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Outpatient Services and Primary Health Care

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  • 1. Outpatient Services and Primary Health Care Christy Harris Lemak, Ph.D Associate Professor 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
  • 5. 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
  • 6. Outpatient Care = Growth!  All trend lines are up, up, up  Why?  Reimbursement changes  Payments  Utilization controls  New technologies  Patient preferences
  • 7. 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.
  • 8. 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
  • 9. The Health Services System  Preventive Care  Primary Care  Secondary Care  Tertiary Care  Restorative Care  Continuing Care
  • 10. The Health Services System  Preventive Care  Primary Care  Secondary Care  Tertiary Care  Restorative Care  Continuing Care
  • 11. 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
  • 12. 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)
  • 13. Primary Care  Three key elements  Point of Entry  Coordination of Care  Essential Care
  • 14. 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?
  • 15. 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)
  • 16. Essential Care  Meeting needs to optimize population health  What is population health?  Why do we care?
  • 17. 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
  • 18. Who Provides Primary Care?  Physicians  Doctors  Extenders  Nurses  Ancillary  Alternative
  • 19. Physicians  PCPs (Primary Care Physicians)  Typically…  Family Practice  General Internal Medicine  Pediatrics  Obstetrics & Gynecology  Others  Controversy  Who?  Specialized primary care training?
  • 20. 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
  • 21. Doctors  Allopathy  Osteopathy  Optometry  Psychology  Podiatry  Pharmacy
  • 22. Physician Extenders or Nonphysician Practitioners  Nurse Practitioners  Physician Assistants  Nurse Midwives  Social Workers  Nutritionist
  • 23. 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
  • 24. Primary Care Tools  Clinical guidelines  Disease management  Case management  Pharmacy care management  Others
  • 25. Future Trends/Issues  The aftermath of September 11, 2001  Mental health needs  Potential for bioterrorism
  • 26. Conclusions