Primary care

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Primary care may be provided in community health centres. Jericho Health Centre 20050326.jpg
Primary care may be provided in community health centres.

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. [1] [2] [3] Patients commonly receive primary care from professionals such as a primary care physician (general practitioner or family physician), a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer (as in parts of Africa), or an Ayurvedic or other traditional medicine professional (as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Contents

Background

The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary healthcare strategy. Primary care involves the widest scope of healthcare, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. Collaboration among providers is a desirable characteristic of primary care.[ citation needed ]

The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit. [4] Common chronic illnesses usually treated in primary care may include, for example: hypertension, angina, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations.[ citation needed ]

In context of global population ageing, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries. [5] [6]

Funding for primary care varies a great deal between different countries: general taxation, national insurance systems, private insurance and direct payment by patients are all used, sometimes in combination. The payment system for primary care physicians also varies. Some are paid by fee-for-service and some by capitation for a list of registered patients. [7]

Primary care by region

Canada

In Canada, access to primary and other healthcare services is guaranteed for all citizens through the Canada Health Act.

Hong Kong

The Hong Kong Special Administrative Region Government's 2016 Policy Address recommended strengthening the development of primary care and establishing an electronic database of the "Primary Care Guide" to facilitate public consultation. The Department of Health developed reference profiles for preventive care for some chronic diseases.[ citation needed ]

In 2017, the policy address recommended the establishment of a primary health care development steering committee to comprehensively review the planning of primary health care services and provide community medical services through regional medical and social cooperation.[ citation needed ]

The 2018 policy address proposed the establishment of the first district health centre and promoted the establishment of district centre in other districts.[ citation needed ]

The Hong Kong Food and Health Bureau established the Primary Healthcare Office on March 1, 2019, to monitor and supervise the development of primary health care services. In the process of developing the district health centers, regional health stations will be set up in various districts as transitional units offering the public with primary care services.[ citation needed ]

Nigeria

In Nigeria, healthcare is a concurrent responsibility of three tiers of government. Local governments focus on the delivery of primary care (e.g. through a system of dispensaries), state governments manage the various general hospitals (secondary care), while the federal government's role is mostly limited to coordinating the affairs of the Federal Medical Centres and university teaching hospitals (tertiary care).general medical[ citation needed ]

Poland

Basic Primary care, (Polish : Podstawowa Opieka Zdrowotna, POZ) is a basic, common element of the health care system in Poland.

The basic health care unit (formerly: health care facility) is a medical entity that provides comprehensive care for people who have declared their willingness to use the services of a family doctor or another doctor who has the right to create an active list of patients. This means treatment and prevention of diseases, rehabilitation, as well as adjudication on the state of health. For a health care center to become a primary care provider, it must also provide care for its health visitor and midwife.[ citation needed ]

Since 2007, only General Practitioners, doctors undergoing specialization in family medicine, and doctors who have previously acquired the right to create an active list due to seniority in POZ before 2007 can be doctors creating active primary care lists. The currently pending proposals of the Ministry of Health, granting the right to create an active list to internists and pediatricians without experience of working in primary care, met with severe criticism of all family medicine organizations.

In organizational terms, POZ can act as:[ citation needed ]

The Act of October 27, 2017 on basic health care (Journal of Laws of 2020, item 172) has been in force since 2017.

POZ clinics are independent companies (except SPZOZ), however, the services they provide are free for insured persons when POZ has a contract with the National Health Fund.

Russia

Primary health care (Russian : Первичная медико-санитарная помощь) in the Russian Federation is free [8] [9] (as part of territorial compulsory health insurance programs).

Primary health care includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle, including reducing the level of risk factors for diseases, and sanitary and hygienic education. Primary health care is provided to citizens on an outpatient basis and in an inpatient setting, in planned and emergency forms. [10]

Types of primary health care:[ citation needed ]

Primary medical health care is provided by general practitioners, district general practitioners, pediatricians, district general pediatricians and general practitioners (family doctors). [9] Primary specialized health care is provided by specialist doctors, including medical specialists from medical organizations that provide specialized, including high-tech, medical care.

United Kingdom

In the United Kingdom, patients can access primary care services through their local general practice, community pharmacy, optometrist, dental surgery and community hearing care providers. Services are generally provided free-at-the-point-contact through the National Health Service. In the UK, unlike many other countries, patients do not normally have direct access to hospital consultants and the GP controls access to secondary care. [11] This practice is referred to as "gatekeeping"; the future of this role has been questioned by researchers who conclude "Gatekeeping policies should be revisited to accommodate the government's aim to modernise the NHS in terms of giving patients more choice and facilitate more collaborative work between GPs and specialists. At the same time, any relaxation of gatekeeping should be carefully evaluated to ensure the clinical and non-clinical benefits outweigh the costs". [12]

United States

As of 2012, there were about six primary care professional societies in the United States, including American College of Physicians, American Academy of Family Physicians, the Society of General Internal Medicine, the American Academy of Pediatrics, the American Osteopathic Association, and the American Geriatrics Society. [13]

A 2009 report by the New England Healthcare Institute determined that increased demand for primary care by older, sicker patients and decreased supply of primary care practitioners has led to a crisis in primary care delivery. The research identified a set of innovations that could enhance the quality, efficiency, and effectiveness of primary care in the United States. [6]

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law is estimated to have expanded health insurance coverage by 20 million people by early 2016 [14] and is expected to expand health care to 34 million people by 2021. [15] The success of the expansion of health insurance under the ACA in large measure depends on the availability of primary care physicians. The ACA has drastically exacerbated the projected deficit of primary care physicians needed to ensure care for insured Americans. According to the Association of American Medical Colleges (AAMC), without the ACA, the United States would have been short roughly 64,000 physicians by 2020; with the implementation of the ACA, it will be 91,000 physicians short. According to the AAMC's November 2009 physician work force report, nationally, the rate of physicians providing primary care is 79.4 physicians per 100,000 residents. [15]

Primary healthcare results in better health outcomes, reduced health disparities, and lower spending, including on avoidable emergency department visits and hospital care. That said, primary care physicians are an important component in ensuring that the healthcare system as a whole is sustainable. However, despite their importance to the healthcare system, the primary care position has suffered in terms of its prestige in part due to the differences in salary compared to doctors that decide to specialize. A 2010 national study of physician wages conducted by the UC Davis Health System found that specialists are paid as much as 52 percent more than primary care physicians, even though primary care physicians see far more patients. [16]

In 2005, primary care physicians earned $60.48 per hour; specialists, on average earned $88.34. [16] A follow-up study conducted by the UC Davis Health System found that earnings throughout the careers of primary care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues. [17] This discrepancy in pay has potentially made primary care a less attractive choice for medical school graduates. In 2015, almost 19,000 doctors graduated from American medical schools, and only 7 percent of graduates chose a career in primary care. [18] The average age of a primary care physician in the United States is 47 years old, and one-quarter of all primary care physicians are nearing retirement. [19] Fifty years ago, roughly half of the physicians in America practiced primary care; today, fewer than one-third of them do. [20]

Projections show that by the year 2033, the population of individuals 65 and older will increase by 45.1%, [21] creating a demand for primary care physicians that is greater than the supply.

The medical home model is intended to help coordinate care with the primary care provider at the center of the patient's healthcare. [22] [23]

Strategies to address the primary care shortage

The Patient Protection Affordable Care Act contains several provisions to increase primary care capacity. These provisions are directed towards medical school graduates and include payment reform, student loan forgiveness programs, and increased primary care residency positions [24] The PPACA also provides funding and mandates to increase the role of mid-level practitioners like physician assistants and nurse practitioners to enhance the primary care workforce. [25] The PPACA is projected to increase patient demand for primary care services. By adopting new patient care delivery models that include physicians working in tandem with physician assistants and nurse practitioners, the demand for future primary care services could be met. [26] Consumer surveys have found the American public to be open to a greater role for physician extenders in the primary care setting. [27] Policies and laws, primarily at the state level, would need to redefine and reallocate the roles and responsibilities for non-physician licensed providers to optimize these new models of care. [26]

According to a FAIR Health analysis, 29 percent of patients who received medical care in the US between 2016 and 2022 did not see a primary care doctor. [28]

Shared-decision making

Involving older patients

There is currently limited evidence to form a robust conclusion that involving older patients with multiple long-term conditions in decision-making during primary care consultations has benefits. [29] Examples of patient involvement in decision-making about their health care include patient workshops and coaching, individual patient coaching. Further research in this developing area is needed.  [ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Medicine</span> Diagnosis, treatment, and prevention of illness

Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US. In Asian countries like India, this term has been replaced mainly by Medical Officers, Registered Medical Practitioner etc.

<span class="mw-page-title-main">Health care</span> Prevention of disease and promotion of well-being

Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

<span class="mw-page-title-main">Physical examination</span> Process by which a medical professional investigates the body of a patient for signs of disease

In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient's medical history followed by an examination based on the reported symptoms. Together, the medical history and the physical examination help to determine a diagnosis and devise the treatment plan. These data then become part of the medical record.

<span class="mw-page-title-main">Clinic</span> Outpatient health care facility

A clinic is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs of populations in local communities, in contrast to larger hospitals which offer more specialized treatments and admit inpatients for overnight stays.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

<span class="mw-page-title-main">Primary care physician</span> US term for medical professional providing first-line care

A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was 'general practitioner' in the US; however in the United Kingdom and other countries the term general practitioner is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote primary care providers.

<span class="mw-page-title-main">Nurse practitioner</span> Mid-level medical provider

A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. One study found that although reasons for referrals to specialists are similar for both physicians and NPs, the quality of documentation in the referrals may be lower for NPs.

In health care, an orphan patient is a patient who has been "lost" within the system or has no primary provider overseeing their care.

A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.

<span class="mw-page-title-main">Clinical pharmacy</span> Branch of pharmacy for direct provision

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors agree to provide enhanced care, including commitments to ensure adequate time and availability for each patient.

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

<span class="mw-page-title-main">Healthcare in Denmark</span> Overview of healthcare system in Denmark

Healthcare in Denmark is largely provided by the local governments of the five regions, with coordination and regulation by central government, while nursing homes, home care, and school health services are the responsibility of the 98 municipalities. Some specialised hospital services are managed centrally.

<span class="mw-page-title-main">Healthcare in Belgium</span> Overview of the health care system in Belgium

Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

An adult-gerontology nurse practitioner (AGNP) is a nurse practitioner that specializes in continuing and comprehensive healthcare for adults across the lifespan from adolescence to old age.

Post-Hospitalist Medicine is the discipline concerned with the medical care of patients residing in Post-Acute, Long-Term Care, Rehabilitation and Assisted Living Facilities. The Physicians whose primary professional focus is the post-hospital medical care of these patients are called Post-Hospitalists.

A retail clinic is a category of walk-in clinic located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services. They are sometimes called "retail-based clinics," "convenient care clinics," or "nurse-in-a-box." Retail clinics in the United States are usually staffed by physician assistants (PAs) or nurse practitioners (NPs) and do not necessarily have a physician physically available onsite. Some, however, are staffed by physicians.

References

  1. ↑ "WHO/Europe – Main terminology". who.int.
  2. ↑ World Health Organization. Definition of Terms. Archived 2011-03-03 at the Wayback Machine Accessed 24 June 2011.
  3. ↑ World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). Geneva. Accessed 24 June 2011.
  4. ↑ World Health Organization. Ageing and life course: Our ageing world. Geneva. Accessed 24 June 2011.
  5. 1 2 Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. Archived 2011-07-11 at the Wayback Machine HealthLeaders Media, May 27, 2009.
  6. ↑ Burch P (19 December 2018). "Funding in primary care". InnovAiT: Education and Inspiration for General Practice. 12 (2): 100–104. doi:10.1177/1755738018805186. S2CID   27415227.
  7. ↑ "Постановление Правительства Российской Федерации от 2 октября 2009 г. № 811 г. "О Программе государственных гарантий оказания гражданам Российской Федерации бесплатной медицинской помощи на 2010 год"" [Decree of the Government of the Russian Federation of October 2, 2009 No. 811 "On the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation for 2010"] (in Russian).
  8. 1 2 "Постановление Правительства Российской Федерации от 21 октября 2011 г. № 856. "О Программе государственных гарантий оказания гражданам Российской Федерации бесплатной медицинской помощи на 2012 год"" [Resolution of the Government of the Russian Federation No. 811 of October 2, 2009 "On the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation for 2010"].
  9. ↑ "Минздрав России подготовил Памятку для граждан о гарантиях бесплатного оказания медицинской помощи" [The Russian Ministry of Health has prepared a Memo for citizens on the guarantees of free medical care] (in Russian). www.rosminzdrav.ru. Retrieved 2019-03-30.
  10. ↑ Royal Commission on the NHS Chapter 7. HMSO. July 1979. ISBN   0101761503 . Retrieved 19 May 2015.
  11. ↑ Greenfield G, Foley K, Majeed A (September 2016). "Rethinking primary care's gatekeeper role". BMJ. 354: i4803. doi:10.1136/bmj.i4803. hdl: 10044/1/40789 . PMID   27662893. S2CID   206912151.
  12. ↑ Klepper B, et al. (2012-10-02). "Strengthening Primary Care With A New Professional Congress". The Health Care Blog. Retrieved 2019-06-15.
  13. ↑ "Health Insurance Coverage and the Affordable Care Act, 2010–2016". ASPE. U.S. Department of Health & Human Services. 2 March 2016. Retrieved 30 May 2017.
  14. 1 2 "AAMC Physician Workforce Policy Recommendations" (PDF). Association of American Medical Colleges.
  15. 1 2 Finney K (25 October 2010). "Wage gap between specialists, primary-care physicians". UC Newsroom. Archived from the original on 30 January 2014. Retrieved 17 April 2013.
  16. ↑ Finney K (18 September 2012). "New Study Identifies Large Gaps in Lifetime Earnings of Specialist and Primary-care Physicians". Archived from the original on 25 June 2018. Retrieved 17 April 2013.
  17. ↑ "Total Number of Medical School Graduates". statehealthfacts.org. The Henry J. Kaiser Family Foundation. 25 June 2019.
  18. ↑ American Academy of Family Physicians (AAFP). Advancing Primary Care". Council on Graduate Medical Education: Twentieth Report. December 2010.
  19. ↑ "The Number of Practicing Primary Care Physicians in the United States". U.S. Department of Health and Human Services. Retrieved 30 May 2017.
  20. ↑ "Primary Care Physician Shortage - South Pointe Healthcare". southpointehealthcare.com. Retrieved 2021-09-16.
  21. ↑ HealthITSecurity (2016-06-03). "Breaking Down the Basics of the Patient-Centered Medical Home". HealthITAnalytics. Retrieved 2019-05-20.
  22. ↑ Wooldridge S (24 April 2019). "Primary care 'medical home' model catching on, slowly". BenefitsPRO. Retrieved 2019-05-20.
  23. ↑ Sommers BD, Bindman AB (April 2012). "New physicians, the Affordable Care Act, and the changing practice of medicine". JAMA. 307 (16): 1697–8. doi:10.1001/jama.2012.523. PMID   22535852.
  24. ↑ Furrow BR (2013). Health law; Cases, materials, and problems. Upper Saddle River: West Publishing Company.
  25. 1 2 Bodenheimer TS, Smith MD (November 2013). "Primary care: proposed solutions to the physician shortage without training more physicians". Health Affairs. 32 (11): 1881–6. doi:10.1377/hlthaff.2013.0234. PMID   24191075.
  26. ↑ Dill MJ, Pankow S, Erikson C, Shipman S (June 2013). "Survey shows consumers open to a greater role for physician assistants and nurse practitioners". Health Affairs. 32 (6): 1135–42. doi:10.1377/hlthaff.2012.1150. PMID   23733989.
  27. ↑ "A Window into Primary Care" (PDF). FAIR Health. 2023-03-15. Retrieved 2023-03-15.
  28. ↑ Butterworth JE, Hays R, McDonagh ST, Richards SH, Bower P, Campbell J (October 2019). "Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations". The Cochrane Database of Systematic Reviews. 2019 (10). doi:10.1002/14651858.cd013124.pub2. PMC   6815935 . PMID   31684697.
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