Primary Care America's Health in a New Era (1996) / Chapter Skim
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Defining Primary Care
Defining Primary Care
Pages 27-51
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From page 27... ...
Some experts and groups have included nurse practitioners and physician assistants (OTA, 1986; Pew Health Professions Commission, 19941; . A set of activities whose functions define the boundaries of primary caresuch as curing or alleviating common illnesses and disabilities; · A level of care or setting an entry point to a system that includes secondary care (by community hospitals)
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From page 28... ...
. While fully acknowledging the need for a clearer sense of primary care to guide policymaking at the national and state level, the committee believes a careful but multidimensional view of primary care will permit a far richer discussion of organizational opportunities, professional development and satisfaction, health curricula reform, and improved health care than any single-dimension definition.
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From page 29... ...
THE FIRST IOM DEFINITION In 1978, the IOM published a report entitled A Manpower Policy for Primary Health Care: Report of a Study (IOM, 1978~. The second chapter, which had been released a year earlier as an interim report, defined the essence of primary care as it should and could be practiced: "accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services." That definition has been widely quoted and used.
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From page 30... ...
That report described community-oriented primary care operationally as the provision of primary care services to a defined community, coupled with systematic efforts to identify and address the major health problems of that community through effective modifications in both the primary care services and other appropriate community health programs (IOM, 1984, p.
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From page 31... ...
THE NEW DEFINITION AND AN EXPLANATION OF TERMS The definition of primary care adopted by the IOM Committee on the Future of Primary Care follows: Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Each term in the definition is summarized in Box 2-1 and is explained in the text following the box.
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From page 32... ...
On the health care delivery side, the team and integrated delivery system provide the means for extending and improving the delivery of primary care. One challenge that faces health care clinicians, policymakers, and administrators is how to foster and maintain such patient-clinician relationships in a complex, integrated delivery system.
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From page 33... ...
Recommendation 2.1 To Adopt the Committee's Dernition This committee has defined primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. The committee recommends the adoption of this definition by all parties involved in the delivery and financing of pri
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From page 34... ...
mary care and by institutions responsible for the education and training of primary care clinicians. The committee has recommended that health policymakers, professional groups and academic health centers adopt this definition for use in all relevant activities within their scope of responsibility.
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From page 35... ...
Individuals have particular health care needs; the community has a broader perspective that emphasizes improving health status2 and reforming the way care is delivered. An integrated delivery system has the potential for melding both perspectives.
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From page 36... ...
help to coordinate the public health, social services, mental health services, and other appropriate services needed by patients. Clinician The term clinician refers to an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health services to patients.
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From page 37... ...
Challenges remain, however, about how to structure a team so that personal relationships are supported, and these challenges are addressed later in this report. Health Care Needs and Health Care Services The term personal health care needs includes reference to physical, mental, emotional, and social concerns that involve the functioning of an individual.
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From page 38... ...
It refers to services and information about the services of all the clinicians and other health professionals pharmacists, nurse midwives, physical therapists, and so forth over an extended period of time. The committee's use of the term integrated when describing personal health care services should not be confused with the widely used term as applied to horizontal and vertical integration in integrated delivery systems.
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From page 39... ...
In many circles, the term gatekeeper has been used to describe the function of using the experience and judgment of the primary care clinician to determine whether diagnostic tests are necessary, whether a patient's problem can be handled by the primary care practice, or whether a person needs to be evaluated or treated by another specialist or subspecialist. The primary care clinician's important role in helping the patient to obtain appropriate care in a complex health system requires a high level of skill and judgment.
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From page 40... ...
The IOM definition refers to a large majority of personal health care needs. That phrase refers to the essential characteristic of primary care clinicians.
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From page 41... ...
collaborates in the care of other patients whose chronic illnesses are of such a nature that the principal provider of care5 is another specialist or subspecialist. The primary care clinician manages intercurrent illnesses, provides preventive care (e.g., screening tests, immunization, counseling about life style)
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From page 42... ...
The primary care clinician also coordinates a patient's transition between health care settings for example, hospital and home, home and nursing home, or between clinicians' offices. Teams.
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From page 43... ...
It combines events and information about events occurring in disparate settings, at different levels of care, and over time, preferably throughout a person's life span. Continuity encompasses patient and clinician knowledge of one another and the effective and timely communication of health information that should occur among patients, their families, other specialists, and primary care clinicians.
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From page 44... ...
The committee acknowledges that the use of a functional definition of primary care does not provide a definitive answer to those who must count primary care clinicians and develop policies regarding payment for primary care services. Because the definition is normative, the committee hopes that the functions of
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From page 45... ...
Some physicians in other specialties may also be practicing primary care. For example, obstetrician-gynecologists undoubtedly deliver some primary care, but others are surgically oriented, are not currently trained in primary care, and do not consider themselves primary care clinicians (Leader and Perales, 1995~.
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From page 46... ...
Primary care clinicians are also accountable to the systems in which they work. Quality of Care Primary care practices are accountable for the quality of care they provide.
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From page 47... ...
preferences in decisionmaking. Interpersonal skills are also essential to primary care clinicians in their roles as coordinators, as members of a collaborative team, and with other health professionals.
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From page 48... ...
This change in perspective from individual patients and clinicians to the performance of health plans might also result in less attention being paid to changes in the patient-clinician relationship. As policymakers shift attention toward systems of care, integration, and team approaches to health care delivery, it will be especially important to understand the relative risks and benefits to health outcomes and patient satisfaction of promoting or disrupting personal relationships.
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From page 49... ...
Good primary care presupposes a careful effort to manage care to ensure the efficient use of resources including the effective use of other health and social services. Ethical Behavior A critical part of accountability in primary care concerns the ethical behavior and decisionmaking by primary health care clinicians in relation to their patients, the community, and the health systems in which they practice.
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From page 50... ...
A major advantage of integration lies in providing infrastructure support for personal health care services and for developing systems of accountability. Such arrangements often do not exist in many pnmary care settings and may be a long time in coming.
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From page 51... ...
Leader, S., and Perales, P.J. Provision of Primary Preventive Health Care Services by ObstetricianGynecologists.
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