with COVID-19 bringing increased isolation in general, how big a problem is getting older patients, what they need, things like medicine and doctor visits?
Dr. Bartkus: It is a tremendous problem. Even before the pandemic, the risk for our older patient population, not being able to access the resources that they need, that was a significant problem. A lot of patients at baseline, have trouble finding transportation, for example. Many of them, can not drive or have willingly given up their ability to drive. So, they have to arrange for transport. A lot of times going to a busy shopping centers, for example, can be difficult and disorienting. So, at baseline it's difficult for these patients often to access what they need. Then when you add on the pandemic on top of things that these patients rightfully so, very afraid of getting sick with this illness. That's it's definitely been shown that, COVID-19, severely impacts the older population, that they are at much greater risk for severe illness and death. So, understandably, a lot of them further self-isolate. That they move away from social engagements, meeting family and friends outside of the home.
Many of them have difficulty using online resources like Zoom, for example, that is just not as intuitive. So, it can be difficult for them to utilize resources like that. Certainly going to the grocery store, or trying to go to a health club to exercise, to maintain their strength, that becomes risky so, that they're not able to do that. And while some of these patients, have the benefit of family and friends who can come and visit with them or deliver groceries for them, or provide these needs for them, many of our patients do not have that support. Some of them are widowed or single. Some of them do not have family in the region, some of them, have close friends who must also self-isolate. So, they don't have those social opportunities. They don't have someone to fall back on who could help transport them to a doctor's visit or transport them to the grocery store or pick up, needed resources for them. So, it really has been, a major detriment, this COVID-19 pandemic for older patients and their ability to access what they require.
Host: And Doctor, another often overlooked condition for older people, often coupled with physical problems, mental issues, mental health, the need to maybe see a therapist, a psychiatrist because of depression. Obviously, as people get older, they have these physical ailments that creep up on them, as well as various people in their life dying off. There are a lot of issues that they're facing for the first time. And that can mean needing a mental professional as well as physical, right?
Dr. Bartkus: Correct. Yes. Certainly as our population ages, we see not only memory changes, but yes mood changes. The brain is a very complex organ and as we age, just like a muscle or a bone, it changes. And the chemical messages that go from one brain cell to the other, they don't always work as they should. So, that can lead to the memory changes we discussed before, but yes, also to mood changes. So, you can see more depression, more anxiety, things of that sort. And that has significant repercussions in how a patient is motivated to care for him or herself. How they handle things like pain. For example, anxiety can greatly worsen one's level of pain control. So it really impacts one's whole healthcare.
So yes, it does become important to seek timely, and adequate mental health support. A lot of primary care physicians, including myself, get a lot of training in how to address common psychiatric conditions like depression and anxiety. So, usually a good place to start is seeing your primary care physician and they can usually guide you.
They can start with common treatments, whether it is referring you to a therapist, whether it's starting a common medication for depression or anxiety, things of that sort. There are certainly situations where a patient might benefit from a specialist. So, a psychiatrist or a psychologist in which case your primary care provider can make that referral.
But yes, it is very important to address the whole person, not only physical, but the emotional and mental health, to make sure that we get the best outcomes and best optimize the patient's quality of life.
Host: And speaking of addressing the whole person as you put it, AMITA Health's C3 clinic, which we've mentioned, offers really a multidisciplinary medical team and also longer appointments when people show up, just a few of the things that separate it from a standard primary care facility, right?
Dr. Bartkus: Yes. So, certainly we are very proud of our, our C3 clinic. And I think this is a good opportunity to discuss some of the added benefits that we have. So, we certainly have the mainstays of any primary care clinic; we have our front desk staff and trained nurses, access to labs and x-rays, other studies, things of that sort.
But in addition to that, we fully acknowledge that for our particular patient population, who usually have more medical conditions, have more medications, have more needs that we need a little bit extra, a little bit more, to make sure that they have all of their needs met. So, the C3, the, the backbone of our clinic, is that we work as a multi-disciplinary team. So, not only will you get to see me, the doctor, you'll also get to see my team members as well and regularly interact with them. Specifically, we have a case manager and a social worker. Her name is Chris. She does an excellent job helping us to coordinate with all of the people involved in the patient's care team.
That we coordinate with other doctors in the health system. And also outside of the health system. We coordinate with other social workers. We coordinate with resources in the community that the patient might need, and could greatly benefit from. We also have a pharmacist whose name is Katie, and she really works closely with our patients to make sure that she knows all of the medicines they're taking, how the medications might be interacting with one another, so we can avoid side effects. And also helps us to optimize medications, to make sure that we are getting the most benefit from the ones that the patient is on. And if there are any opportunities to remove or decrease unnecessary medications. And finally, we have a dedicated medical assistant, Beth, who is our Swiss army knife, I guess you could say. She is the first line for patients to contact and she can help with anything, whether it's helping the patient work through a cold or a COVID-19 infection or helping them link into resources that they might need as well. So, our team-based approach is very helpful.
We do have longer patient appointments. For all of our followup appointments, we have an hour for each appointment rather than the usual 15 or 20 minutes, you see it in those clinics. This is to make sure that we can address all the patient's concerns as well as come back around, to follow up on their chronic conditions that we've been tracking and managing.
So, we can cover everything. We also make sure that we follow with the patient outside of clinic. We make sure that we schedule in, at least one or two phone calls in between visits. So, we can check on the patient, how are they feeling? How are they doing towards progressing in the goals that we established at the last visit?
And if they have any other concerns that might be on their mind. So, that is a lot of the services that we offer. We also make sure that the patient has a comprehensive care plan that is personalized to their needs, at the end of each visit. We write it out, so, they know exactly what we discussed and what goals we are working together to which.
Host: And so with all of that said, where is the C3 clinic located and how can someone make an appointment?
Dr. Bartkus: Excellent. So that is a very good question. So, we are located in the Alexian Brothers Medical Center, in Elk Grove Village, Illinois. The best way to contact us and to make an appointment is to call us directly. I can give you that phone number now. It is (847) 364-6724. And just to repeat that one more time, 847-364-6724. Go ahead and call our clinic and one of our friendly front desk staff will take your call. He or she will go through a very brief questionnaire with you when you first call in, just to make sure that our C3 clinic is the best option to meet your needs.
Once that's completed, we'll set you up with an appointment usually within the next couple of weeks, maybe a month, but usually we're able to get patients in pretty quickly. If you are talking to your primary care provider or specialist, and you would like them to put in a referral, we certainly do have a referral within the AMITA in the Ascension System.
So, all they need to do, your provider, is just type in C three clinical referral, and we'll pop up, that is not necessary that you have a referral from a physician, but it does expedite things a little bit, but when all else fails, you can always just give us a call at that number and we'll set you up with an appointment.
Host: And then finally Doctor, I've saved the most important thing for last. I know you wanted to give a shout out to your wife, Sarah and your baby, Samantha, right?
Dr. Bartkus: Yes, I would. Yes. So, my little seven month old baby, she's teething right now. And she's eating like a pretty voracious little creature, but she is adorable. And we love her dearly and I want to give a big shout out to my wife, Sarah, who is moving heaven and earth to take excellent care of our family.
Host: All right. So, the shout-out for Sarah and for Samantha who were doing their thing, while you're doing yours here, love it. So, folks the message here, if you're an older person suffering from one or more conditions, physical and or mental or both, AMITA Health's C3 clinic is here for you all under one roof as we've discussed. Dr. Ryan Bartkus, Sarah, baby Samantha, we thank all of you. Thanks again.
Dr. Bartkus: Much thanks to you too. I hope to see you all in clinic.
Host: Indeed. And for more information, please visit amitahealth.org/C3. That's the number three. And if you found this podcast helpful, please share it on your social media. And thank you for listening to, AMITA HealthCast, the podcast from AMITA Health. I'm Joey Wahler.