Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
Ensuring that members of society are healthy and reaching their full potential requires the prevention of disease and injury; the promotion of health and well-being; the assurance of conditions in which people can be healthy; and the provision of timely, effective, and coordinated health care. Achieving substantial and lasting improvements in population health will require a concerted effort from all these entities, aligned with a common goal. The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) requested that the Institute of Medicine (IOM) examine the integration of primary care and public health. Primary Care and Public Health identifies the best examples of effective public health and primary care integration and the factors that promote and sustain these efforts, examines ways by which HRSA and CDC can use provisions of the Patient Protection and Affordable Care Act to promote the integration of primary care and public health, and discusses how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coordinate to improve efforts directed at disease prevention. This report is essential for all health care centers and providers, state and local policy makers, educators, government agencies, and the public for learning how to integrate and improve population health.
CARE AT HOME -HOME CARE Health care in the Netherlands looks to be a well structured system. Supplementing the vital level of self-care and informal care are four levels of professional care: the public health service (known in the Netherlands as basic health care) is mainly concerned with preventive work aimed at the population at large; individuals with problems can contact their general practitioner or other primary care provider, who can -depending on the problem -refer them to specialists in the cure-oriented and hospital-centred secondary sector; where necessary, patients can then be referred on to the institutions of the tertiary sector with their role in mainly long-term care. On paper this pyramidal structure appears to work well; in practice, and in particular where complex forms of care are involved, the boundaries become blurred. Medical advances and social and economic developments may delay death to ever greater ages, but disease is not defeated; and since the risk of developing chronic conditions rises with age, more and more people become incapacitated and those who do remain so for longer. This leads to a growing demand for care and compels us to reconsider patterns of provision. The need for such reconsideration is reinforced by users' changing needs and aspirations, as patients increasingly wish to be nursed and cared for in their own surroundings if at all possible. Technological advances mean that wish can often be accommodated.
Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.
Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.
How can the public health system best be organised in the future and which factors are the main determinants thereof? These are key questions in the scenario report The Future of Public Health: a Scenario Study. The report is the result of a study commissioned by the Steering Committee on Future Health Scenarios and carried out by a research team of the TNO Institute of Preventive Health Care and the STG Scenario Committee on the Future of Public Health. The report focuses on activities in collective prevention of diseases, generally known as primary prevention. The future images developed make use of two examples, the control of infectious diseases and public health for the elderly. In designing those scenarios, two sets of possible trends were combined: centralisation versus decentralisation and nationalisation versus privatisation. These combinations resulted in three scenarios; a local government scenario, a central government scenario, and a private enterprise scenario. The consequences of these future alternatives were developed in terms of their effect on organisation, policy control, financing, information supply, expertise and effectiveness. Although the report primarily focuses on the public health system in the Netherlands, the analysis of the processes examined, and the alternative scenarios based on them are also thought-provoking for readers throughout the world.
CARE AT HOME -HOME CARE Health care in the Netherlands looks to be a well structured system. Supplementing the vital level of self-care and informal care are four levels of professional care: the public health service (known in the Netherlands as basic health care) is mainly concerned with preventive work aimed at the population at large; individuals with problems can contact their general practitioner or other primary care provider, who can -depending on the problem -refer them to specialists in the cure-oriented and hospital-centred secondary sector; where necessary, patients can then be referred on to the institutions of the tertiary sector with their role in mainly long-term care. On paper this pyramidal structure appears to work well; in practice, and in particular where complex forms of care are involved, the boundaries become blurred. Medical advances and social and economic developments may delay death to ever greater ages, but disease is not defeated; and since the risk of developing chronic conditions rises with age, more and more people become incapacitated and those who do remain so for longer. This leads to a growing demand for care and compels us to reconsider patterns of provision. The need for such reconsideration is reinforced by users' changing needs and aspirations, as patients increasingly wish to be nursed and cared for in their own surroundings if at all possible. Technological advances mean that wish can often be accommodated.
This book examines methods for selecting topics and setting priorities for clinical practice guideline development and implementation. Clinical practice guidelines are "systematically defined statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." In its assessment of processes for setting priorities, the committee considers the principles of consistency with the organization's mission, implementation feasibility, efficiency, utility of the results to the organization, and openness and defensibility--a principle that is especially important to public agencies. The volume also examines the implications of health care restructuring for priority setting and topic selection, including the link between national and local approaches to guidelines development.
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