Chronic Disease Management Clinic in Stoughton, MA

At Centered Primary Care, we are dedicated to providing exceptional chronic disease management tailored to the unique needs of each patient. Our approach is comprehensive and patient-centered, focusing on enhancing the quality of life for individuals dealing with long-term conditions. Dr. Roberto Amado, MD, MHA, and his team believe managing chronic diseases requires a proactive approach focused on prevention, early detection, and ongoing care to prevent progression and minimize complications.

Our practice believes in the power of collaboration, bringing together healthcare providers, patients, and their families to form a strong support system. This partnership empowers patients to take an active role in their health management. Education is a cornerstone of our approach, as we strive to equip patients with the knowledge they need to understand their conditions, adhere to medication regimens, make beneficial lifestyle changes, and recognize warning signs of potential health issues. By fostering an environment of informed decision-making, we help patients gain control over their health.

We offer individualized care plans designed to meet the specific needs of each patient. These plans include regular monitoring through scheduled check-ups to ensure we stay ahead of any potential complications. Our multidisciplinary team collaborates to provide a holistic approach to disease management, addressing not only physical health but also emotional and social well-being.

At our practice, we support patients in adopting healthier lifestyle choices, such as balanced diets, regular exercise, smoking cessation, and stress management. These changes help control symptoms, reduce complications, and improve overall health. Our goal is to minimize the impact of chronic conditions on daily life, prevent disease progression, and empower patients through education, personalized care plans, and regular monitoring to achieve better health outcomes and lead fulfilling lives.

At Centered Primary Care, we are committed to providing comprehensive and personalized care for patients with multiple chronic conditions through our Chronic Care Management (CCM) program. Our practice is dedicated to ensuring that each patient receives coordinated and continuous care to enhance their overall health and quality of life. A CCM program is specifically designed for patients who are managing two or more chronic conditions that are expected to last at least 12 months or until the end of life. These conditions often pose significant risks such as potential exacerbations, functional decline, or even life-threatening complications if not properly managed. We aim to mitigate these risks by offering structured and proactive care.

A wide array of qualifying conditions, including diabetes, hypertension, and heart disease, require vigilant monitoring and management to prevent complications. Patients with asthma and chronic obstructive pulmonary disease (COPD) also receive specialized care, with a focus on strategies to reduce hospitalizations and emergency visits.

Comprehensive care is essential for patients with heart failure, coronary artery disease, and chronic kidney disease, addressing their complex health needs.

Care plans are tailored for patients with neurological disorders such as dementia, Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis, addressing their progressive nature and unique needs. Expertise is also provided in managing various forms of arthritis, including rheumatoid arthritis and osteoarthritis, to help patients maintain mobility and effectively manage pain.

Support is also provided for patients undergoing cancer treatment, ensuring access to long-term care, symptom management, and consistent medical attention for those living with HIV/AIDS. At our practice, we evaluate each patient’s health status to create a personalized care plan. Our ultimate goal is to facilitate seamless care coordination, improve health outcomes, and reduce the necessity for emergency care or hospital admissions through effective chronic condition management.

When you are first diagnosed with a chronic condition, our team will work closely with you to establish a detailed treatment plan. During this initial phase, you may need to consult more frequently to ensure that your treatment is on the right track and to monitor your progress closely. Our goal is to partner with you to stabilize your condition efficiently and effectively.

As your condition becomes more stable, the frequency of your visits may decrease. Typically, for well-managed chronic conditions, a visit every three to six months may be sufficient. These visits, for example, enable us to check your blood sugar levels and modify your medication as necessary if you have diabetes. Similarly, if you have heart disease, regular check-ups will help us ensure that your medications are effective and your heart health is maintained.

In some situations, more frequent visits may be necessary. If symptoms are uncontrolled, there are significant changes in a condition, or after a recent hospitalization, additional support and monitoring may be needed. It is also encouraged for patients starting a new medication regimen to schedule more frequent appointments to assess effectiveness and make timely adjustments.

Conversely, if your chronic condition is stable and well-managed, our emphasis shifts to empowering you with tools for regular self-monitoring and lifestyle modifications, complemented by periodic professional evaluations. This approach ensures continued stability and quality of life.

We believe that the frequency of doctor visits should be personalized to suit your individual health needs and circumstances. Our team is committed to open communication, ensuring that your management plan is both effective and convenient. Regular check-ups are an integral part of maintaining your health, even if you feel well, as they allow us to detect potential issues early and make necessary adjustments to your treatment.

We recognize the critical importance of chronic disease management in enhancing the health and well-being of our patients. Specializing in patient-centered care, we are dedicated to providing personalized and proactive healthcare solutions for individuals living with long-term conditions.

Our approach to chronic disease management is built on the foundation of preventing disease progression and improving patient outcomes. By offering regular monitoring and crafting tailored treatment plans, we empower our patients to manage their conditions effectively. Our team of healthcare professionals works closely with patients to implement a combination of medication management, lifestyle modifications, and routine check-ups, aimed at stabilizing health conditions and reducing the risk of serious complications like heart attacks or strokes.

At Centered Primary Care, we focus on patient education and self-care to empower individuals to manage their health. By providing valuable insights on conditions, early warning signs, and healthy lifestyle choices, we help patients make informed decisions for better health. Contact us or schedule your appointment to start your journey toward better well-being. We are conveniently located at 966 Park Street, Suite B6, Stoughton, MA 02072. We serve patients from Stoughton MA, Avon MA, Canton MA, Walpole MA, Easton MA, Abington MA, and surrounding areas.