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

5. 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

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. 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

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 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)

12. 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)

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. 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

17. Who Provides Primary Care? • Physicians/Doctors • Extenders • Nurses • Ancillary • Alternative

18. Physicians • PCPs (Primary Care Physicians) • Typically… • Family Practice • General Internal Medicine • Pediatrics • Obstetrics & Gynecology • Others • Controversy • Who? • Specialized primary care training?

19. 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

20. Physician Extenders or Nonphysician Practitioners • Nurse Practitioners • Physician Assistants • Nurse Midwives • Social Workers • Nutritionist

21. Alternative Medicine Providers • Also known as “complementary medicine” • Examples include… • Chiropractic • Homeopathy, herbal formulas • Acupuncture • Meditation, biofeedback • Spiritual guidance • Others

22. Primary Care Tools • Clinical guidelines • Disease management • Case management • Pharmacy care management • Others

23. 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

24. Conclusions • Primary care is a fundamental component of the health care system today and tomorrow. • http://hsrmp.phhp.ufl.edu