Direct access, primary care, and autonomous practice Flashcards
definition: 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 within the context of family and community.
primary care
definition: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient’s illness/injury.
differential Dx
(true/false) The role of primary care practitioner is consistent with the expectations of education and practice as stated in the official documents of the APTA and CAPTE
true
What primary care models have successfully paved the way for direct access?
Military
kaiser permanente (Large HMO structure)
VA (large hospital system)
Mercy health system (community hospital setting)
90% of family physician training is in what setting? How long must they be in a musculoskeletal training?
outpatient ( >1 month of MSK experience)
(true/false) family physicians do not have a heavy psychosocial focus.
false
General internists have an emphasis of caring for what type of patients? How long of MSK training do they need? Do they have outpatient training/practice experience)
hospitalized patients (no MSK requirements and no outpatient practice)
Nurse practitioners are grads of what training program? Who are typically their instructors?
RN; instructors are typically nurses, not MDs
(true/false) nurse practitioners have prescriptive authority in all states
true
(true/false) nurse practitioners can function independently
true (they are the closest to being a provider)
RNs require a _____ degree.
bachelors
LPNs require a ___ degree
associates
Nurse practitioners require a ___ degree.
masters
Physician assistants receive a _____ or ___ degree after graduate school.
bachelors or masters
Who are the typical instructors for physician assistant students?
PAs (some MDs)
(true/false) PAs have prescription authority in all states.
false (most states)
(true/false) PAs can function independently.
False (only functions under the supervision of an MD)
Who has more autonomy, NPs or PAs?
NPs
How many years after undergraduate phase does a NP need in graduate school?
2 years
(undergrad 2-4 years)
How many years after graduate school does an MD need to be in a fellowship?
3-5 years
While in casualty situations, PTs manage patients in the ___ category.
minimal (“walking wounded”)
Who augments the otho dept in mass casualty situations? Why?
a. PTs –> considered as a tactical admin
b. frees up surgeons and expedites access for patients with MSK/neuro MSK conditions
How many PTs are in the army?
300+
How many PTS are in the air force?
150
How many PTs are in the navy?
90
How many PTs are in the marine corps?
0
With Kaiser permanente, PTs are part of the _______ care team.
primary
In kaiser permanente model, PTs were recognized as experts in ___ conditions.
MSK
__-__% of patient visits to adult primary care were MSK related
20-25%
What are the 4 methods to see a PT in the kaiser permanente model?
- physician referral
- joint consult with PT and MD
- triaged to PT with calling or walk-in to a medical station
- triaged after calling a medical advice line
What are PT patient requirements for the kaiser permanente model?
- 18 to 65 y/o
- non-industrial injury/ non-3rd party liability
- afebrile
- no chest or abdominal pain
- not seeking medical intervention
- willing to see a PT instead of an MD or NP
What are the PT adult primary care staff guidelines in the kaiser permanente model?
- minimum of 4-6 years of OP ortho experience
- demonstrate continued education in ortho
- team communication skills
What is the largest health system in the US?
VA
What is the typical patient population for the VA?
older population with complex, multiple, medical problems
What are the 3 methods to see a PT in the VA model?
- ED
- primary care clinics
- telephone triage systems
What preparations do PTs need for the VA?
> 4 months experience in a primary care internship program
What primary care model developed a model of education for physicians by PTs during clinical care of patients with NM conditions?
mercy health system
What are the characteristics of autonomy?
- Independent, self determined judgment
- Responsibility and acceptance of risk
- Ability to refer and collaborate
- Recognition of need for consult
- Clinical decision making independent of financial considerations
- PT governance and control of PT practice
(true/false) Acute care in indiana is highly regulated
true –> 1 of 2 states that have no form of direct access
