The healthcare delivery providers are part of the Healthcare Marketplace Specialization. Module 4.1.2 Primary Care, Services and Organization. Learning Outcomes for this lecture will be to discuss services a primary care clinic provides and then review the various types of organization of primary care. Doctor of Medicine, Primary Care Physician, Advanced Practice Registered Nurse, Physician's Assistant. So now we will look at the services that a primary care physician or primary care clinic provides. So I have done this for the last many years in smaller towns, in bigger cities and typically, I want you to visualize a primary care clinic. So there are physicians and nurse practitioners, physician's assistants that have offices. Patients come in, get checked in, registered, insurance is verified, and then they wait. A physician schedule opens up, a physician or their nurse or medical assistant comes out, gets the patient, they go in. And the physician and the patient will then typically spend some time together discussing the history, so what's going on, looking at the patient's record, either on paper but, more and more now, electronically. And then there's typically an examination that the physician does and then diagnosis, treatment, either giving prescriptions or referral to either specialty care or sometimes to a hospital. So again, it's a very busy, dynamic place. It's not as busy as a hospital emergency department or a hospital unit, but it is busy in different ways. So imagine, physicians in white coats and nurse practitioners running around between rooms. A busy practice, patients coming and going, nurses and other staff interacting inside the clinic. So, again, very dynamic fun wonderful place and a place that is part of a community and a population where physicians and their partners and care teams enhance and improve, constantly the care of the community they are privileged to serve. Primary care clinics and primary care provides many different services in outpatient or ambulatory setting. These visits are to diagnose and to treat conditions. They also provide preventive visits, check ups, for example, sports physicals, or other typical visits are preventative visits at age milestones. They do immunizations, they do minor surgeries and office procedures, like removal of moles, or other small skin procedures, or other procedures. Also, they provide telephonic triage where there are nurses that the patients can call in. And the nurse then will determine if the patient needs to go to the emergency department, or needs to come into the office, or can be treated at home. Also primary care physicians and their teams do referrals for consultations to specialty care and also manage those referrals. So, a patient that was sent to a specialist, what happened there? Did the information come back? And then connecting back with the patient to close the loop. All of these are types of case management tactics, and case management that a primary care physician and their clinic does. There are many different staff within primary care, obviously, the primary staff are the providers of clinical care, so physicians, advance practice nurses and physicians assistance. As important though, is the clinical team made of up nurses, case managers who are typically nurses, medical assistants who help room the patients, do the blood pressure and other testing. And get the patient ready for the physician or provider, lab services, and many other new emerging services like the community health worker, social workers and the like. And obviously, for financial management there is the business office where there's billing, coding, and management of the financials that happens. There are many different types of Primary Care Physicians. Typically, they would be Family Medicine, also called Family Physicians, or Internal Medicine physicians. For children, it's pediatrics, also, for older adults and elders, they are the Geriatrics physicians, and I am one, off of a type of geriatric physician. Also Ob-Gyn physicians consider themselves to be Primary Care Physicians for moms around the time of pregnancy and childbirth. Let's do a quiz. Some of the key infrastructure basis for primary care provision are Information Technology. And as you can imagine, that is being revolutionalized month by month and year by year. So electronic health record has absolutely changed the delivery of primary care. It increases the connectivity with the patients, and also increases the connectivity with other care team members. For example, a primary care provider might get connected to home health care, might get connected to a specialist, might get connected to a hospital. So again, increased coordination and increased connectivity. Here's what a typical primary care provider clinic looks like, so here's the entry door, and then there's typically registration, so kiosks for the patient to get registered, insurance get verified. And then back here, would be the rooms where physicians and other providers sit, so the patient gets registered, goes and gets seen. Also, there might be a lab here, so the patient if they need lab would go to a lab to get the lab tests. The lab then is transmitted to the computer for the physician to see the patient goes back to the clinic room and the physician sees the patient and discusses the lab. Another type of service might be X-ray, right on-site in the clinic and then as I have discussed this, there's also a hub of case management, with triage nurses, social workers, community health workers and many other types of services. And finally, there's the billing and coding offices right here that deal with the financial management. The type of primary care clinic might be inside a multi-specialty clinic. So, this part of the clinic could be primary care physicians. This might be another specialist for example heart care. This might be another specialist. So again, they share infrastructure and have efficiencies and economies of scale and scope. But this a multi-specialty clinic integrated with primary care. Summary, Primary Care provides many basic horizontal services to promote health of the population and communities they serve. And primary care organization is evolving as the payment models change and as technology gets improved, year after year. And so, this is leading to a revolution in how primary care is provided.
