scholarly journals Concierge Medicine: Should Financial Considerations Prevail Over Ethical And Moral Concerns?

2011 ◽  
Vol 7 (2) ◽  
Author(s):  
Fred Lauer ◽  
Benjamin A. Neil
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Good Health ◽  
Ethical Question ◽  
Care Providers ◽  
Financial Status ◽  
Existing Problems ◽  
Care Health

<p class="MsoNormal" style="text-align: justify; margin: 0in 0.5in 0pt; background: white;"><span style="color: black; font-size: 10pt;"><span style="font-family: Times New Roman;">Many primary care physicians are now considering changing <span style="letter-spacing: -0.1pt;">their practices to the new concierge medical practice. Also known as </span><span style="letter-spacing: -0.05pt;">boutique medicine, retainer or "highly attentive" medicine. This new </span><span style="letter-spacing: -0.2pt;">style practice offers access to a physician who has now limited the size of </span><span style="letter-spacing: -0.1pt;">his practice in exchange for an annual fee.<span style="mso-spacerun: yes;">&nbsp; </span></span>These practices are nearly all primary care, and usually vary in <span style="letter-spacing: -0.15pt;">size from 600 patients to 300 or less and carry a typical fee of $1,500.00 </span><span style="letter-spacing: -0.05pt;">a year. Although a recent phenomenon, boutique medicine remains a </span><span style="letter-spacing: -0.1pt;">small niche. But the number of practices continues to grow. Particularly on the East and West coasts where there are more wealthier people, who </span>expect more from their health care providers.<span style="mso-spacerun: yes;">&nbsp; </span><span style="letter-spacing: -0.1pt;">Benefits of this new practice include same-day or next-day </span>appointments not under time constraints, house calls, 24 hour a day <span style="letter-spacing: -0.2pt;">access by cell phone, annual wellness evaluations and highly appointed </span><span style="letter-spacing: -0.5pt;">offices.<span style="mso-spacerun: yes;">&nbsp; </span></span><span style="letter-spacing: -0.25pt;">One of the major criticisms of concierge medicine involves those </span><span style="letter-spacing: -0.05pt;">who do not participate in such a program. The practices also displace </span>patients to other medical providers. And as such, create problems of <span style="letter-spacing: -0.15pt;">excessive demand on the existing physicians who do not participate.<span style="mso-spacerun: yes;">&nbsp; </span></span><span style="letter-spacing: -0.05pt;">Generally speaking, the patients who elect to participate in concierge practices are healthier and require less intensive care than </span><span style="letter-spacing: -0.1pt;">those cared for in other settings. All this without consideration of the approximately 45 million Americans who live without health care insurance, which only serves to compound the existing problems.<span style="mso-spacerun: yes;">&nbsp; </span></span>There "VIP" medical services with their superior amenities and <span style="letter-spacing: -0.2pt;">convenience can be purchased by those with sufficient wealth. However, </span><span style="letter-spacing: -0.1pt;">the question should not turn on the quality of health care which depends on the amount of money an individual can spend on it. Many would </span><span style="letter-spacing: 0.05pt;">regard good health as a right rather than a privilege.<span style="mso-spacerun: yes;">&nbsp; </span></span><span style="letter-spacing: -0.05pt;">The final ethical question is to consider the thought that an </span><span style="letter-spacing: -0.1pt;">individual might experience more or less morbidity or mortality based on how much money they could devote to medical care. Health care </span><span style="letter-spacing: -0.05pt;">should not be discretionary, as everyone should be entitled to the </span>quality without regard to financial status.</span></span></p>

Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History

2006 ◽  
Vol 24 (32) ◽  
pp. 5105-5111 ◽  
Author(s):  
Patricia A. Ganz
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cancer Survivors ◽  
Medical History ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Care Providers ◽  
Follow Up Care ◽  
Physical Effects

Cancer survivors frequently visit their primary-care physicians, as well as oncology specialists, for follow-up care. There is a need to monitor these survivors for the late physical effects of cancer, yet few health care providers have received training in how to do this. This article provides guidance on how to take a cancer survivor-directed medical history to facilitate the elicitation of relevant exposures, family history, and symptoms that may be related to the late effects of cancer therapy.

scholarly journals Medically Underserved Populations: The Athletic Trainer's Role

2020 ◽  
Vol 15 (4) ◽  
pp. 289-294
Author(s):  
Jefferson Jackson Wetherington ◽  
Forrest Quinn Pecha
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Athletic Training ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
Care Delivery ◽  
Medically Underserved ◽  
Care Providers ◽  
Medically Underserved Populations

Context Health care cost continues to rise; the US continues to spend dramatically more money than other developed nations per individual without increased health outcomes. More individuals are finding it harder to get access to a health care provider, especially those in medically underserved areas and populations. Objective To increase the knowledge of the athletic training educator about medically underserved populations and the roles athletic trainers (ATs) play as leaders in health care delivery. Background Current and future physician shortages are known and are only going to increase as more than one-third of current primary care physicians are expected to retire in the next 10 years. Forty percent of the population lives in areas that are medically underserved and designated by the government as areas of professional medical shortage; patients in these areas are primarily served by primary care physicians. Synthesis As with access to physicians, access to ATs has been shown to be based upon socioeconomic status and presents more challenges for the medically underserved. Early access to health care providers has shown to be important in adolescents, as negative health behaviors can carry into adulthood, leading to poorer health-related outcomes throughout life. Recommendation(s) To ensure that athletic training educational programs include opportunities to provide service to the medically underserved, education on social determinates of health, and the means by which ATs can fill critical holes in providing care for these patients. More research is needed to validate ATs' roles in providing quality health care. Additionally, more research is needed around how AT education can help meet patient needs. Conclusion(s) As the athletic training profession continues to evolve and responds to the growing demands of the complex health care system, access to an AT may provide a vital bridge to overall health care for patients within medically underserved populations.

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

scholarly journals Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals

2020 ◽  
Vol 6 (1) ◽  
pp. e1846844
Author(s):  
Anwen Zhang ◽  
Zlatko Nikoloski ◽  
Sarah Averi Albala ◽  
Winnie Yip ◽  
Jin Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Patient Choice ◽  
Care Providers ◽  
Care Facilities

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

scholarly journals Providing gender-affirming hormone therapy through primary care: Service users' and health professionals' experiences of a pilot clinic

2020 ◽  
Author(s):  
A Ker ◽  
Gloria Fraser ◽  
Antonia Lyons ◽  
C Stephenson ◽  
T Fleming
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New Zealand ◽  
Hormone Therapy ◽  
Health Care Providers ◽  
Health Professionals ◽  
Care Service ◽  
Gender Diversity ◽  
Service Users ◽  
Care Providers

© 2020 CSIRO Publishing Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a. INTRODUCTION: Primary health care providers are playing an increasingly important role in providing gender-affirming health care for gender diverse people. This article explores the experiences of a primary care-based pilot clinic providing gender-affirming hormone therapy in Wellington, New Zealand. AIM: To evaluate service users' and health professionals' experiences of a pilot clinic at Mauri Ora (Victoria University of Wellington's Student Health and Counselling Service) that provided gender-affirming hormones through primary care. METHODS: In-depth interviews were conducted with four (out of six) service users and four health professionals about their perspectives on the clinic. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Three themes were identified in service users' interviews, who discussed receiving affirming care due to the clinic's accessibility, relationship-centred care and timeliness. Three themes were identified in the health professionals' interviews, who described how the clinic involves partnership, affirms users' gender and agency, and is adaptable to other primary care settings. Both service users and health professionals discussed concerns about the lack of adequate funding for primary care services and the tensions between addressing mental health needs and accessing timely care. DISCUSSION: The experiences of service users and health professionals confirm the value of providing gender-affirming hormone therapy in primary care. Models based in primary care are likely to increase accessibility, depathologise gender diversity and reduce wait times.

scholarly journals Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S157-S157
Author(s):  
Shabinabegam A M Sheth ◽  
Bhavya Bairy ◽  
Aurobind Ganesh ◽  
Sumi Jain ◽  
Prabhat Chand ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Health Problems ◽  
Care Providers ◽  
Primary Health ◽  
Secondary Outcomes

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.

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