Outpatient Services and Primary Health Care

1
Outpatient Services andPrimary Health Care

• Heidi Kinsell
• Manager, Academic Programs
• Health Services Administration

2
Overview for Today

• Outpatient Care
• Primary Care
• What are key issues?

3
Some Key Terms

• Outpatient Services
• Ambulatory Care
• Primary Care

4
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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Trends to Watch

• 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

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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
• Main health care provider in non-emergency
  situations
• Secondary Care
• Specialist 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