Week 10 - Primary Care and Long-Term Care

WHO definition of primary care services
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Terms in this set (47)
WHO definition of primary care services
essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community by any means acceptable to them and at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self determination
IOM definition of primary care services
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
primary care services three main components
comprehensive: address any health problem at any given stage of a patients life cycle

coordinated: the provision of a combination of health services

continuous care: care administered over time by a single provider or a team
What falls under accountability for primary care services
provide quality care

produce patient satisfaction

use resource efficiently

behave in an ethical manner
Primary care providers (PCPs)
physicians trained in family medicine, internal medicine, pediatrics, and obstetrics and gynecology
non-physician providers
nurse practitioners

physician assistants

certified nurse-midwives
features of primary care services
Point of entry, coordination of care, essential healthcare
point of entry
the gatekeeper role

the point of first contact with health services

visit the primary care practitioners before seeing specialists

send referral to admit to the hospital

usual source of care
coordinated of care
to coordinate the delivery of health services between the patient and the myriad of delivery components of the system

keys: continuity and comprehensiveness

benefits:
-better health outcomes
-lower hospitalization rates
-fewer ED visits
-cost saving
-lower mortality
essential healthcare
provide healthcare at right place at right time

improve quality of clinical care

provide more preventive care services such as up to date on screening, immunization and health habit counseling

reduce health disparities

achieve desired population health
evolution of primary care modelprimary care model chronic care model medical home accountable primary care modelnew directions in primary carepatient-centered medical homes (PCMHs) direct primary care (DPC) modelpatient-centered medical homes (PCMHs)the team oriented health care delivery model with a interdisciplinary team of physicians and allied health professionals responsible for evidence-based protocols to deliver and coordinated care promote appropriate care reduce inappropriate and duplicated care and save costsdirect primary care (DPC) modela membership model a patient directly contracts with his/her primary care physician in a monthly payment plan for the health care services advantages: -to avoid extra payment of third party payer -no need health insurance -spend more time patients disadvantages: -inadequate allocation of resources to primary carea complex subsystem providing a variety of services and support that help people live as independently and safely as possible individualized, well-coordinated services that promote the maximum possible independence for people with functional limitationsmost common type of long term carepersonal carecharacteristics of long-term care usersindividuals who need a variety of healthcare services over time complex health conditions -multiple chronic disease -cognitive impairment -physical functional limitations two indicators assess functional limitations -activities of daily living (ADLs): Basic personal tasks of everyday life -instrumental activities of daily living (IADLs): assistance with everyday life tasks 50% of LTC users are younger than age 65 -development disability (DD) -intellectual disability (ID) -patients with HIV/AIDSNature of LTCvariety of services individualized services well-coordinated total care and holistic care maintenance of residual function extended period of care quality of life use of current technology use of evidence-based practicesvariety of servicesfit the needs of different individuals address their changing needs over time suit their personal preferencesindividualized servicestailored to the needs of the individual patientwell-coordinated total care and holistic careprimary care, mental health services, acute care services and specialty caremaintenance of residual functiondependency with aging goals: maintain residual function and prevent further declineextended period of careduration of LTC variesquality of lifeloss of self worth accompanies disability patients remain in LTC settings for long periodsuse of current technologypersonal emergency response system (PERS) for safetyuse of evidence-based practicesevidence-based protocols for staff trainings and safetySome important LTC servicessocial support housing end of life caremedicare does not cover most LTC servicesonly for LTC requiring skilled services or rehab services in a nursing home for a maximum of 100 days, however the average medicare covered stay is much shorter (22 days)medicaid requires spending one's assets to poverty levels to qualifydoes pay for the largest share of ltc servicesprivate health insurance covers only the same kinds of limited services asmedicarepublic policy created few incentives to spur LTC _______ growthinsurancecost of ltc services depends on the ____ and ____ of care, the ____ and ____type and duration, provider and locationsfactors that contribute to the cost of ltctime of the day, extra charges for certain services and variable rateslevel of care continuumpersonal care custodial care restorative care skilled nursing care subacute carepersonal carelight assistance with basic ADLscustodial carenonmedical care requiring no active medical and nursing treatmentrestorative careshort-term therapy treatments to help a person regain or improve physical functionskilled nursing careprovided by a licensed nurse under the physicians direction with a plan of caresubacute carepost-acute services for people who remain critically ill or who have complex conditions with ongoing monitoring and intensive treatment -extensive care -special -clinically complex care -intensive rehabHome and Community Based Services (HCBS)Home health care Adult day care Adult foster care Senior centers Home-delivered and congregate meals Homemaker services Continuing Care at HomeHome Health Agency (HHA)is primarily engaged in providing skilled nursing services and other therapeutic services is licensed pursuant to state or local law, or has approval as meeting the standards established for licensing by the state or locality medicare is the single largest payer for home health services the term home health agency does not include any agency or org which is primarily for the care and treatment of mental diseasesinstitutional long-term care continuum -determinants:inability to live alone or lack of social supportinstitutional long-term care continuum -concept:aging-in-placeinstitutional long-term care continuum -main providers:nonphysician staffsinstitutional long-term care continuum -types:residential and personal care facilities assisted living facilities skilled nursing facilities subacute care facilities - three main locations: -long term care hospitals (LTCHs) -hospital transitional care units certified as SNFs -freestanding nursing homesinstitutional long-term care continuum -assisted living facilities (ALF)provide personal care, 24 hour supervision, social services, recreational activities and nursing and rehab services predom on a private-pay basis require to be licensed by states no federal standardsinstitutional long-term care continuum -skilled nursing facilities (SNF)more complex conditions requiring long-term stays strictly regulated through licensure and certification requirements at state level skilled nursing facility for medicare only nursing facility for medicaid only