Chapter 1 Flashcards
Primary care
Care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any health concern such as outpatients clinics and primary health care centers.
Secondary care
Medical care that is provided by a specialist and facility upon referral by a primary care physician and that requires more specialized knowledge, skill, or equipment than the primary care physician can provide such as specialized hospital.
Primary care example
Outpatient clinics and primary health centers
Secondary care examples
Specialized hospital
Tertiary care
Specialized consultative health care, usually for inpatients and referral from primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment such as tertiary referral hospital.
Tertiary care example
Tertiary referral hospital
Clinical encounter
Medical clinical encounters or consultations usually occurs in
1. Outpatient clinics
2. Hospital wards
3. Emergency departments
4. Personal houses
5. House visits
6. Teleconsulations
Teleconsultations
Interactions that happen between a clinician and a patient for the purpose of providing diagnostic or therapeutic advice through electronic means.
Advantages of telepresence
Allows a patient to feel as if she or he were present without being physically in the same location.
Patients and medical personnel interact virtually via
Technology
Advantages of teleconsultations
- Currently used in many countries.
- Provides timely care that is easily accessible.
- Teleconsultations agencies are growing rapidly.
Services that can be done through Teleconsultations
- Providing results of investigations.
- Repeated prescriptions.
- Request sick notes or claim notes.
- Triage of emergency appointment requests.
- Triage of home visit requests.
- Health promotion Eg. Promoting immunization and smoking cessation services.
- Effective healthcare delivery Eg. Follow up depressed or diabetic patients.
Benefits of Teleconsultations
- Convenience for patients: no time off work, no transport issues, and no childcare issues.
- Convenience for doctors: tends to be shorter consultation and so provides better time management.
- May reduce practice costs: more doctor time available for other patients.
- Can overcome the issue of a lack of consultations rooms.
- Can improve medical access for the disabled.
Disadvantages of telecommunications
- Absence of non-verbal cues and missed hidden agendas or fears.
- No examination findings.
- Deafness, accents, or language can be a big barrier to communication.
- Reduced opportunity for health promotion: blood pressure management.
- No opportunity for basic investigations: pregnancy test or urine dip test.
- Issue of confidentially- who are you talking to and who may overhear.
Teleconsultations use during the pandemic
A. Safe effective way to assess suspected cases and guide the patients diagnosis and treatment, minimizing the risk of disease transmission.
B. Enable many of the key clinical services to continue to operate regularly and uninterrupted.
C. Remote assistance and help with administrative management of patients, triage, follow up, meetings and technical discussions among physicians in different locations
Teleconsultations in Kasr Al-Ainy hospitals
Phone triage service
Patient centered care
Philosophy of care that encourages shared consultation, decisions about interventions or management of health problems with the patient. It focuses on the patient as a whole.
Patient centered care involves
- Transforming the relationship between the providers and patients from the traditional model in which a care provider prescribes the same treatment to patients with same diagnosis to patient provider relationship which considers treatment options based on patients unique preferences.
- Treating patients as partners: planning and responsibly for their own health.
- Patients active role in their own care.
- Replaces disease oriented model by patients experience of illness, psychological, and decision making patients and family.
Pickers 8 principles of patient centered care
- Respect for patients preferences.
- Coordination and integration of care.
- Information and education.
- Physical comfort.
- Emotional support.
- Involvement of family and friends.
- Continuity and transition.
- Access to care.
Medical model patient role
Passive
Medical model recipient of treatment
Doesn’t voice concerns.
Medical model provider dominated decisions
Doesn’t offer options.
Medical model disease centered
Dialysis is focus of patients life
Medical model provider does most talking
Does not allow time for questions
Medical model patient complies
No
Patient-centered model patient role
Active
Patient asks questions
Patient-centered model partner in treatment plan
Patients asks for information about options.
Patient-centered model collaborative decisions
Pros and cons options
Patient-centered model quality of life centered
Family life is focus of patients activities.
Patient-centered model
Provider listens more and talks less
Allow Ike for discussion
Patient-centered model patients follows treatment plan
Self manages diet and meds
Methods of Patient-centered methods
- Exploring both the disease and the illness experience.
- Understanding the whole person.
- Finding common ground.
- Prevention and health promotion.
- Patient-doctor relationship.
- Being realistic.
Dimension of disease
Theoretical terms of abnormality, structure, and function of body organ systems including physical and mental disorders.
Dimension of disease traditional methods
- History
- Examination
- Differential diagnosis
- Investigations
Empathy
Ability to experience the feelings of another person.
Sympathy
Caring and understanding for the suffering of others.
Dimension of illness
How patient feel about being ill.
Concerns, ideas, and impact.
Understanding the whole person
Persons
1. History
2. Personality
3. Development
4. Methods of adaptation
Finding common ground
Mutual definition of problem, priorities, goals of management of treatment, and roles.
Being realistic
In time and availability of resources emotional and physical energy needed.
Health enhancement
Doctor and patient monitor areas in patient’s life that needs improvement for long term physical and emotional health.
Risk reduction and early detection
Doctors monitor recognize problems and screen unrecognized disease. Doctors collaborate as well.
Patient-centered method advantages
- Greater levels of patient’s satisfaction.
- Greater levels of doctor’s satisfaction.
- Better patient adherence.
- Improves patients outcomes.
- Has positive impact on health care utilization costs.
- Fewer malpractice claims.
- Higher quality of self-reporting.
- Greater physician detection and patient insight.
How do you assess quality of health care?
By degree of patient satisfaction.
