Essay Sample on primary care as a clinical setting

Introduction

The complexities in the healthcare system are increasing as time goes by as demands for healthcare also increase across populations. High prevalence of chronic illnesses, the aging population and the introduction of the affordable care act have resulted in high demand for primary care. However, the number of primary care providers is diminishing; thus the demand may not be met. In 2012 and 2014, the National Committee for Quality Assurance and the Institute of Medicine respectively recommended an increased workforce to meet the demand for primary care by involving nurse practitioners. As a recommendation, to make the healthcare systems stable and ready for any future uncertainties, it was also agreed that high functioning teams be formed. Aided with technology, this would allow the current primary care physicians to attend to five times more patients (Arifkhanova, 2017). According to projections, as observed by Green, Savin, and Lu (2013), the number of nursing practitioners will double by 2020 and will potentially optimize the health services in primary care. At present, the diminishing availability of primary care physician has allowed many patients to seek the services of family nurse practitioners to address all their primary care needs. The number of nurses in the US, as of 2017, is huge (Arifkhanova, 2017) (See Figure.1). This suggests the evolved roles of nurse practitioners and physicians due to the expanding opportunities that have been witnessed in specialty medicine, a dominant trend that is affecting healthcare professionals. Family nurse practitioners engage patients by helping them understand the nature of their illnesses as well as suggesting practical measures that patients can utilize to improve their conditions. These aspects are collaborative and family-centered routes to primary care embedded on the core values and knowledge of nursing practice. The roles that family nurse practitioners play have become dominant because they now meet almost all patient primary care needs unlike a few decades ago (Offredy & Townsend, 2000). This paper analyses primary care as a choice for the future for advanced practice registered nurse and also highlighting the core requirements including the rings of information and how primary care aligns with the designs of the clinical information system.

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Primary Care-Features, Needs, Content, Value of Data, Information, Knowledge, and Clinical Decision

Primary care refers to the care provided by trained and skilled physicians with comprehensive knowledge in both first contact and continuing care for people with any health concern or condition (Pohl, Thomas, Bigley & Kopanos, 2018). As a clinical setting, primary care features include disease prevention, health maintenance, patient education, counseling, diagnosis as well as treatment of chronic and acute illnesses in various healthcare settings including in-patient, home, and critical care. Other than the nursing roles, an advanced practice registered nurse (APRN) is also expected to undertake some roles of a physician except surgery. According to the information sources available, this flexibility is aimed at reducing the costs of increased specialization. The scope of responsibilities includes but not limited to diagnosis, treatment and drugs prescriptions. The ability of nurse practitioners to work independently without the supervision of the physician has been on the rise albeit still controversial. But the increased need for primary care as well as the shortage of primary care physicians has shed light on nurse practitioners and how they can fill the gap by providing primary healthcare needs.

The data comparing graduation rates of nurse practitioners and physicians indicate that the number of nurses continues to rise while that of physicians has remained constant (Pohl, Thomas, Bigley & Kopanos, 2018). According to a report from the office of Diseases Prevention and Health Promotion, patients with primary care continue to live longer and healthier lives with fewer disparities as well as lower costs as compared to those under specialty care. It is a requirement that nurses provide collaborative care whereby they liaise with other healthcare professionals including physicians, psychologists, and pharmacists to achieve better outcomes. The value and demand for primary care have experienced an upsurge making this setting an attractive and relevant area of specialization in future for a family nursing practitioner (Pohl, Thomas, Bigley & Kopanos, 2018).

Expanding Rings of Information

The utilization of information in public the public health sector has been made possible through incorporation of technology. Because public health plays a crucial role specifically in building the blocks for community health-information sharing, its function has been immense as far as the long-term viability of medical policies, visions, standards, and requirements are concerned. The mutual benefits between public health and primary care lie within the records and information shared. These advantages are embedded in the four frameworks outlined in the Strategic Framework report released in 2004 by the Department of Health and Human Services (Kass-Hout et al., 2007). According to that report, the objectives of information sharing by all practitioners include to inform clinical practice, personalize care, interconnect clinicians and improve population health. Through this framework, the Regional Health Information Organizations was created to encourage collaborations through clinical records. The Nationwide Health Information Network (NHIN) was also created to foster communication and allow the exchange of interoperable information among organizations. These organizations depend on the electronic medical records (EMR) which are digitally collected and stored information on patients/populations and can be shared among healthcare collaborative teams. The Public Health Information Networks (PHIN) offers technical tools to ensure that public health agencies smoothly exchange electronic data and information (Kass-Hout et al., 2007). All these activities incorporate or constitute healthcare information warehousing conducted via specific software applications (Green, Savin & Lu, 2013).

Primary care aligns with features of clinical information systems. Since primary care is a collaborative venture that requires inputs from numerous health practitioners, health records and information exchange is of great significance to the practice. It is known that nurse practitioners offer patient-centered care; this means that they involve/engage patients in the exchange of health information (Tripathi, Delano, Lund & Rudolph, 2009). Health information exchange (HIE) is one of the means through which nurses earn the trust of their patients after which they can share crucial health information or data that can be shared electronically. As a result, HIE becomes so relevant and reliable and can, therefore, sustain the activities of RHIOs, and PHIN among other information sharing bodies. This way, the national health information can be used to formulate policies and standards relevant to public health. Collaborative models/approaches depend so much on EMRs and have been used in particular scenarios to considerable levels, and the results have been desirable (Kass-Hout et al., 2007).

Since 2009 after the establishment of the American Recovery and Reinvestment Act (ARRA), the use of EHR/EMRs has increased across hospitals and clinics. By 2015, it is reported that 96 % of hospitals and 87% of office related physician services were already using EHRs. One of the few organizations that have made patients participate in electronic data sharing voluntarily is the Massachusetts eHealth Collaborative (MAeHC). Accountable care organizations (ACOs) which are new delivery model have also been implemented to promote collaboration, improve patient care and contain costs. Generally, the use of EHR has become widespread globally especially in the developed countries because more patients are becoming aware of the benefits and medical practitioners are efficiently accessing and getting the health information they need. Health informatics is an indispensable tool for all medical professionals including nurses with regards to getting patient information and administering patient-centered care. All these aspects mean that primary care aligns with the relevant requirements needed to offer healthcare services (Palgon, 2018).

Conclusion

In conclusion, primary care as a clinical setting is becoming increasingly relevant as more persons seek medical care. The aging populations, increasing chronic and acute health conditions and the availability of affordable care have forced many individuals to seek primary care plans. The diminishing number of primary care providers has enabled nurse practitioners to step up and fill the gap. The needs cared for by the nurses include but not limited to diagnosis, treatment, prescription of drugs, and health promotion. Data and information collected on the nursing practice in primary care show that there are improved health outcomes, longer and healthier lives. The use of EMR/EHRs has extensively been used to get health information electronically and use the same for making decisions and policies surrounding healthcare. This capability, in which information technology is involved, has encouraged collaborative care whereby nurses can liaise with other medical practitioners to make care delivery effective and efficient. Informatics has also contributed immensely to public health decisions nationally and globally as more countries embrace digital health information systems. The perspectives that have been discussed and analyzed in this paper present primary care as a possible area of interest and specialization for a future family nurse practitioner.

References

Arifkhanova, A. (2017). The Impact of Nurse Practitioner-Scope of Practice Regulations in Primary Care (Ph.D). Pardee Rand Graduate School.

Green, L. V., Savin, S., & Lu, Y. (2013). Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication. Health Affairs, 32(1), 11-19.

Kass-Hout, T. A., Gray, S. K., Massoudi, B. L., Immanuel, G. Y., Dollacker, M., & Cothren, R. (2007). NHIN, RHIOs, and public health. Journal of Public Health Management and Practice, 13(1), 31-34.

Offredy, M., & Townsend, J. (2000). Nurse practitioners in primary care. Family Practice, 17(6), 564-569. Retrieved from https://academic.oup.com/fampra/article/17/6/564/507381

Palgon, G. (2018). The History of Heath Information Management - From Then to Now | Liaison Technologies. Retrieved from https://www.liaison.com/blog/2017/05/02/history-heath-information-management-now/

Pohl, J., Thomas, A., Bigley, M., & Kopanos, T. (2018). Primary Care Workforce Data And The Need For Nurse Practitioner Full Practice Authority | Health Affairs. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20181211.872778/full/

Tripathi, M., Delano, D., Lund, B., & Rudolph, L. (2009). Engaging Patients For Health Information Exchange | Health Affairs. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.2.4