Outpatient: Detailed Information
Please see the Outpatient Main Page for more information.
Pediatric outpatient providers see patients Monday-Friday from 9 a.m. – 5 p.m. We are responsible for the care of the approximately 1200 chronic pediatric patients on our Chronic Pediatrics Patient Registry (CPP), as well as for the routine care of children in our assigned villages. Outpatient providers are assigned panel villages based on number of patients as well as locations of villages in the area. The goal of scheduling is to have continuity of care within the villages providers serve. Ultimately, providers will attempt to do village trips to assigned villages. Family practice providers, village health aides and the State of Alaska Public Health Nurses who give immunizations and check-ups also do well child visits in the remote villages. All infants who are six – eight weeks of age will have their well child visit and immunizations with a provider in Bethel. This coincides with the maternal 6-week post partum visit.
Pediatric providers perform six-week checks of high risk, chronically ill infants and infants from assigned villages. We provide primary care for the children in assigned villages; family medicine and Emergency Room patients that require pediatric follow up; and cross cover for other pediatricians as our schedule allows or if a parent requests a pediatrician.
Pediatricians provide clinic follow up of patients recently discharged from Alaska Native Medical Center (ANMC) and Providence Hospitals in Anchorage from the NICU, inpatient or PICU services. We evaluate patients en route back to their home villages and provide additional information and prescriptions if needed.
Since some of the well care and routine pediatric illnesses are handled elsewhere, you will find that your clinic patients are usually more complicated and sicker than the patients you would see in a lower forty-eight general pediatrics practice.
Some of the pathology and diseases that you are likely to encounter in the delta are: Seizures, Congenital Adrenal Hyperplasia, Asthma, Bronchiolitis Chronic Lung Disease, Cardiac Lesions, Meningitis, Sepsis, Prematurity, CPT -1 Deficiency, ADHD, Developmental Delay and FASD. It is not unusual for you to contact various subspecialists during a clinic day. If you have a question regarding one of your patients, do not hesitate to contact a specialist for guidance. We are blessed with a whole range of providers who are familiar with our unique patient population available for consult by phone/email that are happy to answer your questions. If you cannot find the subspecialty you need, ask an “old timer” for help.
We are responsible for helping to support Pediatric subspecialty field clinics in Bethel within the following areas: Pediatric Cardiology, Pulmonology, Endocrinology, ENT, Orthopedics, Surgery and Neurology.
If you have a patient that requires one of these specialties you can check to see when the next field clinic is scheduled and place a referral in RAVEN.
If the patient requires an appointment sooner than is available in Bethel you can also send patients to Anchorage to see Pediatric Cardiology, ENT, Urology, Pediatric Gastroenterology, Pediatric Endocrinology, Allergy/Immunology, and Genetics. For patients requiring procedures such as EEG, MRI, swallow study, hip ultrasounds etc. that are not available in Bethel.
Order a referral in RAVEN and send a communication to pediatric case manager who can coordinate the appt., travel, etc. for the patient. Be thorough in filling out the referral form to provide enough information to the consultant. To ensure adequate care for complicated cases, it may be helpful to write a letter summarizing the case and/or have the case manager assistant include a copy of lab and radiology reports with the referral information.
Surgical referrals require an accepting physician. You must consult a surgeon at ANMC via phone if urgent and via telemedicine if non urgent.
All clinic notes should be completed in RAVEN within 24 hours of encounter. Include a brief past medical history and review of systems. Medications and drug allergies should be reconciled on the patient’s chart at every visit. Labs should be clearly documented as well as treatment plan and follow-up instructions. All chronic pediatric patients should have some sort of follow up plan at the bottom. Documentation of parent/patient education should be given as well as the level of education and level of receptivity; it need not be specific but can be more general such as “asthma education provided.” Every note should include documentation of instructions for returning to the clinic or health aide i.e. difficulty breathing in a patient with bronchiolitis.
You will see several cases in the Delta that are unique and/or more severe than those encountered in children in non-Eskimo cultures. Examples are:
- Bronchiolitis / Wheezing – 3-24 Months
- Fever – Infants 0-90 days
- Otitis Media 3 months–12 years
- Pharyngitis, Strep (Group A Strep)
- Septic Arthritis (Septic Joint)
- Skin and Soft Tissue Infections (Abscess, Cellulitis)
- Congenital Adrenal Hyperplasia (CAH)