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Outpatient Services andPrimary Health Care
Christy Harris Lemak, Ph.D
Associate Professor
Health Services Administration
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
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
Outpatient Care = Growth! All trend lines are up, up, up Why?
Reimbursement changes Payments Utilization controls
New technologies Patient preferences
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.
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
The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care
The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care
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
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)
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?
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)
Essential Care Meeting needs to optimize population
health What is population health? Why do we care?
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
Physicians PCPs (Primary Care Physicians) Typically…
Family Practice General Internal Medicine Pediatrics Obstetrics & Gynecology Others
Controversy Who? Specialized primary care training?
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
Physician Extenders or Nonphysician Practitioners
Nurse Practitioners Physician Assistants
Nurse Midwives Social Workers Nutritionist
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
Primary Care Tools Clinical guidelines Disease management Case management Pharmacy care management Others
Future Trends/Issues The aftermath of September 11, 2001
Mental health needs Potential for bioterrorism