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98 Cards in this Set
- Front
- Back
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Primary Care
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– First contact care
– Care over time in sickness and health – Coordinative function – Highly personalized |
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Definition of a Primary Care Physician
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A generalist that provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient’s care.”
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A generalist that provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient’s care.”
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Osteopathic primary care is the definitive care provided to a patient from the point of first contact by a generalist, with the continuing responsibility for providing the patient's care. It recognizes the interrelationships of body, mind, and spirit as well as structure and function, and incorporates all accepted means of promoting prevention, patient education and recovery from illness through intrinsic healing and the use of medications, surgery and osteopathic manipulation.”
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Primary care medicine includes which specialties
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Family Practice
Internal medicine Pediatrics |
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Discipline
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Field of study
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Specialty
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– a particular occupation or branch of learning
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Specialist
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– One who devotes themselves to a special occupation or branch of learning
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What are the requirements to be a primary care physicians?
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-Must be a generalists
-Training of generalist include at least 90% of the key diagnoses |
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Family Practice
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is a medical specialty based on the discipline of Family Medicine
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Pediatrics and Internal Medicine
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are the specialties of their respective disciplines
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AOA Definition of Internal Medicine
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“ The practice of internal medicine is devoted primarily to the application of subjective, objective, laboratory, and all appropriate procedures in studying and evaluating the afflictions, diseases, and functional disorders of the circulatory, respiratory, digestive, endocrine, metabolic, musculoskeletal hematopoietic, and eliminative systems of the human body to (1) The correlation of data thus secured with clinical observations to reach diagnostic conclusions; (2) The management of cases within this field by the utilization of all appropriate procedures; (3) Assistance in planning the therapeutic utilization of the techniques of other specialty branches of medical and surgical practice in the care of patients.”
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Definition of Pediatrician
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“Pediatricians focus on the physical, emotional, and social health of infants, children, adolescents, and young adults from birth to 21 years. Developmentally oriented and trained in skilled assessment, their patient-care lens is focused on prevention, detection, and management of physical, behavioral, developmental, and social problems that affect children. Pediatricians diagnose and treat infections, injuries, and many types of organic disease and dysfunction. They work to reduce infant and child mortality, foster healthy lifestyles, and ease the day-to-day difficulties of those with chronic conditions. With structured evaluation and early intervention, pediatricians identify and address developmental and behavioral problems that result from exposure to psychosocial stressors. They appreciate the vulnerability of childhood and adolescence, and actively advocate for measures to protect their health and safety.” - http://www.aap.org/profed/Peds101.pdf (an AAP online brochure available also in print entitled Pediatrics 101 – Revised April 2003)
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WVSOM Definition of Family Medicine
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Family Medicine is a discipline of Osteopathic Medicine dealing with all aspects of care of the entire family from birth to death.”
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ACOFP Definition of an Osteopathic Family Physician
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A physician whose training and experience qualify him/her to practice in fields of medicine and surgery and to accept the continuing responsibility of the patient and/or the family as a whole”
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Family
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A household
A group of people under one roof A group of people of common ancestry A significant group of intimates with a history and a future |
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Family
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Affinity
Intimacy Reciprocity Continuity Primary Care Physicians note these four factors in their relationships with their patients |
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Affinity
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joined by interpersonal bonds
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Intimacy
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willing to expose ones vulnerabilities
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Reciprocity
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sharing between members
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Continuity
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expectation that the relationship will continue
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Scope of Responsibility
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Continuity of care
Closeness to patient Interactions with family Familiar with patient’s past Chronic care Cost effective care Comprehensive care Preventive care Effective use of interpersonal skills Maintain confidentiality Accessibility Maintain diagnostic skills Coordinator of care Community Family |
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Comprehensive Care
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Manages the majority of patient’s problems
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Interpersonal skills-
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compassion, empathy, maintain dignity, provide insight, gather information rapidly, organize, listen, motivate, detect non-verbal cues.
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Accessibility
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patients must be able to reach you
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Maintain diagnostic skills
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very important but ¼ of all patients never assigned a diagnosis as resolution occurs first.
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Coordinator
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pt’s access to health care, overall care, care among providers, tie multiple findings and treatments into a single plan.
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Community
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COPC (community oriented primary care) evaluate the health problems of the community because they contribute to the poor health of your patient. Ex access to care due to poor transportation, smoking.
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Family
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Patients and yours
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Scope of Responsibility of an Osteopathic Family Physician
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The Osteopathic Family Physician must take into account the basic principles of Osteopathy, prevention and screening, coordination of care, continuity of service and family and community dynamics.”
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Scope of Practice
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Varies according to:
Community needs Patient needs Physician’s training 2/3rds are seen each year |
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6 Aims of the 21st – Century Health Care System
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Safe
Effective Patient-Centered Timely Efficient Equitable |
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List the components for the chronic care model
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Community
-resources and policies Health System -Health Care Organization The above two will combine to make: -self-management support -Delivery system design -decision support -Clinical information system The above 4 items will make the physician prepared, proactive and part of a practice team and then the physician will utilize these resources to have a productive interaction with the patient outcome: INFORMED AND ACTIVATED PATIENT!!! |
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Self-Management Support
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Empower and prepare the patient to manage their care
Emphasize patient’s central role in their health Self-management strategies Goal-setting Development of action plans Assist the patient with problem solving Follow-up Help develop an environment which assist the patient with self-management Organize resources to provide support |
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Why is self-management so important? What is different?
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Clinical outcomes are dependent on patient actions.
Patient self-management is inevitable. The provider’s role is to be in partnership with the patient Professionals are experts about diseases, patients are experts about their own lives |
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What is self-management support
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Effective self-management support means more than telling patients what to do. It means acknowledging the patients’ central role in their care, one that fosters a sense of responsibility for their own health. It includes the use of proven programs that provide basic information, emotional support, and strategies for living with chronic illness. Self-management support can’t begin and end with a class. Using a collaborative approach, providers and patients work together to define problems, set priorites, establish goals, creates treatment plans and solve problems along the way.
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What is self-management support?
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Self-management support is what health caregivers do to assist and encourage patients to become good self-managers.
Early definition of self-management support (Thomas Creer): “including patients in their own care.” |
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How to emphasize the patient’s role
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Simple messages from the primary care provider: “Diabetes is a serious condition. There are things you can do to live better with diabetes and things the medical team can do to assist you. We are going to work together on this.”
Consistent approach Culturally and linguistically appropriate |
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How has the approach to healthcare changed?
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-Increased Longevity, therefore, More People with Chronic Conditions
-Increased Complexity of Care -Emphasis on Management vs. Short Term Treatment -Continuous care vs. Episodic Care -Team concept vs. Single provider |
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The Health Care System in Crisis
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Quality is less than expected
International comparisons RAND studies in adult and pediatrics Hospital errors and quality studies Costs are high and continuing to rise Cost per year per family exceeds minimum wage earnings (>12,000) Cost 40%> than other equivalent countries Negative correlation between cost and quality (Fisher, MedPAC) Purchasers, patients and physicians (especially primary care) all highly dissatisfied with current status of health care |
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Patient-Centered Medical Home Principles
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Personal Physician
Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and Safety Enhanced access Payment |
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Describe the 8 segments of the health care population as established in the bridges to health model
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Population Segments
Healthy Maternal and infant health Acutely ill Chronic conditions, normal function Stable but serious disability Short period of decline before dying Limited reserve and exacerbations Frailty, with or without dementia |
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Healthy
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Priority concerns of this population
Longevity Preventing accidents Illness Progression of early stages of disease. Major components of health care Physicians’ offices Health clinics Occupational health Health information available to the public Goals for health care Staying healthy |
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Maternal and Infant Health
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Priority concerns for this population
Healthy babies Low maternal risk Control of fertility Major components of health care Prenatal services Delivery and perinatal care Fertility control and enhancement Goals for health care Staying healthy. |
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Acutely ill, with likely return to health
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Priority concerns for this population
Return to healthy state with minimal suffering and disruption Major components of health care Emergency services Hospitals Physicians’ offices Medications Short-term rehab. Goals for health care Getting well |
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Chronic Conditions, With Generally “Normal” Function
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Priority concerns for this population
Longevity Limiting disease progression Accommodating environment Major components of health care Self-management Physicians’ offices Hospitalizations ER visits. Goals for health care Living with illness or disability |
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Significant but Relatively Stable Disability, Including Mental Disability
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Priority concerns for this population
Autonomy Rehabilitation Limiting progression Accommodating environment Caregiver support Major components of health care Home-based services Environmental adaptation Rehabilitation Institutional services Goals for health care Living with illness or disability |
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Dying” with Short Decline
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Priority concerns for this population
Comfort Dignity Life closure Caregiver support Planning ahead Major components of health care At-home services Hospice Personal care services Goals for health care Coping with illness at the end of life |
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Limited Reserve and Serious Exacerbations
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Priority concerns for this population
Avoiding exacerbations Maintaining function Specific advance planning Major components of health care Self-care support, At-home services 24/7 on-call access to medical guidance Home based care. Goals for health care Coping with illness at the end of life |
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Long Course of Decline, From Dementia and/or Frailty
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Priority concerns for the population
Support for caregivers Maintaining function Skin integrity Mobility Specific advance planning Major components of health care Home-based services Mobility and care devices Family caregiver training and support Nursing facilities Goals for health care Coping with illness at the end of life |
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Patient-Centered Medical Home Definition
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An approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a care setting that facilitates partnerships between individual patients, and their personal physicians and when appropriate, the patient’s family.
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Discuss the unique challenges in the care of patients with chronic diseases
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Self-Management comprises of 80% of care with patients with chronic illnesses
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How to emphasize the patient’s role
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-Simple messages from the primary care provider:
-Consistent approach -Culturally and linguistically appropriate Make sure everyone on the team understands the philosophy that patients are in charge. Be aware of and adaptive to cultural and linguistic challenges. Having staff that mirror the patient population is an excellent strategy. |
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Personal Action Plan
Things that can help with self-management |
1. Something you WANT to do
2. Describe How Where What Frequency When 3. Barriers 4. Plans to overcome barriers 5. Confidence rating (1-10) 6. Follow-Up plan |
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Tips to create agreement
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-Base goals on patient priorities
-Goals are something to achieve in 3-6 months -Plans are specific steps to help achieve goals -Plans must be behavior-specific Remember the goal is the patient’s and we want them to be successful. Often the goal or plan does not seem related to the chronic illness from our point of view, but to the patient they make sense. Sometimes patients choose something small or apparently peripheral to do, but with success, they will take on more challenging and specific things to try. |
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Decision Support
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Evidence-based guidelines
Embedded in system Available at the point-of-care Discuss evidence-based guidelines with the patient Increase the patients and caregivers Health literacy Encourage their participation Use proven provider education methods Integration of specialty care and primary care |
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Delivery System Design
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-Planned visits
-Guidelines review and scheduling of tests and evaluations -Patient-centered goals Evaluation of patients success toward goals Support and advice -Evaluation of associated problems Depression Hypertension Circulation Etc. -Provide clinical case management services for complex patients Use of the registry to identify those patients that will need additional support and follow-up Phone contact Nursing visits Assist with problem solving Address special needs -Ensure regular follow-up Appointments to be made prior to leaving office Or recall system When patients fail appointments chart is flagged of phone follow-up and rescheduling appointment. |
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Features of Case Management
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Regularly assess disease control, adherence, and self-management status.
Either adjust treatment or communicate need to primary care immediately. Provide self-management support. Provide more intense follow-up. Provide navigation through the health care process. |
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Effective delivery of care
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Improving the health of people with chronic illness requires transforming a system that is essentially reactive responding mainly when a person is sick – to one that is proactive and focused on keeping a person as healthy as possible. That requires not only determining what care is needed, but spelling out roles and tasks for ensuring the patient gets care using structured, planned interactions. And it requires making follow-up a part of standard procedure, so patients aren’t left on their own once they leave the doctor’s office. More complex patients may need more intensive management (care or case management) for a period of time to optimize clinic care and self-management. Health literacy and cultural sensitivity are two important emerging concepts in health care. Providers are increasingly being called upon to respond effectively to the diverse cultural and linguistic needs of patients.
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Clinical Information Systems
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Use of Registries
Provide timely reminders for providers and patients. Identify patient subpopulations requiring proactive care. Facilitation of individual patient care planning. Sharing of information when appropriate to improve coordination of care. Monitor performance of team and system |
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Explain the evolution of the Appalachian culture in West Virginia
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School and post offices close and consolidate into area centers for several communities
Small “mom & Pop” stores close, the Marts emerge Town doctors group and try to survive with larger and under insured |
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Define and discuss the Appalachian concept of health
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Absence of illness (as a general population)
Ability to do what we want and need to do. Having our needs met: Hunger, shelter, freedom, belonging, family, community Failure to see the values of prevention Fatalism Powerful others |
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Discuss the health disparities and barriers to healthcare in West Virginia
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Cost
Transportation Financial cultural Education Maturity(work for a delayed reward) Previous medical treatment personal and professional medically underserved areas |
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Health Belief Model
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1)Perceived Susceptibility To disease X Perceived seriousness(severity) of disease -->
2)Perceived Threat of Disease X --> 3)Likelihood of taking Recommended preventive health action |
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Discuss how a functional definition of health affects the health care system
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Office Visits
Well visits and Sick visits. Not regular in follow-up. Poor compliance Referrals missed |
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List three culturally sensitive strategies to care for Appalachian people
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-empowerment
-partnerships -one thing at a time Deal with the Immediate problem Help them get a grip Be a partner to them Help them make a plan and be their support Find needed recourses |
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Discuss the future demographic changes in the U.S.
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people of diverse racial, ethnic, and cultural backgrounds
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List at least six reasons for cultural competence in your practice
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-Perception of illness and disease and their causes varies by culture
-Diverse belief systems exist related to health, healing, and wellness -Culture influences health seeking behaviors and attitudes toward health care providers -Individual preferences affect traditional and non-traditional approaches to health care -Patients must overcome personal experiences of biases within health care systems; and -Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery systems |
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Explain how culture defines health and the perceived need for health care
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How the patient interprets, explains, responds to, and deals with a disease.
When they seek heath care |
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RACE
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Webster defines as a “class or kind of people unified by a community of interests, habits, or inherited physical characteristics
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Culture
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Unifying beliefs of any group of people of similar religious, values attitudes, ritual practices, family structure, language, or mode of social organization.
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Ethnicity
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-A cultural group’s sense of identification associated with the groups common social and cultural heritage.
-Common geographical origin, language, religious faith and cultural ties. -Shared traditions values, symbols, literature, music, and food preferences. |
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Disease
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Disorder in which there is a change from normal in the body's structure or function involving one or more of the body’s organs
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Illness
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Subjective distress felt by patient and those close to him rather than the actual state of ill health
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Define primary,barriers for healthcare among minorities
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lack of insurance. underinsurance, and inability to pay for care or treatments.
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Define secondary barriers for healthcare among minorities
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all barriers encountered between
home and providers’ office: availability of care, transportation, waiting times, ie, systems of care |
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Define tertiary barriers for healthcare among minorities
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when language
and culture hinder and limit the provider-patient communication |
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Distinguish between the various minorities' view of health and health care that were discussed in class and in your text.
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Absence of illness
Freedom from evil Health is day Illness is night Hot, cold Punishment from God The Evil eye |
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List and explain at least eight general guides for culturally competent care
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1) recognize that cultural diversity exists
2) demonstrate respect for people as unique individuals with cultural as one factor that contributes to their uniqueness 3) Respect the unfamalier 4) identify, examin, and descipline your own attitudes, biases and beliefs if you are to work successfully with others 5) recognize that some cultural groups have definitions of health and illness and practices that attempt to promote health and cure illness that may differ from your own 6) be willing to modify health care delivery in keeping with the patient's cultural background 7) do not expect all members of one cultural group to behave in exactly the same way 8) appreciate that each person's cultural values are ingrained and therefore very difficult to change |
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Identify and describe the elements of primary care as they pertain to the U.S. health care system in the 21st Century
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-Primary care physicians are physicians of first resort. They initiate care, take responsibility in the patients care, and establish relationships with the patient.
Longitudinal care is when primary care DO’s in the osteopathic profession follow their patients over a number of years for various health care reasons. Safe, equitable, and effective. Patient-centered. Health care should be in a timely fashion and efficient |
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1.Define the economic payer models of health care delivery
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-Indemnity
Fee for service What the market will bear -Private pay No insurance 21% of West Virginians age 18-64 have no health insurance WV ranked 10th worst in US -CMS: Centers for Medicare and Medicaid Services Medicare Elderly and disabled Federal Part A – hospital Part B – medical insurance (Doctor) Medicare Part D Prescription drug benefits usually through a pharmacy Medicare is federally run. Medicaid is state run for the indigent |
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Describe the unique and distinct economic, social, cultural, political and service roles of Osteopathic medicine and the Osteopathic Primary Care Physician.
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-Education and prevention.
-Cost control -Act as a consultant for OPP Osteopathic primary care is the definitive care provided to a patient from the point of first contact by a generalist, with the continuing responsibility for providing the patient's care. It recognizes the interrelationships of body, mind, and spirit as well as structure and function, and incorporates all accepted means of promoting prevention, patient education and recovery from illness through intrinsic healing and the use of medications, surgery and osteopathic manipulation |
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Managed Care
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A system of both financing and delivering a defined set of health care benefits by a defined provider network that is responsible for controlling the cost of delivering health care benefits to a defined population without compromising quality
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patient-centered medical homes
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Many Primary Care D.O.’s are already doing this for free
Face-to-face and non-face-to-face personalized care Develop agreements to be appropriately paid by insurance or the patient For a different point of view |
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Discuss responsibilities and aspects regarding HIPAA
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-Privacy of progress notes and data of medical record are private and confidential.
-Security needs to be in place. If using a computer, must be on a secure line that cannot be tapped into. -Transactions have to do with billing. These have to be good and secure |
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what are the challenges of the payer models in the U.S. health care system.
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-3rd party payers will continue to restrict payments in order to control expenses.
-Visits tend to take longer these days.Payment for telephone care or electronic visits. -Contracts -demands form -Malpractice - |
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P4P
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pay for performance
Review other peoples work, report on it, and set guidelines. P4P – financial reward for good care |
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CAP
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-Clinical Assessment program.
-Evaluate practice against evidence based guidelines -Tracks patient outcomes |
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POEMs
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-Patient-Oriented Evidence that Matters
-Google Patient-Oriented Evidence that Matters -POEMs have to meet three criteria |
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EBM
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-Evidence-Based Medicine
-"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient -It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996) |
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EHR
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EHR – Electronic Health Record
Computer is a good thing, but it is not easy. Its not really a time saver. It’s a better system to document. The progress is not immediately shared and it’s a good way to share data |
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Define community care.
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Programs and policies in the community that aid in the health care process
i.e state and federal programs can be for or not for profit |
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Describe coordinated care in the managed care environment
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Ensuring the patient receives the appropriate service at the right place at the right time
Coordination and integration of services to avoid fragmentation |
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Describe the Chronic Care Model
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-Organization focuses on improving the care to the chronically illness care.
-Linkages to community agencies and a referral system in place. -Patients encouraged to be active in their own health and become competent in management of illness. -Physicians use evidence based guidelines in treatment and patient care. -Continuity between primary and specialty care with liaison person. -Clinical information systems with care reminders for physicians and patients |
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Define informal services
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Services provided at little or no cost
Provided in the community -Providers are family, friends, or neighbors -Extent of service is not known |
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Define formal services
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-Provided by formally organized groups or organizations.
-Usually have a cost or fee -Occurs when the informal system is unable or unwilling to provide the needed service. |
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Describe the components of case management including benefits and limitations
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Broker-linkage to the needed service
Gatekeeper-must go through you for the service Advocate-plans care and ensures receipt of appropriate service Educator-services available, encouraging self help Evaluator-appropriate, a good service |
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Describe the physician's role as the coordinator
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-Awareness and respect for the patient values and culture
-Coordination and integration of care -Information, communication, and education -Physical comfort -Emotional support- relieve fear and anxiety -Find both formal and informal resources in the community to help empower patients |
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List the types of community services that are often available
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-Greenbrier Valley Hospice
-Committee on Aging -Case Management for Medicaid Waiver -Community Action -Community Services -Housing Authority -Civic Organizations -Headstart -Gateway -Open Doors -Family Refuge Center -Children’s Home Society -Coordinating Council for -Independent Living -Libraries -Support Groups -Educational Groups |
