Levels of Healthcare

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Original Editors - Kirenga Bamurange Liliane and Naomi O'Reilly and ReLAB-HS

Top Contributors - Naomi O'Reilly, Chelsea Mclene, Tarina van der Stockt, Kim Jackson, Oyemi Sillo and Lucinda hampton      

Introduction

The healthcare providers who are part of these three levels of healthcare order, together provide medical services such as health issue finding, evaluating, providing treatment or referring to the next level of care based on the health needs. Primary, secondary and tertiary care refer to the complexity and severity of health challenges that are addressed, as well as the nature of the patient-provider relationship (i.e. whether it is an ongoing, long-term relationship or a short-term relationship aimed at addressing an acute condition). As mentioned previously, lower-level, longer-term care is generally classified as primary care, whereas more specialized and intensive medical care and treatments fall into the categories of secondary and tertiary care, depending on the severity of the condition being treated.

In the curative domain there are various forms of medical practice. They may be thought of generally as forming a pyramidal structure, with three tiers representing increasing degrees of specialization and technical sophistication but catering to diminishing numbers of patients as they are filtered out of the system at a lower level. Only those patients who require special attention either for diagnosis or treatment should reach the second (advisory) or third (specialized treatment) tiers where the cost per item of service becomes increasingly higher. The first level represents primary health care, or first contact care, at which patients have their initial contact with the health-care system.

Primary Care

Primary care is the first level of care that patients receive, and is focused on patient wellness and the prevention of severe health conditions. Primary care providers are typically patients’ first point of contact when they have medical concerns or needs. The relationship between patient and provider is also much longer term in primary care settings versus secondary and tertiary care settings, with providers often following a patient’s development and medical history for several years. Primary care is also delivered in outpatient settings, as the low-level care and consultations provided to patients do not require hospitalization.

Nurse practitioners who typically work in primary care settings include family nurse practitioners, adult primary care nurse practitioners, and pediatric primary care nurse practitioners. However, nurse practitioners who are board certified in acute care can work in primary care settings depending on their background and

The primary care level is the “gatekeeper”, the first point of medical consultation. As a patient you are usually seen by a primary care physician, also called a general practitioner or family physician. Primary care is provided at a doctor’s office, health center or Urgent Care center. The Emergency Room is also often a source of primary care for the un- or under-insured.

According to the New England Healthcare Institute, demand for primary care continues to grow as patients become older and sicker. At the same time, there’s an increasing shortage of general practitioners. To meet the demand, physicians are starting to utilize nurse practitioners and physician assistants.

As health care systems attempt to meet the needs of populations living longer and with more complex health needs, and with health service delivery being shifted to the community, there has been an increasing emphasis on primary health care. Primary health care is often the first point of contact for people in need of healthcare. It is the part of the health system that people use most and may be provided by a wide range of health care professionals, for example, a general practitioner (GP), dentist, physiotherapist or pharmacist. Primary care is often the first point of contact for people in need of healthcare

A primary healthcare service may diagnose and treat common health conditions within their area of expertise. They have the ability to assess the urgency of the condition and, direct the patient by providing appropriate referrals to other medical specialists where needed. Studies have shown that primary care providers benefit the healthcare system as a whole by offering enhanced access to healthcare services, better health outcomes, which often lead to a decrease in hospitalisation and use of emergency department visits.

Primary Health Care is an approach to health care that moves beyond traditional primary care to address health concerns at an early stage, emphasize health promotion and illness prevention through health and wellness programmes, and ensure that individuals receive accessible health and social services in their community.vii

• As the name implies it refers to the primary care focuses on the basic healthcare services that address the health issues faced by an individual.
• The care does not require a specialist and can be addressed comprehensively by a relevant health care professional.
• Primary care is witnessing a vigorous growth in both the developed and developing cities across all countries in the world.
• The goal is to make the general health solutions accessible to every individual.
• Primary care expects the increased participation of the general healthcare players, induce good healthcare practices at the basic level and meeting the expectations of the healthcare receivers.

In many parts of the world, particularly in developing countries, people get their primary health care, or first-contact care, where available at all, from nonmedically qualified personnel; these cadres of medical auxiliaries are being trained in increasing numbers to meet overwhelming needs among rapidly growing populations. Even among the comparatively wealthy countries of the world, containing in all a much smaller percentage of the world’s population, escalation in the costs of health services and in the cost of training a physician has precipitated some movement toward reappraisal of the role of the medical doctor in the delivery of first-contact care.

Benefits of Rehabilitation in Primary Healthcare

Primary health care is where the diagnosis of a large majority of health conditions, the identification of problems in functioning, and referral to other service delivery platforms need to occur.  The following benefits can be listed among others:

• Better quality of life.
• Reduction of the prevalence and minimization of the disabling effects of chronic conditions among adults and children.
• Facilitation of the continuity of care that supports full recovery.
• Helps to lessen the risk of preventable complications and secondary conditions.
• It can also help to avoid costly hospitalizations and re-admissions

Early access to rehabilitation through integration in primary health care helps to optimize outcomes, mitigate disability and improve people’s ability to live independent lives. WHO’s emphasis on universal health coverage and its recent launch of the Rehabilitation 2030 Call for Action are encouraging steps towards the goal of strengthening rehabilitation within the health system and in particular in primary health care.

Secondary Care

When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise about your condition.

Secondary care is more specialized and focuses on helping patients who are struggling with more severe or complex health conditions requiring the support of a specialist. Secondary care is typically delivered in inpatient settings, and is best defined as care for patients who require intensive specialist care but whose vital signs are stable. Examples of medical situations needing secondary care services include cancer treatment, medical care for pneumonia and other severe and sudden infections, and care for broken bones. Adult gerontology acute care nurse practitioners, adult acute care nurse practitioners, and pediatric acute care nurse practitioners tend to work in these settings; however, certified primary care nurse practitioners can also work in secondary care settings depending on their previous work experiences, the regulations in their state, and the specific needs of their employer.

Medical specialists and other health professionals, who typically don’t have initial contact with patients, provide secondary care. For example, a primary care physician might refer a patient to a cardiologist, rheumatologist, or a urologist or other specialty physician. Some secondary care physicians do not require a patient to have a referral from a primary care practitioner.

Another category of secondary care is hospital care, or acute care. The term covers care as an admitted patient in a hospital, a visit to a hospital ER, attendance in childbirth, medical imaging (radiology) services and care within an intensive care unit.

Physical therapists, respiratory therapists, speech therapists, occupational therapists and other allied health professionals often work in secondary care.

S.econdary Health Care is the specialist treatment and support provided by doctors and other health professionals for patients who have been referred to them for specific expert care, most often provided in hospitals. Secondary care services are usually based in a hospital or clinic, though some services may be community based. They may include planned operations, specialist clinics such as cardiology or renal clinics, or rehabilitation services such as physiotherapy. Secondary healthcare includes a wide range of specialists such as psychiatrists, cardiologists, obstetricians, dermatologists, pediatricians and gynecologists.

• Secondary Healthcare includes specialists such as cardiologists, dermatologists, urologists and other specialists.
• Individuals reach out to the secondary medical care providers through the referral of the primary healthcare professionals.
• In few countries, the individuals cannot consult the specialists without the referral of the medical practitioner at the primary care level.
• The secondary healthcare providers act as a liaison between the patient and the advanced medical care.

Tertiary Care

Tertiary care has been defined as highly specialised medical care, usually over an extended period of time, that involves advanced and complex diagnostics, procedures and treatments performed by medical specialists in state-of-the-art facilities . As such Consultants in tertiary care centres may have access to more specialised equipment and expertise for your condition.

Tertiary care is another form of specialized care that is a level above secondary care in that it involves supporting patients who are encountering life threatening illnesses and whose vitals are not stabilized. Tertiary care is delivered in settings such as the intensive care unit (ICU), emergency room, trauma, organ transplant, and critical care units.

Tertiary care can either be Regional or National, dependant on the size of the country. For most people they may have to travel to reach a tertiary care centre. It is generally an inpatient based service, although there are elements of care that can also be performed on an outpatient basis. Referral for tertiary care services come from both primary and secondary care health professionals. Examples of tertiary care services include specialist cancer management, neurosurgery, cardiac surgery, transplant services, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.

• This is the care comes into the picture as a referral to patients by the primary and healthcare providers.
• The individuals may require advanced medical procedures such as major surgeries, transplants, replacements and long-term medical care management for diseases such as cancer, neurological disorders.
• The specialized consultive medical care is the highest forms of healthcare practices and performs all the major medical procedures.
• Advanced diagnostic centers, specialized intensive care units and modern medical facilities are the key features in the Tertiary Medical Care.
• The practices that provide tertiary medical care could be part of the government or a combination of both public and private sectors. The healthcare system in India is an example of the latter.

Conclusion

The cost of treatment at the various levels can be dramatically different, and generally the cost of treatment for patients at the primary health-care level is usually only a small fraction of that at the third level. Ideally, provision of health care at all levels of care and in all settings should be available to all patients; such health care is referred to as universal health care.