primary care questions and answers 100% correct

primary care questions and answers 100% correctprimary care vs. primary health care primary care vs. primary health care Q: What is the difference between primary care and primary health care? A: Primary care is essentially about care for sick or injured individuals based in the community. It is often based around medical care ('primary medical care') but may also involve allied health, nursing care or alternative therapies. Primary health care is broader in that can also deals with the determinants of health - environmental factors (air pollution), social factors (bullying at school), and individual factors (lack of health literacy) - and include a stronger focus on promoting health as well as preventing or treating illness (primary care sometimes involves interventions to prevent specific health problems - immunisation etc.) Primary health care often has stronger links to the community, since it is the communities' health problems (rather than just individual health problems) that are being addressed. Primary health care involves a more social view of health. Q: Does it matter that these are often used interchangeably? If so, why? A: The difference between them matters since primary health care recognises and addresses a broader range of health issues and contributing factors, has a wider range of strategies (more focus on prevention, education, community engagement and capacity building), involves a wider range of players (councils, education, welfare, community organisations as well has health services) and has a philosophy which recognises more easily the contribution which individuals and communities make to their health. If the terms are used interchangeably, then the 'extra' in primary health care is likely to be forgotten, or crowded out by the dominant primary care/primary medical care approach. parimary care 1. first point of contact 2. delivered by doctors and other hcp 3. gneralists focus on whole patient 4. delivered in the community why should we care abt primary care because primary care is majority of Health care services, 13700 family physician visits in 24 hours timeline of primary care reform, in ONTARIO FEE for service, solo physician practices - payment per procedure -private for profit businesses - many operated as solo practice, no interaction of others alternative payment models- community health centres (CHC) and health service organizations (HSO) - what is CHC - non profit org with community elected boards, interprofessional teams, located in high need community, focus on primary care, illness prevention, health promotion etc. romanow commission on primary health care transforming hhealth care system by taking away focus on hospitals and medical treamtnes, breaking down barriers that exist between cp and focus on preventing illness and improving healht primary care vs. primary health care primary care: physician focused, treatment/illness, episodic care, passive patient primary health care: primary care, health promotion, teams of practitioners, patient empowerment, community involvment why has primary care reform been so difficult? 1. federal provincial division of powers-- province or federal responsible for the reform? 2. private practice and public payment 3. powerful physician lobby primary care reform primary health care transition fund- 800 million from federal into province for transition into primary hc 2003, first ministers accord on health care renewal- 5 year 16 billion health reform fund (praimry hc, home care, catastrophic drug coverage) 2004 first ministers meeting - establishing best practices network, work with infoway to accelerate development of e-health records and e-prescribing what's happening outside of ontarios between 2004-present in BC and alberta BC: division of family practice (community-based groups of family physicians working together to achieve common health care goals), integrated health networks (IPE) alberta: primary care network (grp of family physicians and other hcp primary care reform iN ONTARIO- physician payments changes fee for service (family health group, comprehensive care model) blended capitation (family health networks, family health org) blended salary(family health careas blended compliment and other specialied models (rural northern physician group agreement) primary care reform iN ONTARIO- changes to model of care! 1. patient enorllment 2. group practice 3. 24/7 access requirement 4. multidisciplinary care in Onatrio (FHT, nurse practioner lead clinics, expansion of comuniity health centre) patient enrollment Family physicians are also encouraged to take new patients into their practices. A premium is available to physicians when they enrol new patients. In order to claim this fee, the physician, in addition to formally enrolling the patient, must co-sign with the patient a New Patient Declaration form. Who Should be Invited to Enrol? Physicians in a FHT who previously enrolled their patients while practicing in a Family Health Network, Primary Care Network or other harmonized model do not need to re-enrol their patients. Patients enrolled to Family Health Group physicians who are transitioning to a FHT do not need to re-enrol their patients. All patients in the practice of a Family Health Team physician, regardless of their health status, must be invited to enrol, provided they are not otherwise ineligible. In order to enrol in a FHT, patients will complete the Patient Enrolment and Consent to Release Personal Health Information form (the enrolment/consent form). Once the enrolment/consent form is completed, the physician acknowledges it and sends it to the Ministry of Health and Long-Term Care (the ministry) for processing. It should be noted that enrolling is voluntary; patients are not required to enrol to continue receiving services, nor will they be refused enrolment due to their health status or need for services. expansion of multidisciplinary care has 2 examples Family health teams and nurse practitioner led clinics 200 FHTs, 25 NP led clinics, 48 full time phramacist in family health teams also 76 community health centres (CHC) community health centres Community Health Centres (CHCs) are non-profit organizations that provide primary health and health promotion programs for individuals, families and communities. A health centre is established and governed by a community-elected board of directors. CHCs work with individuals, families and communities to strengthen their capacity to take more responsibility for their health and wellbeing. They provide education and advice on helping families access the resources they need from other community agencies. CHCs work together with others on health promotion initiatives within schools, in housing developments, and in the workplace. They link families with support and self-help groups that offer peer education, support in coping, or are working to address conditions that affect health. As such, the Community Health Centre Program contributes to the development of healthy communities. key issues today! (3) access, cost, quality enough physicians, appropriate access, equitable access? increasing costs? quality of care imrproved with this increase in cost? in terms of access 1.1 GP per 1000 population (GP increasing faster than population, and GP more satisfied with their job now) however, hard to get same day appointment and have to wait 6 days or more resources (ex diabetes doctors) are not allocated with equitable access. more doctors with low paptient population and less doctors in high patient population in terms of cost the cost to see physicians is going up in terms of quality hospital admision rate for preventable hosptial admissions are going down. now is this due to better primary health care reform? we don't know! what is primary care- WHO defn first level of contact of the individual, the vamily and the community with teh national health system brining healthcare as close as possible to hwere people live nad owrk and constitutes the first element of a continuing care process what is primary health care- WHO def addresses the main health problems in the community, providing promotive, preventive, curative supportive and rehabilitative services accordingly 5 principles of primary care 1. accessibility- available to all people with no unreasonale geographic or financial barrier 2. public participation- invidivals have right to be active partners in decision making abt their health care 3. health promotion- process of enabling people to increase control over and to improve their health 4. appropriate technology- using service delivery and procedures that are socially acceptable and affordable, use the most appropraite not necessarily more expensive 5. intersectoral cooprations- commitment from all sectors (gov't community and health) is essential for meaninful action on health determinants gaols of primary care (3) relational continuity- maintenance of patient provider relationship over time nad consistency of personnel informational continuity- information on preior events is used to give care appropriate to patients current circumstances management continuity- care received from different providers is connected in a coherent way why care about primary care strength of country's primary care system decreased mortality, premature mortality, and general better health regardless of GDP per capita what does primary care deal with acute problems, chronic problems and prevention (at individual and community level) nurse practitioners want to see role expanding, people are comfortable with being treated by nurse practitioners, to manage health care cost also where is primary care provided doc's office, health clinics, walk in clinics, emergency department, people's homes! community health centres (chc) operate on global budget, physicians on salary???, multidisciplinary, focus on prevention/health promotion and acute care, community board how do docs work 25% work alone, fewer than 10% work with multidisciplinary, lots not availbe after hours and leave clinic uncovered when on holiday payment methods (4) fee for service capitation (payment/ month per patient registered regardless of whether or not patient has been seen, payment based on age and sex of patient) blended (portion comes from capitation, portion comes from extra doing like attending births) salary (paid at rate determined by board of organization theoretical problems with fee for service, capitation and salary FFS: incentive to providing more than necssary to increase income capitation: limit effort by restricting access to care, less willingless to devote time to patient salary: doc will select simplest cases ease of access to primary care in canada very difficult to get care in the evening, weekends or holidays without going to emergency difficult to get same day appointment Emergency vs. walk in vs. GP GP> WC> ED for waiting time**, communication and doc's attitude but ED provide better quality of care GP are not doing enough preventative measures compared to CHC true