scholarly journals Primary Care in the USA: The Long Struggle to Build its Foundational Role

2021 ◽  
Author(s):  
John Geyman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Access To Health Care ◽  
Universal Access ◽  
Reform Initiatives ◽  
Access To Health ◽  
The Usa ◽  
History Of ◽  
Current Reform

Family practice was recognized as the 20th specialty in American medicine in 1969. With the hope that primary care would become the foundation of an improved health care system, vigorous efforts were launched in medical education, research and practice to achieve that goal. This chapter traces the history of that effort, together with negative system changes that have obstructed that goal. Although primary care physicians have been shown to improve access to care, contain costs, decrease inequities, and improve patient outcomes, they are still too few in number to meet national needs for primary care. The COVID-19 pandemic revealed the extent of inadequacy and vulnerability of the system. The U. S. still lacks a system of universal access as has been in place for many years in most other advanced countries around the world. Corporate stakeholders in a largely privatized financing and delivery system continue to challenge the future of primary care. Lessons from the failure of reform initiatives over the last 50 years are discussed, as are current reform alternatives, only one of which would at last bring universal access to health care in this country.

Care Coordination and the Expansion of Nursing Scopes of Practice

2014 ◽  
Vol 42 (1) ◽  
pp. 93-103 ◽  
Author(s):  
Y. Tony Yang ◽  
Mark R. Meiners
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Access To Health Care ◽  
Primary Care Providers ◽  
Cost Curve ◽  
Care Providers ◽  
Access To Health ◽  
Recent Developments

Recent developments in the health care industry have precipitated a new wave of interest in expanding the scope of practice for nursing. This is because the Patient Protection and Affordable Care Act (ACA), broadly designed to increase access to health insurance, will inevitably result in increased demand for primary care providers. And with compensation for primary care physicians already lagging far behind that of specialists, the role of nurse practitioners is once again receiving increased attention as a viable means by which to ease the pressure for access to health care.But the economics of this trade-off are controversial. On one hand, it sets primary care physicians at odds with specialists; namely, if the ultimate goal is to “bend the cost curve downward,” should specialist compensation be reduced in order to increase spending on primary care?

Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711005
Author(s):  
Raza Naqvi ◽  
Octavia Gale
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Outcomes ◽  
Ethnic Minority ◽  
Access To Health Care ◽  
Health Screening ◽  
Service Utilisation ◽  
Community Based ◽  
Access To Health ◽  
Minority Ethnic

BackgroundPreventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation.AimTo consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups.MethodAn open community health screening event (n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views.ResultsSeventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care.ConclusionThis study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

scholarly journals Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elizabeth Hyde ◽  
Matthew H. Bonds ◽  
Felana A. Ihantamalala ◽  
Ann C. Miller ◽  
Laura F. Cordier ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Malaria Incidence ◽  
Universal Access ◽  
Surveillance Systems ◽  
Passive Surveillance ◽  
Transmission Season ◽  
Access To Health ◽  
Spatio Temporal ◽  
Geographic Access To Care

Abstract Background Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. Methods We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations’ financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

Telemedicine Basics

2021 ◽  
pp. 3-11
Author(s):  
Guenevere Burke ◽  
Jared Lucas
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Access To Health Care ◽  
Electronic Information ◽  
Remote Areas ◽  
Access To Health ◽  
History Of ◽  
Key Terms ◽  
Improve Access

Telemedicine is a rapidly growing field in health care and emergency medicine. Telemedicine, telehealth, and virtual health refer to the use of telecommunications technology and electronic information to support health and provide care over distance. It has been used to improve access to health care in geographically remote areas for decades, but its use and recognized benefits have expanded considerably over the years, accelerated by the COVID-19 pandemic. This chapter provides a brief overview of the history of telemedicine, introduces key terms, and reviews basic definitions that are foundational to telemedicine practice. Finally, it summarizes a wide array of telehealth applications in emergency medicine, which are detailed further in later chapters.

Global Health, Vulnerable Populations, and Law

2013 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Solomon R. Benatar
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Universal Access ◽  
Human Condition ◽  
Right To Health Care ◽  
Legal Provisions ◽  
Access To Health ◽  
Access To Medical Care ◽  
The Impact ◽  
Emergency Health Services

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the potential to provide a modicum of protection when we find ourselves in those situations (for example, through legislation, effective emergency health services can be created to reduce the impact of our potential vulnerability). There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue.

scholarly journals Estimating the local spatio-temporal distribution of disease from routine health information systems: the case of malaria in rural Madagascar

2020 ◽  
Author(s):  
Elizabeth Hyde ◽  
Matthew H Bonds ◽  
Felana Angella Ihantamalala ◽  
Ann C Miller ◽  
Laura F Cordier ◽  
...  
Keyword(s):  
Health Care ◽  
Geographic Distribution ◽  
Access To Health Care ◽  
Malaria Incidence ◽  
Universal Access ◽  
Surveillance Systems ◽  
Passive Surveillance ◽  
Transmission Season ◽  
Under Five ◽  
Access To Health

Background: Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to estimate the unobserved burden of malaria missed by routine passive surveillance in a rural district of Madagascar to produce realistic incidence estimates across space and time, less sensitive to heterogeneous health care access. Methods: We use a geographically explicit dataset of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results: Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations' financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions: Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

The Social and Ethical Implications of Universal Access to Health Care in Russia

1993 ◽  
Vol 3 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Raisa V. Korotkikh ◽  
Igor Falaleyev
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Universal Access ◽  
Ethical Implications ◽  
Access To Health ◽  
The Social
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