Altamonte Pediatric Associates, a comprehensive Central Florida pediatric health care resource for babies, children, adolescents, teens and their parents, is celebrating 40 years of service. The stable practice has evolved over the last four decades from a small office founded by two local pediatricians to six American Academy of Pediatrics (AAP) fellows and six pediatric certified nurse practitioners and physicianassistants serving patients via three office locations in Seminole and Orange Counties: Altamonte Springs, Apopka, and Lake Mary. While much has changed over the years, patients continue to receive the same high-quality easily accessible personal care the practice has offered from the start. The practice is continually committed to delivering quality compassionate care and serving as a medical home, while offering a wide range of services aimed at increasing convenience while reducing the need for referrals and urgent care visits.
Convenient Quality Extended Pediatric Services
Altamonte Pediatric Associates offers regular well-child health supervision examinations, urgent visits for illness evaluation, consultations for advice on parenting and behavioral issues, as well as visits to manage on-going and chronic conditions. The scope of treatment includes services such as vaccinations, treatment of respiratory and infectious illnesses, injuries, preventive health care, and management of other issues such as attention deficit hyperactivity disorder. Care begins with the newborn visit in the hospital and the final visit is usually the physical exam after high school before the patient goes off as a young adult to college or the work force.
During periodic health wellness exams, the pediatrician, staff, and parents partner to ensure the child’s health is optimum. Staff evaluate the patient, perform and interpret lab work, and communicate results to parents. The parents, patient, and doctor typically discuss growth and development, any health issues that the patient or parent may be experiencing, and anticipatory guidance.
The practice makes a significant effort to offer quality services in a convenient accessible manner. Office facilities are cheerful, child-friendly, and clean with separate reception areas for ill and well children. Additionally, a separate newborn reception area is available in the Altamonte facility. Patients are escorted to examination rooms within fifteen minutes of their scheduled appointment time. Convenient hours including evening and weekend hours for busy families and emergencies are available. Offices are open six days a week, until 8:30 p.m. many evenings. Pediatricians and nurses are available by phone 24 hours a day, seven days a week, 365 days a year.
Additionally, the practice has made electronic medical records a priority to maximize the quality and efficiency of patient care by improving documentation and communication between collaborating physicians and offices. Brian Harris, M.D. F.A.A.P., medical director of the practice, says, “ Despite having three offices and a large staff, our patients’ charts will always be available and updated.”
The comprehensive practice offers extended services in an effort to increase convenience for families by avoiding referrals and additional time consuming or expensive visits. In-house staff can perform most cultures such as strep and urine. The patient’s family is contacted within within 48 hours with results and next steps. Most of what typically arises in children can be handled in house. Everything from suturing lacerations to setting simple fractures to draining abscesses and even circumcision can be handled in the office. In addition, the practice can address significant issues such as attention deficit hyperactivity disorder, asthma, vision and bilirubin testing, and concussions without a referral.
Attention Deficit Hyperactivity Disorder
According to the United States Center for Disease Control’s (CDC) National Survey of Children’s Health, 11 to 13 percent of Florida’s youth ages 4 to 17 were reported to have been diagnosed with Attention Deficit Hyperactivity Disorder (ADD/ADHD) in 2011. This is a statistic that is continually increasing in recent years, raising concern. In fact, the CDC reports, “ADHD is one of the most common neurodevelopmental disorders of childhood.” The disorder is exhibited in one of three forms. Some children experience predominantly inattention alone. Others experience mostly hyperactivity and some have a combination of difficulty paying attention along with hyperactivity. Additionally, it affects boys more than girls. Regardless, Wayne Soven, M.D. F.A.A.P, a dedicated in-house ADD/ADHD specialist at Altamonte Pediatric Associates and his team are available to help. Families can conveniently obtain both a diagnosis and treatment without leaving the office. Once a diagnosis is made, records are updated electronically to reflect new treatment plans, medications, therapies and other considerations.
Asthma is another condition greatly affecting youth. The Florida Department of Health recently stated in Burden of Asthma in Florida that 21 percent of public high school students reported lifetime asthma in 2011. Statistics such as these caused Altamonte Pediatric Associates to dedicate efforts to diagnosing and treating asthma in house. Pulmonary functioning testing is accessible in all 3 offices without a referral for diagnosis and treatment of asthma. When undergoing this testing, patients breathe into a spirometer which records information about how efficiently the lungs are working. This information allows doctors to determine whether a patient has asthma and whether treatments are working. Asthma is treated by controlling the patient’s environment and with long term and quick relief medications that often come in the form of an inhaler, nebulizer, or pill. The practice stocks nebulizers in the office so patients can take one home and achieve relief immediately.
Altamonte Pediatric Associates offers advanced vision screening in office with PediaVision. This superior technology allows for much more accurate data regarding a patient’s vision than the traditional eye chart. Eye charts rely on verbal skills, cognition, and honesty to verbalize and interpret what the eyes see. This can be problematic for diagnosing vision difficulties in children. In seconds, PediaVision can detect vision issues such as near-sightedness, far-sightedness, and astigmatism. It can also detect anisometropia, a condition where the eyes perform at varying degrees of accuracy. This technology is effective in patients as young as one year old. The practice offers this advanced technology because vision can significantly impact the development of a child. In fact, experts say nearly 80 percent of learning is achieved visually. From a school-age child learning to read to a toddler simply observing the world around them, clear vision is necessary for a child to reach his or her full potential.
Newborn babies commonly experience jaundice or yellowing of the skin and eyes caused by abnormally increasing bilirubin levels in the blood following birth. In most people, the liver removes bilirubin from the blood, but the liver in some newborn babies may not eliminate bilirubin appropriately from the start. High bilirubin levels can cause brain damage leading to issues such as deafness or cerebral palsy. For this reason, it is important that babies’ bilirubin levels be monitored. Babies often leave the hospital as early as one to two days after birth and need to be monitored for jaundice after leaving since it can develop several days after birth. Altamonte Pediatric Associates can perform the heel prick blood test in office eliminating the need to take the baby back to the hospital or to a commercial lab full of other patients . This is convenient for new mothers and aids in limiting the new baby’s exposure to germs while his or her immune system is immature.
Altamonte Pediatric Associates also provides concussion evaluation and follow-up for youth athletes. Much has been learned in recent years regarding recovering from concussions. As a result, the practice utilizes the Sport Concussion Assessment Tool (SCAT) for evaluation, protocols, and follow up. The result is much more careful observation and consideration as an injured athlete returns to school, exercise, and sports. The brain is given ample time to rest and heal with careful observation following concussions. Cognitive rest is critical and conducive to a successful return to physical activity and Altamonte Pediatric Associates plays a critical role in ensuring a complete recovery.
Altamonte Pediatric Associates: A Comprehensive Medical Home
Janet Belton, M.D., F.A.A.P., a pediatrician at Altamonte Pediatric Associates, says, “The distance between doctors and patients continues to increase and we don’t want to simply be a provider.” Altamonte Pediatric Associates’ mission is to serve as a convenient accessible medical home for patients. The goal is to be a complete resource for patients and their families, eliminating the need to fragment care by visiting urgent care centers, after hours clinics, labs, and emergency rooms. With the scope of services offered, referrals are reduced. Operating under the medical home philosophy, the practice provides the highest level of care because they truly know each patient and their complete history. When care is fragmented, opportunity for error exists. By serving as a medical home, doctors at the practice can schedule more time and recurrent visits for patients based on their history and needs.
The Florida Agency for Health Care Administration and the Florida Department of Health endorse the medical home model and have partnered with the American Academy of Pediatrics to increase quality of pediatric care through the Florida Pediatric Medical Home Demonstration Project. Altamonte Pediatric Associates was appointed one of 24 practices in the state to assess and test strategies to increase the quality of health care by operating as a medical home. An overall evaluation is being conducted by the University of Florida to uncover best practices.
Evolution of Health Care
The landscape of health care has changed dramatically since Altamonte Pediatric Associates was founded in July of 1974 by Drs. Edward Zissman and Stephen Albert and by office administrator Phyllis Zissman. Back then, it was the first pediatric practice in south Seminole County and Florida Hospital Altamonte was just opening. Physician’s offices were recording appointments on paper calendars; now they utilize electronic records. Back then, patients had relationships with their doctors that lasted years. Your doctor knew you and your family and you knew his or hers. Unfortunately, it’s become more difficult for doctors to maintain those relationships when patients are forced to leave due to insurance plans. Care has become more fragmented, leaving chances for error.
Families at Altamonte Pediatric Associates, however, have the opportunity to have a medical home; providing accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. For this reason, the practice has become very large, serving thousands of patients in the area. In fact, the practice commonly has multiple family members as patients and frequently treats children of former patients.
Over the years, additional pediatric offices arose in the area, but mergers and acquisitions have become increasingly common consolidating many of those smaller practices into large conglomerates. With these mergers, physicians become employees and often their ability to make their own decisions or implement change is reduced.
Altamonte Pediatric Associates is noteworthy because it is one of the area’s longest standing single-entity practices. This means they make needed decisions and alterations in care when appropriate. The team meets monthly to review recent developments in medical protocols and how the practice can adjust office procedures in response. The team is constantly reviewing new studies and revising procedures given emerging evidence-based medicine. Team members decide collaboratively on how to manage current and future cases. This allows the practice to offer highly personalized services and respond quickly to new research in the field to offer patients up-to-date care. While the practice offers current pediatric medical care by being nimble to respond to advances in the field, care remains quality and grounded by adhering to the guidelines, standards, and recommendations of the American Academy of Pediatrics. The practice has been fortunate to have had an excellent office administrator for its entire forty year existence.
Altamonte Pediatric Associates is actively involved in clinical research through their subsidiary Children’s Research. Most of this research involves vaccine evaluation and infant formula evaluation. Of course vaccinations are administered according to American Academy of Pediatrics schedule, however new research and studies indicate some of the vaccinations can be combined. Parents of new babies are offered the opportunity to participate in a research study that reduces the vaccination schedule by nine injections. Participating patients receive compensation for participating. Blood work is completed to confirm the effectiveness of the study. Participation in studies such as these will likely lead to better vaccination practices becoming widely accepted.
Additionally, the practice now offers the human papillomavirus (HPV) vaccination. This vaccination emerged in recent years as protection for girls against a virus that causes cervical cancer and abnormal pap smears in woman as well as genital warts in males and females. Protection is critical to protect against future infections.
Access to Quality Care for All
Altamonte Pediatric Associates operates under a guiding principle of providing quality pediatric care for all and that includes helping and advocating for the less fortunate. The practice accepts most insurances including most Medicaid or government insurances. Patients with these insurances often have difficulty obtaining high quality care, but Altamonte Pediatric Associates is a place they are welcomed just the same as patients with private insurance. Even if it means not being paid for every procedure, the practice remains diligent in providing the appropriate care to all children regardless of their background. Edward Zissman, M.D., F.A.A.P, practice founder and CEO, says, “Regardless of a family’s situation, we treat all children the same. It’s not the fault of any child which insurance they may or may not have.”
Janet Belton, M.D., F.A.A.P. brings years of mission work to the practice while Dr. Katherine Good, M.D., F.A.A.P. will be joining the practice bringing diverse medical military experience. Additional staff have served in numerous volunteer capacities in the Central Florida community. The practice also has an interest in teaching and has had many nurse practitioner students, medical students, and pediatric residents complete rotations at the office.
One of the biggest political issues facing pediatrics in Florida is that the Florida law that mandates same access to care for all is not being adhered to or enforced. Much of the work these professional organizations are doing involves working to ensure all patients have access to the same care and the practice’s staff are involved in significant volunteer leadership roles in these efforts.
Comprehensive Pediatrics with a Personal Touch
Altamonte Pediatric Associates, has a long history of providing equal access to comprehensive convenient pediatric services while serving as a medical home for Central Florida families. While much has changed in health care during the past 40 years, the practice has always provided the highest quality pediatric medical care while striving to decrease the distance between patients and doctors.