Outpatient%20Services%20and%20Primary%20Health%20Care

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Outpatient Services andPrimary Health Care

• Christy Harris Lemak, Ph.D
• Associate Professor
• 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
• Home health agencies
• Ambulatory clinics and surgery centers
• Chiropractors, other types of providers
• Neighborhood health centers
• Public health centers/services
• Hospice

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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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Some Trends to Watch

• Telephone and Email visits
• Group visits
• Use of the Internet in various ways
• Information (general, specific)
• Tracking care (conditions, progress)
• Finding providers
• Finding support groups, community
• Increased role of the consumer/patient

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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 Care

• Primary Care
• Secondary Care
• Short-term, sporadic consultation from a
  specialist for expert opinion or surgical/other
  intervention
• Typically includes hospitalization, surgery,
  rehabilitation
• Tertiary Care
• Complex care for conditions that are relatively
  uncommon (usually institution-based and
  technology-driven)
• Can be long-term
• Quaternary Care

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Two Dimensions to Consider

• Type of Care
• Preventive ----- 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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Essential Care

• Meeting needs to optimize population health
• What is population health?
• Why do we care?

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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
• Future
• Growing demand for PCPs
• Income still lower
• New organizational and financial structures
  promoting use of primary care physicians

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Doctors

• Allopathy
• Osteopathy
• Optometry
• Psychology
• Podiatry
• Pharmacy

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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
• Trends
• Growth!
• Growing acceptance by traditional health care
  systems

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Primary Care Tools

• Clinical guidelines
• Disease management
• Case management
• Pharmacy care management
• Others

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Future Trends/Issues

• The aftermath of September 11, 2001
• Mental health needs
• Potential for bioterrorism

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Conclusions