scholarly journals The Resurgence of Home-Based Primary Care Models in the United States

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 41 ◽  
Author(s):  
Mattan Schuchman ◽  
Mindy Fain ◽  
Thomas Cornwell
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Institutional Care ◽  
Target Population ◽  
The United States ◽  
Community Services ◽  
Fee For Service ◽  
Home Based Primary Care ◽  
Home Based

This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs.

Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

2015 ◽  
Vol 63 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Bruce Leff ◽  
Christine M. Weston ◽  
Sarah Garrigues ◽  
Kanan Patel ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Quality Improvement ◽  
The United States ◽  
Current State ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

Interdisciplinary Team Perspectives on Mental Health Care in VA Home-Based Primary Care: A Qualitative Study

2019 ◽  
Vol 27 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Suzanne M. Gillespie ◽  
Chelsea Manheim ◽  
Carrie Gilman ◽  
Jurgis Karuza ◽  
Tobie H. Olsan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Interdisciplinary Team ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Katherine O’Brien ◽  
Sara Bradley ◽  
Vanessa Ramirez-Zohfeld ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Home Setting ◽  
Caregiver Support ◽  
Qualitative Survey ◽  
Home Based Primary Care ◽  
Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

PP97 Delineating Key Components Of Community Paramedicine Programs

2018 ◽  
Vol 34 (S1) ◽  
pp. 102-103
Author(s):  
Charles Yan ◽  
Bing Guo ◽  
Paula Corabian
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Target Population ◽  
The United States ◽  
Careful Consideration ◽  
Integration Model ◽  
Community Paramedicine ◽  
Primary Health ◽  
The Uk

Introduction:Population growth, epidemiological and demographic transition, and a shortage of healthcare workers are affecting health care systems in Australia, Canada, the United Kingdom (UK), and the United States (US). Community paramedicine (CP) programs provide a bridge between primary care and emergency care to address the needs of patients with low acuity but lack of access to primary care. However, how to capture the key characteristics of these programs and present them in a meaningful way is still a challenge. The objective of this presentation is to identify and describe the characteristics of currently existing CP programs in the four countries to inform policy-making on CP program development in Alberta.Methods:Information was obtained from systematic reviews, health technology assessments, general reviews, and government documents identified through a comprehensive literature search. The characteristics of the CP programs are described using a framework originally developed in Australia with three categories: (i) the primary health care model, (ii) the health integration model (in Australia, called the substitution model), and (iii) the community coordination model.Results:In general, Australia emphasizes rural/remote paramedics, whereas Canada, the UK, and the US implement expanded paramedic practice within different environments including rural, remote, regional, and metropolitan settings. Extended care provider programs have been intensively investigated and widely implemented in the UK. While the identified CP programs vary in terms of program components, designation of providers, skill mix, target population, and funding model, the majority of these CP programs fall under the primary health care category of the Australian framework.Conclusions:Transitioning from hospital-based to community-based health care requires careful consideration of all key factors that could contribute to future program success. Delineating key components of CP programs using the Australian framework will help Alberta decision-makers design, develop, and implement appropriate CP programs that adequately address local needs.

scholarly journals Health Care Professionals� Clinical Perspectives on Glycemic Control and Satisfaction With a New Blood Glucose Meter With a Color Range Indicator: Online Evaluation in India, Russia, China, and the United States (Preprint)

2017 ◽  
Author(s):  
Mike Grady ◽  
Laurence Barry Katz ◽  
Pamela Anderson ◽  
Brian Leonard Levy
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Blood Glucose ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
The United States ◽  
Color Features ◽  
Glucose Meter ◽  
Diabetes Educators

BACKGROUND We previously demonstrated in patients with diabetes that displaying blood glucose results in association with color improved their ability to interpret glucose results. OBJECTIVE The objective of this study was to investigate the perceptions of health care professionals (HCPs) in specific countries about the value of color on a new glucose meter and to determine if HCP perspectives among countries differ on the value of this approach in clinical practice. METHODS A total of 180 HCPs, including 105 endocrinologists, 34 primary care physicians, 25 diabetes educators, and 16 pharmacists, were recruited from India (n=50), Russia (n=50), China (n=50), and the United States (n=30). These HCPs experienced the OneTouch Select Plus Simple glucose meter online from their own office computer using interactive demonstrations (webpages, meter simulator, and video clips). After providing demographic and current clinical practice insights, HCPs responded to questions about the utility of the color-enhanced glucose meter. RESULTS Mean age and years in their current professional role for the 180 HCPs was 41.3 (SD 8.1) and 13.3 (SD 6.8) years for endocrinologists, 41.3 (SD 8.3) and 14.1 (SD 6.8) years for primary care physicians, 37.5 (SD 8.7) and 12.7 (SD 6.8) years for diabetes educators, and 35.9 (SD 5.3) and 9.5 (SD 5.2) years for pharmacists. In all, 88% (44/50) of Russian and 83% (25/30) of American HCPs said their patients find it easy to recognize low, in-range, or high blood glucose results compared to 56% (28/50) of HCPs in China and 42% (21/50) in India. Regardless of country, HCPs had less confidence that their patients act on blood glucose results with 52% (26/50) in Russia, 63% (19/30) in the United States, 60% (30/50) in China, and 40% (20/50) in India responding positively. During the interactive online meter experience, HCPs from all countries responded positively to questions about a meter with color features. After reflecting on the value of this meter, most HCPs strongly agreed or agreed their patients would be more inclined to act on results using a meter with color features (Russia: 92%, 46/50; United States: 70%, 21/30; China: 98%, 49/50; India: 94%, 47/50). They also said that color was particularly useful for patients with lower numeracy or education who may struggle with interpreting results (Russia: 98%, 49/50; United States: 77%, 23/30; China: 100%, 50/50; India: 82%, 41/50). CONCLUSIONS This multicountry online study provides evidence that HCPs had high overall satisfaction with the OneTouch Select Plus glucose meter, which uses color-coded information to assist patients with interpreting blood glucose results. This may be especially helpful in patient populations with low numeracy or literacy and limited access to health care and direct interaction with HCPs.

scholarly journals Cancer Care and Cancer Survivorship Care in the United States: Will We Be Able to Care for These Patients in the Future?

2009 ◽  
Vol 5 (3) ◽  
pp. 119-123 ◽  
Author(s):  
Lawrence N. Shulman ◽  
Linda A. Jacobs ◽  
Sheldon Greenfield ◽  
Barbara Jones ◽  
Mary S. McCabe ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Cancer Survivors ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Survivorship Care ◽  
Patients With Cancer ◽  
Number Of Patients

The combination of a shortfall in oncologists and primary care physicians and an increased number of patients using more health care resources raises concerns about our health care system's ability to accommodate future patients with cancer and cancer survivors.

scholarly journals In which journals do family and community physicians in Brazil publish?

2021 ◽  
Vol 16 (43) ◽  
pp. 2589
Author(s):  
Leonardo Ferreira Fontenelle ◽  
Miguel Henrique Moraes de Oliveira ◽  
Stephani Vogt Rossi ◽  
Diego José Brandão ◽  
Thiago Dias Sarti
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
Journal Articles ◽  
Scholarly Journals ◽  
Primary Care Research ◽  
National Journal ◽  
Primary Health ◽  
De Medicina

Introduction: Authors choose scholarly journals not only to advance their careers but also to interact with their respective scholarly communities. Objective: To describe the journals where family and community physicians in Brazil publish their work. Methods: In late 2018, we compiled a nationwide list of family and community physicians, and downloaded their curricula from the Lattes Platform. We extracted data on their complete journal articles from their curricula, completed these data with queries to CrossRef, VHL/LILACS, and PubMed/MEDLINE, and obtained data on the journals with queries to the United States NLM Catalog. Results: We found 3558 unique articles, published by 1011 journals. The most productive journal was RBMFC (Revista Brasileira de Medicina de Família e Comunidade), which published 347 (9.8%) of these articles. About one in six articles were published in journals on family practice or primary health care. The proportion of articles published in journals in Brazil decreased during the study period from 83.8% to 58.4%. Conclusion: As in other countries, family and community physicians in Brazil usually publish in the national journal dedicated to their scholarly community, while also publishing extensively in journals from other disciplines. The increasing proportion of articles published in journals outside Brazil suggests primary care research in Brazil is increasingly of international relevance.

scholarly journals Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

JMIR Aging ◽  
10.2196/12415 ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. e12415 ◽  
Author(s):  
Andrzej Kozikowski ◽  
Jillian Shotwell ◽  
Eve Wool ◽  
Jill C Slaboda ◽  
Karen A Abrashkin ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Qualitative Study ◽  
Nurse Practitioners ◽  
Care Program ◽  
The United States ◽  
Care Team ◽  
Medical Needs ◽  
Home Based Primary Care ◽  
Home Based

Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.

scholarly journals Frailty and Dementia: Differences in Health Care Utilization and Costs

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 821-821
Author(s):  
Stephanie Denise Sison ◽  
Gahee Oh ◽  
Sandra Shi ◽  
Brianne Olivieri-Mui ◽  
Ellen McCarthy ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Retrospective Cohort ◽  
Care Delivery ◽  
The United States ◽  
Care Utilization ◽  
Fee For Service ◽  
Total Cost ◽  
Nuanced Understanding

Abstract Frailty and dementia are associated with poor health outcomes and increased health care utilization. A more nuanced understanding of this dynamic may be useful in improving care and developing policies. This retrospective cohort study was conducted using 5% random sample of Medicare fee-for-service beneficiaries (n=1,132,367; mean age 76.2 years; 57.9% female) in 2014-2016. We compared average 1-year home time (number of days alive outside of the hospital and SNF), mean total cost per beneficiary, and number of incident ICU stays per 100 person-years (PY) across four groups: frailty and dementia, dementia alone, frailty alone or neither. Frailty and dementia were identified using validated claims-based algorithms. We also determined differences in costs per group across different regions within the United States. Beneficiaries with both frailty and dementia had a high 1-year mortality rate of 21.9% (vs. dementia alone [9.7%], frailty alone [9.4%] or neither [2.1%]), while having less home time (306 days; difference of 36 days, 31 days, and 53 days, respectively), and more incident ICU stays per 100 PY (29.9 vs 9.5, 25.8, and 5.6, respectively). Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively). Across the United States, range of costs varied the most for beneficiaries with both frailty and dementia ($13,244-31,987 vs $4,621-15,364, $20,090-30,965, and $7,672-10,450, respectively). Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.

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