Outpatient Services and Primary Health Care Heidi Kinsell Manager, Academic Programs Health Services...
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Transcript of Outpatient Services and Primary Health Care Heidi Kinsell Manager, Academic Programs Health Services...
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Outpatient Services andPrimary Health Care
Heidi Kinsell
Manager, Academic Programs
Health Services Administration
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Overview for Today Outpatient Care Primary Care What are key issues?
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Some Key Terms Outpatient Services Ambulatory Care Primary Care
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Definitions Outpatient Services = those that do not
require overnight hospital stay. Ambulatory Services = services provided
to the “walking” patient. Community Medicine = services provided
in the immediate “community” where patients live
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Where is Outpatient Care Provided? Physician offices Hospital outpatient departments
Diagnostic (e.g. lab, radiology) Therapeutic (e.g. PT, chemotherapy)
Hospital emergency departments Nursing homes, Home health, Hospice Ambulatory clinics and surgery centers Chiropractors Public health centers/services Retail Clinics
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Outpatient Care = Growth! All trend lines are up, up, up Why?
Reimbursement changes Payments Utilization controls
New technologies Patient preferences
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Important Considerations Outpatient services are delivered….
In a variety of settings By various types of providers For various conditions
Acute Chronic Preventive Primary, secondary, tertiary Etc.
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Retail Clinics Use of the Internet in various ways
Information (general, specific) Tracking care (conditions, progress) Finding providers, support groups, “community”
Increased role of the patient/consumer “Medical Home” Email and Phone visits
Trends to Watch
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The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care
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The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care
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Understanding Primary CarePrimary Care
Main health care provider in non-emergency situations
Secondary CareSpecialist for expert opinion or surgical/other
intervention.Tertiary Care
Complex care for relatively uncommon conditions (usually institution-based and technology-driven)
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Two Dimensions to Consider Type of Care
Preventive-- Coordination-- Continuing
Location of Care Inpatient --- Outpatient With various inpatient sites (e.g. hospital,
nursing home) and outpatient locations (e.g. physician office, surgery center, home)
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Primary Care Three key elements
Point of Entry Coordination of Care Essential Care
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Point of Entry First contact with health care system Gatekeepers
Patients come “through” primary care physicians to hospitals and specialists Con: Limits care? Pro: Prevents unnecessary care?
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Coordination of Care PCPs coordinate delivery of care from
many sources Patient advisors, patient advocates Ensure continuity and comprehensiveness The Evidence
this works (better health outcomes) people prefer it (patient satisfaction)
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Ideal Attributes of Primary Care Integrated Coordinating Continuity of care Accessibility
Remove barriers of geography, financing, race, language, culture
Accountability For both patients and providers
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Who Provides Primary Care? Physicians/Doctors Extenders Nurses Ancillary Alternative
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Physicians PCPs (Primary Care Physicians) Typically…
Family Practice General Internal Medicine Pediatrics Obstetrics & Gynecology Others
Controversy Who? Specialized primary care training?
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PCP Trends Historically
over-supply of specialists Bias towards specialists and sub-specialists Follow the money
Now/Future Growing demand for PCPs Income still lower New organizational and financial structures
promoting use of primary care physicians
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Physician Extenders or Nonphysician Practitioners
Nurse Practitioners Physician Assistants
Nurse Midwives Social Workers Nutritionist
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Alternative Medicine Providers Also known as “complementary medicine” Examples include…
Chiropractic Homeopathy, herbal formulas Acupuncture Meditation, biofeedback Spiritual guidance Others
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Primary Care Tools Clinical guidelines Disease management Case management Pharmacy care management Others
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Future Trends/Issues Will the system “adjust” to appropriate
mix of primary & speciality care?
Enough primary care physicians in the right places? (Rural, Urban)
Healthcare Reform-GME payments
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Conclusions Primary care is a fundamental component
of the health care system today and tomorrow.
http://hsrmp.phhp.ufl.edu