Medicine
In developing countries, most primary health care is provided not by doctors or nurses, but by community health workers who have limited or minimal medical training. In the U.S., in contrast, most primary care services are provided by physicians with extensive residency training in family medicine, internal medicine, pediatrics, and obstetrics/gynecology. Even the emerging concept of the primary care team largely remains centered around the physician and his or her office practice.
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Medicine
Partnering with community health workers for better primary care
In developing countries, most primary health care is provided not by doctors or nurses, but by community health workers who have limited or minimal medical training. In the U.S., in contrast, most primary care services are provided by physicians with extensive residency training in family medicine, internal medicine, pediatrics, and obstetrics/gynecology. Even the emerging concept of the primary care team largely remains centered around the physician and his or her office practice.
But when patients with multiple uncontrolled chronic medical conditions need intensive primary care, health services researchers are discovering that the critical role of the community health worker may be just as relevant in the U.S. as it is in the Third World. An Innovation Profile in the March issue of the journal Health Affairs describes a pilot program in Vermont where patient-centered medical homes are supported by community health teams consisting of registered nurses, behavioral counselors, and dietitians, and community health workers. These teams have reduced hospital admissions, emergency department visits, and overall costs. As the profile notes, community health workers play multiple vital roles in helping patients access and navigate the care system:
Community health workers on the team help patients fill out insurance applications, follow treatment plans, manage stress, and work toward their personal wellness or disease management goals. In some cases, community health workers accompany patients to appointments and help them find transportation or child care. ... Providers said that they felt they could respond to a range of patient needs - nonclinical as well as clinical - with the community health team's support. As [one physician] puts it, "Having access to the community health team removes the fear of asking a patient the simple open-ended question, 'So, how are things?' If the patient breaks into tears or admits that things at home are chaotic, I do not feel that I need to solve all of their social woes then and there by myself. I have a whole team to help."
As Vermont moves toward becoming the first state in the nation to enact a single-payer health system for all of its residents, its thus-far successful experiment with community health teams as primary care partners bears watching closely.
- How Care Teams Can Support Shared Decision Making In Primary Care (2 Of 2)
Yesterday, I delivered the keynote speech at the Team Care Challenge, sponsored by the Patient-Centered Primary Care Collaborative, Medstro, and the American Resident Project. This is the second of two posts containing the text of my talk. Part 1 is posted...
- How To Avoid Dropping The Baton On Patient Care Handoffs
As a long distance runner on my high school track team, I won few accolades in individual events, but shone in relays. My teammates and I spent hours perfecting our baton exchanges, which must occur within a limited area of the track, until these handoffs...
- How Would You Rate Your Health Care Team?
Two recent commentaries in the Annals of Family Medicine and the New England Journal of Medicine argue that the performance of modern family doctors can only be as good as their practice teams. In "The Myth of the Lone Physician: Toward...
- Your Primary Care Team Will See You Now
In a previous post about how health reform will change your doctor's visits, I mentioned that you're likely to see your future primary care delivered by a "team" of health professionals rather than your doctor. You might be surprised to hear that...
- Can Primary Care Practices Be "dream Teams"?
The greatest U.S. Olympic basketball team ever assembled, dubbed the "Dream Team," dominated the rest of the world at the 1992 Summer Olympics. This team, which beat opponents by an average of 44 points en route to a gold medal, included 10 eventual NBA...