Diabetes, high blood pressure, and high cholesterol often appear together, and each one affects how the others are treated. One care team that tracks your labs, medications, and goals in a single chart can make managing several conditions simpler and more consistent.
Coordinated chronic disease care means one team manages all of your ongoing conditions together, using one chart and one plan. It is designed for adults living with diabetes, high blood pressure, high cholesterol, or kidney changes, especially when more than one of these is present. Our three providers offer this kind of care at our Hudson and Trinity offices, working as one team across both locations.
Chronic conditions often travel together
Diabetes, high blood pressure, and high cholesterol frequently show up in the same person. Each one affects the others. Blood sugar and blood pressure both influence the health of your blood vessels, heart, and kidneys. A medication chosen for one condition may also help, or need adjusting for, another.
When each condition is managed separately, it can be hard to see the full picture. A shared plan gives you and your providers one view of your health, so every decision takes everything else into account.
What coordinated care looks like
With one team, the same providers track your key numbers side by side:
- Your A1C and blood sugar trends
- Blood pressure readings from the office and from home
- Cholesterol levels
- Kidney function labs
- Every medication you take, including those prescribed elsewhere
Because our providers share one chart across both offices, anyone on the team can see your history and recent results. That context helps keep your care consistent from visit to visit. Learn more about our diabetes management and high blood pressure care.
In office testing keeps things moving
Many of the tests used to monitor chronic conditions happen right in our offices. Blood draws and lab work, EKGs with results reviewed the same visit, and blood pressure checks can all be done on site. When results are ready sooner, your provider can adjust your plan sooner, and you make fewer extra trips.
Practical guidance for daily life
Medication is one part of managing a chronic condition. The small choices you make each day matter too. Visits with our team often include practical conversations about:
- Meal planning that fits your tastes, budget, and culture
- Ways to add more movement to your week at a level that feels right for you
- Checking blood sugar or blood pressure at home and what to do with the numbers (see our home blood pressure log guide)
- Sleep, stress, and how they affect your readings
- Taking medications on schedule and managing refills
Progress often comes from steady, realistic steps. Your provider will work with you to set goals that make sense for your life.
Support between visits
For patients with Medicare who have two or more chronic conditions expected to last at least 12 months, Chronic Care Management can add support between office visits. It includes a care plan and care coordination between visits, and it requires your consent. Costs depend on your plan, so call the office to verify your coverage.
You can also use the patient portal to message your care team, view results, and manage refills. For many follow up visits and medication checks, a secure telehealth visit through the Healow app may be an option.
If you are managing more than one condition
You deserve a plan that brings everything together. Ask us about building a single management plan that covers all of your conditions at once. Bring your medication list, any home readings, and recent lab results from other offices to your first visit. Our team will review it all and help you set clear next steps.
Call 911 for chest pain, trouble breathing, sudden weakness or numbness on one side of the body, trouble speaking, or confusion. Very high blood pressure readings with any of these symptoms need emergency care right away.
Schedule a visit with our care team
New patients age 18 and older are welcome at both offices. Appointment availability is determined by the office. Call our Hudson office at (727) 605-3000 or our Trinity office at (727) 997-1635, or request an appointment online to talk about coordinated care for your conditions.
This article is general health information from the Internal Medicine MD care team and is not a substitute for advice from your own provider.
Diabetes Management
Hypertension Control
Chronic Care Management