Illustration by George Folz, © 2019 Board of Regents of the University of Wisconsin System
Practice settings in healthcare are frequently categorized as inpatient or outpatient based on whether care is being delivered/received inside or outside of a hospital. Primary care clinics represent the foundation, or hub, of outpatient healthcare services. Interprofessional teams within primary care take responsibility for the entirety of a patient’s health and well-being. This includes directly managing acute illnesses and chronic conditions unless they are severe or uncommon.1–4 For severe acute illnesses and uncommon diagnoses, specialists are needed, and the primary care team steps into a coordination role, making referrals to, or recommendations for consultation with, appropriate providers.3,5 Sometimes these referrals are to specialty outpatient providers (e.g., cardiology, rheumatology, urology clinics), while other situations require referral for urgent or emergency care.
Importantly, primary care teams continue to coordinate with other providers in referral situations, which allows them to advocate for the overall healthcare needs of patients when multiple specialty providers become involved. After urgent or emergent situations are addressed, patients then transition back into the care of the primary care team. Another key feature of primary care is the provision of preventive health services, including helping patients stay up-to-date on immunizations and health promotion such as improving lifestyle (e.g., diet, exercise, smoking cessation).2 Primary care teams also conduct recommended screenings to identify health issues early in the course of a disease before severe consequences emerge. For more information on lifestyle and prevention efforts by pharmacists, readers are encouraged to explore the illustrated cases “Change Talk,” “Screen,” and “Mobilized” in Chapter 4 Prevention & Wellness.
The four pillars of primary care delivery include first-contact care, continuous care, comprehensive care, and care coordination.2,6 Primary care providers are often the first contact patients have with the healthcare system.3 From there, the primary care team attempts to provide continuous care; meaning, care delivered by the same team. This allows the patient, as well as their family and community, to establish relationships with healthcare providers and other health professionals.2,7 From a pharmacy perspective, the term provider is generally reserved for health professionals who are legally empowered to write prescriptions or order medications, such as physicians, physician assistants, nurse practitioners, and dentists; in some states, pharmacists are also granted limited prescribing authority as well. The ability of patients to develop trusting relationships with primary care providers and other health professionals on the team through repeated encounters promotes patient-centered care. Common conditions managed by primary care teams include high blood pressure, upper respiratory infections, depression, anxiety, back pain, arthritis, dermatitis, ear infection, diabetes, and cough.1 Lastly, primary care teams coordinate the overall health plan for patients to ensure the recommendations from specialists, as well as the conditions that the primary care team is managing, are safe and comprehensive.2...