Introduction to Healthcare and Public Health in the US: Delivering Healthcare (Part 2)
Audio Transcript
Slide 1
Welcome to Introduction to Healthcare and Public Health in the US: Delivering Healthcare (Part 2). This is Lecture (c).
The component, Introduction to Healthcare and Public Health in the US, is a survey of how healthcare and public health are organized and services are delivered in the US.
Slide 2
The Objectives for Delivering Healthcare (Part 2) are to:
· Describe the organization of clinical healthcare delivery in the outpatient setting and the organization of outpatient healthcare.
· Describe the organization of ancillary healthcare delivery in the outpatient setting.
· Discuss the role of different healthcare providers, with an emphasis on the delivery of care in an interdisciplinary setting.
Slide 3
This lecture will discuss retail clinics, urgent care centers, and the emergency department or emergency room as outpatient venues for healthcare.
One venue for obtaining outpatient healthcare is a retail clinic. These are facilities located in stores or pharmacies, although they may also be free-standing. They are usually staffed by nurse practitioners, who are nurses with additional training, also known as mid-level providers. Retail clinics are intended to treat common and minor illnesses such as sore throats, uncomplicated urinary tract infections, conjunctivitis, also known as pink eye, or simple sprains.
Slide 4
Urgent care centers offer a level of care that is more acute and more sophisticated than that offered by retail clinics. There are more than eight thousand five hundred acute care centers in the US, and this trend has been growing since the 1970s. Urgent care centers are usually walk-in clinics, which means that a patient does not require an appointment to see a provider. The provider in urgent care centers is usually a physician. These centers may have extended hours and usually provide care for acute illnesses and injuries that are beyond the scope of care of a typical primary care practice.
Slide 5
Urgent care centers are usually staffed by a licensed practitioner. They typically have laboratories or x-ray facilities on site, and some of them also have more advanced diagnostic equipment. However, urgent care centers are not intended to treat life-threatening emergencies. The emergency room of a hospital is best equipped for these.
Slide 6
This slide provides some statistics on the emergency department (ED), also called the emergency room, or ER. In 2007, one in five people in the US had one or more emergency room visits. The number of people using emergency rooms has increased over time. In 1996, there were more than ninety million ER visits. By 2006, the number had risen to more than one hundred nineteen million. That equals about two hundred twenty-seven visits to emergency rooms every minute during 2006.
The age group with the highest annual number of ER visits per capita was infants under twelve months of age. This group made about three-point-five million ER visits.
In 2006, twelve-point-eight percent, or about fifteen million, ER visits resulted in admission to the hospital.
Slide 7
Emergency rooms are intended to treat life-threatening emergencies, but a substantial number of ER visits are not for emergencies. Approximately eleven percent of all ambulatory medical care visits in the US occur in the emergency room, and the number of non-emergency ER visits may be very high. For example, in 2008, forty-two to forty-six percent of ER visits in upstate New York were potentially unnecessary.
Slide 8
The sheer number of people who are seen in emergency rooms in the US has led to overcrowding. Overcrowding in the ER is associated with delays in the treatment of serious medical conditions, such as heart attacks or strokes. Overcrowding also increases waiting times for people with minor illnesses and reduces the promptness and the quality of pain management for people with acute pain. Patients who are admitted to the hospital may be boarded in the hallways while waiting for rooms to open up. Ambulances may be diverted from full emergency rooms toward more distant emergency rooms that are able to take in patients. Finally, overcrowding decreases physicians’ productivity within emergency rooms. All of these are significant issues, and the problem is only getting worse.
Slide 9
So why are there so many emergency room visits? In the example from upstate New York, forty-five percent of potentially unnecessary ER cases occurred between 9 am and 5 pm. This means that the hours of operation of primary care clinics are not necessarily the issue. In fact, the statistics suggest that patients simply cannot be seen in primary care clinics between 9 am and 5 pm and therefore, they seek care in emergency rooms. Could this be a consequence of the primary care crisis discussed in the previous lecture?
Slide 10
There are many reasons why patients with non-emergent medical issues choose to seek care in emergency rooms. Some patients do not have a primary care provider. Many primary care clinicians are overextended, and there is a shortage of primary care providers. Patients who lack medical insurance find it difficult to go through the system of primary care clinics, so lack of insurance is often a barrier to care. Patients on Medicaid may seek emergency care more often than those with private insurance coverage or the uninsured because of higher rates of disability and chronic medical conditions.
The growing trend of patients receiving non-emergent primary care services from the emergency room, rather than relying on primary care clinics, is troubling because the cost of providing care in the emergency room is far greater than the cost of delivering identical healthcare services in the setting of the primary care clinic. Therefore, inappropriate ER visits are driving up the cost of healthcare in the US in general.
Slide 11
One important strategy for reducing the number of inappropriate ER visits is patient education. A patient who is aware of the ramifications of inappropriate ER visits and the financial burden associated with these visits is less likely to use ERs inappropriately.
Primary care clinics need to be able to provide comprehensive services, especially for patients with complex medical issues or chronic illnesses who tend to use the emergency room. Primary care physicians can coordinate a patient’s care longitudinally and comprehensively by establishing patient-centered medical homes.
Sometimes patients do not know where to go — whether it is more appropriate for them to go to the primary care clinic or to the emergency room. This problem could be avoided with a telephone triage system, where nurses can direct callers to the appropriate healthcare setting.
Another effort should be to improve the availability of after-hours care with extended hours in primary care clinics, convenience care centers, or even urgent care centers, to reduce the level of utilization of emergency rooms after office hours. Inappropriate ER visits could also be reduced by increasing enrollment in safety net programs.
Health information is often complex and patients sometimes find it difficult to care for themselves, but if health information were simplified, patients would be better able to care for themselves effectively and avoid going to the emergency room in the first place.
Slide 12
This completes Lecture (c) of Delivering Healthcare (Part 2). In summary, this lecture discussed retail clinics, urgent care centers, and the emergency department or emergency room as venues for healthcare. The problems and possible solutions for overcrowded emergency rooms were reviewed.
Slide 13
References slide. No audio.
Health IT Workforce Curriculum Introduction to Healthcare and Public Health in the US 1
Version 3.0/Spring 2012 Delivering Healthcare (Part 2)
Lecture c
This material (Comp1_Unit3c) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.