Medical Director’s Report: The Important Role of Primary Care at AFC

Arlington Free Clinic is a truly comprehensive healthcare home where patients receive all they need to get and stay healthy, be that dental or behavioral healthcare, hearing screenings or physical therapy. At AFC, it’s not uncommon for a patient being seen for a medical complaint to not only leave with a prescription, but also a referral for supplemental groceries or housing assistance — or that colonoscopy they’re due for.

At the core of AFC’s model is a strong and well-integrated primary care program, without which we could never sustain such a deep level of services. Patients seen by our dentists, for example, also must have been seen in primary care in the past year. This allows us to ensure that patients in our dental chairs, the majority of whom require deep cleanings (that can dislodge bacteria and be risky for those with cardiac conditions) or dental procedures (where there’s a risk for bleeding in patients on blood thinners) are medically stable to receive oral healthcare.

At AFC, our primary care team — 23 volunteer providers and a staff nurse practitioner — holistically approaches each patient’s healthcare in such a way that past issues (e.g., a high blood pressure reading at their last appointment) and present needs (e.g., preventive health measures such as vaccines and colonoscopies) are being routinely assessed and addressed. Staff nurses and medical assistants play a key role in our model. Their work preparing patient charts in advance of each appointment helps flag important information for the provider and maximizes our ability to deliver care that goes beyond simply addressing the need that brought the patient in.

About 12 years ago, we added a staff family nurse practitioner with the idea that through this position, we would be able to offer timely access to care for acute needs. Over time, this role has evolved to be the template for our whole primary care model and gives us the ability to pilot new practices — like oral health histories and behavioral health screenings in primary care — that have the potential to transform care delivery clinic-wide. Our nurse practitioner also follows patients with episodic issues like an uncontrolled chronic disease and manages healthcare long-term for those who have extremely low health literacy and very complex needs. Good primary care is important for everyone, but the foundational role it plays at AFC cannot be overstated.