{"id":106,"date":"2017-12-18T19:01:34","date_gmt":"2017-12-18T19:01:34","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/atd-clinton-hsm111\/?post_type=chapter&p=106"},"modified":"2017-12-18T19:01:34","modified_gmt":"2017-12-18T19:01:34","slug":"primary-care-and-outpatient-settings","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/atd-clinton-hsm111\/chapter\/primary-care-and-outpatient-settings\/","title":{"raw":"Primary Care and Outpatient Settings","rendered":"Primary Care and Outpatient Settings"},"content":{"raw":"
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\r\n\r\n\"\"\r\n\r\nAccording to the 2008 National Ambulatory Medical Care Survey, there were over 960 million visits to office-based physicians. But outpatient care is not limited to primary care services.\u00a0 Once performed only in hospitals, most surgeries are performed on an outpatient basis, or day surgery. Non-hospital based outpatient services are expanding to include home health care, ambulatory clinics and several other specialty services.\r\n\r\nPRIMARY CARE<\/b>\r\n\r\nA primary care provider (PCP) is a physician who is seen for checkups and general health problems, helping to\u00a0manage overall patient health. Primary care is seen as the entry point\u00a0to the health care system, with the use of primary care physicians as \"gatekeepers\" to the system.\r\n\r\nThe term \"generalist\" often refers to medical doctors (MDs) and doctors of osteopathic medicine (DOs) who specialize in internal medicine, family practice, pediatrics or obstetrics and gynecology.\r\n\r\nObstetrician\/Gynecologists (OB\/GYNs) are doctors who specialize in obstetrics and gynecology, including women's health care, wellness, and prenatal care. Many women use an OB\/GYN as their primary care provider.\r\n\r\nOther health professionals involved in the primary care setting include nurse practitioners (NPs) who\u00a0can serve as a primary care provider in family medicine (FNP), pediatrics (PNP), adult care (ANP), or geriatrics (GNP). Others are trained to address women's health care (common concerns and routine screenings) and family planning. NPs can prescribe medicines.\u00a0 A physician assistant (PA) can provide a wide range of services in collaboration with a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).\u00a0Licensed practical nurses (LPNs) are state-licensed caregivers who have been trained to care for the sick, registered nurses (RNs) have graduated from a nursing program, have\u00a0passed a state board examination, and are licensed by the state. Advanced practice nurses have education and experience beyond the basic training and licensing required of all RNs. Advanced practice nurses include nurse practitioners (NPs): clinical nurse specialists (CNSs) have training in a field such as cardiac, psychiatric, or community health; certified nurse midwives (CNMs) are trained in women's health care needs, including prenatal care, labor and delivery, and the care of a woman who has given birth. Licensed pharmacists have graduate training from a college of pharmacy. Pharmacists prepare and processes drug prescriptions written by\u00a0primary or specialty care providers.\r\n\r\nOUTPATIENT SETTINGS<\/b>\r\n\r\nFacilities where ambulatory or outpatient services are offered include medical procedures or tests that can be done\u00a0 without an overnight stay.\u00a0The types of \u00a0procedures and tests, offered usually within\u00a0a few hours, include wellness and prevention services, such as counseling and weight-loss programs; diagnostic services, such as lab tests and\u00a0imaging scans; treatment, such as\u00a0day surgeries\u00a0or \u00a0chemotherapy; and, rehabilitation, such as physical therapy or addiction treatment\r\n\r\nBecause no overnight stay is involved outpatient services usually cost less., Some centers specialize in one kind of treatment or procedure, although many\u00a0can be provided in one place.<\/b><\/i><\/u>\r\n

PRIMARY CARE PRACTICES<\/h3>\r\n
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Primary Care<\/h5>\r\n
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Primary Care is the entry point into the health care system.\u00a0 Primary care clinics are the point of delivery of individual care, based on care over time and is not disease oriented, but rather preventive.\u00a0Primary care is the type of\u00a0medical facility where conditions seen at the clinic are not serious or life threatening. It is rather a \u201cgateway\u201d to healthcare services. The definition of primary care, adopted by the IOM Committee on the Future of Primary Care states: \"primary care is the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.<\/div>\r\n
Primary care medical specialities may include family medicine, general internal medicine, obstetrics and gynecology and general pediatrics.<\/div>\r\n
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Attributes of primary care\u00a0encompass care that is accessible, comprehensive, coordinated and continuous.\u00a0 The perspectives of primary care are intended to\u00a0target the patient and family, the community and the\u00a0ecosystem,<\/div>\r\n
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Read article:\u00a0 A 2020 Vision of Patient-Centered Primary Care<\/div>\r\n
https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1490238\/<\/u><\/a><\/div>\r\n

General Internal Medicine<\/h3>\r\n

General Medicine<\/b>, or\u00a0Internal Medicine<\/b>, is the practice of specialized adult patient care of a broad and comprehensive range of illnesses when undefined symptoms present to a primary care physician. Patients are referred to these specialists for diagnosis related to a variety of symptoms, such as shortness of breath, chest pain, abdominal pain and back pain. Collaboration in the treatment of chronic illness and in health promotion and disease prevention.\u00a0involves a\u00a0multidisciplinary team of specialized experts. Preventive care includes mammograms, Pap smears, routine colon cancer screening evaluations, cholesterol screening and blood pressure screening.\u00a0Internists\u00a0<\/b>communicate with primary providers so care plans for ongoing care when\u00a0a patient\u00a0returns home. Internists also provide comprehensive management\u00a0<\/b>for hospitalized patients, including risk assessment for\u00a0preoperative patients. Internist practice primary care as the follow adult patients over their lifetime.<\/p>\r\n

In the United States, Internal medicine is the largest medical specialty, with nearly 200,000 internists in practice. Internists may function as generalist physicians practicing primary care, hospital medicine, or both. They may also pursue further training to practice a subspecialty.\u00a0\u00a0<\/i><\/b>The National Institutes of Health (NIH) is awards over two-thirds of it's research grants\u00a0to internists.<\/p>\r\n\r\n

Family Practice<\/h4>\r\n

Family Medicine provides healthcare for the individual and family, integrating all aspects of care and encompassing all ages, genders and types of diseases.\u00a0 Family physician visits account from 20% of medical office visits, almost half of all medical specialties combined.\u00a0<\/u>According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The types of medical training of family physicians are usually\u00a0\u00a0the Doctor of Medicine (MD) or Doctor of Osteopathy (DO)\u00a0 degree. Family practice physician visits account for 25% of all doctor visits in the United States, over 200 million office visits per year. Family practice physicians provide preventive care through routine checkups, health risk assessments, immunization and screening, and health behavior and lifestyle counseling.\u00a0 Family practitioners also diagnose and treat acute and chronic illnesses and coordinate with specialists to manage chronic illnesses.<\/p>\r\n

Although the number of primary care providers in slowly increasing,\u00a0many studies\u00a0indicate\u00a0the demand for family physicians will exceed their supply by 2020. Salaries for family practice physicians are lower than specialty providers and the increasing frustrations in billing, financing and record keeping has contributed to the shortage.\u00a0Most family physicians have solo or small group practice, or practice as an employee of a hospital.<\/p>\r\n\r\n

Pediatrics<\/h4>\r\n

Pediatrics is the branch of medicine that deals with the care of infants, children and adolescents. Pediatric health services include diagnosis and treatment of diseases.\u00a0 The specialty recognizes the anatomical, physiological and immunological differences between children and adults.\u00a0The differences in body size are paired with developmental issues of greater concern than when treating an adult. Pediatricians are proficient in the differing diagnostics and prescription needs of the infant and child. Another consideration is that the patient is not responsible for their own care, so the pediatrician must consider issues of guardianship, privacy, legal responsibility and informed consent\u00a0.\u00a0<\/b><\/i>Pediatricians often must take in to account the patient as part of a family in procedure.<\/p>\r\n\r\n

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Obstetrics and Gynecology<\/h4>\r\n

Gynecology<\/b>\u00a0is the care of the female reproductive system. The specialities of gynecology and obstetrics are most often combined. In the United States, law and many health insurance plans allow gynecologists to provide primary care in addition to aspects of their own specialty.<\/p>\r\n

Obstetrics<\/b>\u00a0is the care of women during pregnancy and immediately after childbirth.\u00a0Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests: ultrasound,\u00a0c<\/span>omplete blood count (CBC), blood type, general antibody screen,,\u00a0amniocentesis,\u00a0hematocrit and\u00a0screens for gestational diabetes. During labor, the obstetrician monitors the progress of labor, delivery and the postpartum phase.<\/p>\r\n\r\n<\/b><\/i><\/u>A primary care physician (PCP), or primary care provider, is a health care professional who practices general medicine. PCPs are our first stop for medical care. Most PCPs are doctors, but\u00a0nurse practitioners<\/u><\/a>\u00a0and even physician assistants can sometimes also be PCPs.\r\n\r\nA PCP is the person your child should see for a routine\u00a0checkup<\/u><\/a>\u00a0or non-emergency medical care. If your child has a mild\u00a0fever<\/u><\/a>,\u00a0cough<\/u><\/a>, or rash, or is short of breath or nauseated, a PCP usually can find the cause and decide what to do about it.\r\n\r\nUsually, PCPs can treat conditions in their own offices. If they can't, they can refer you and your child to a trusted specialist. If your child needs ongoing treatment or is admitted to a hospital, the PCP may oversee the care, help you make decisions related to treatment, or refer you to other specialists if needed.\r\n\r\nOne of a PCP's most important jobs is to help keep kids from getting sick in the first place. This is called preventive care.\r\n\r\nThe best preventive care means forming a relationship with a PCP you like and trust, taking your child for scheduled checkups and\u00a0vaccines<\/u><\/a>, and following the PCP's advice for establishing a healthy lifestyle, managing weight, and getting the right amount of exercise.\r\n

Types of PCPs<\/h3>\r\nDifferent types of PCPs treat kids and teens. Which is right for you depends on your family's needs:\r\n