Access to primary, secondary, tertiary and quaternary

Access to primary, secondary, tertiary and quaternary health care. Please give your thoughts on this and what you would change if you could to make improvements. FIG. 3.1 Access to Primary, Secondary, Tertiary and Quaternary health care. Primary care refers to “first contact” services to which the public has direct access. Traditionally a person would go to see a primary care provider, who for the most part is a family physician or a nurse practitioner, for medical advice. However, with a multidisciplinary team approach to primary care that may vary, enabling individuals to contact a variety of providers for initial treatment (in addition to a physician or nurse practitioner) ranging from a chiropractor, physiotherapist, nutritionist, counsellor, or psychologist. Primary care facilities include your provider’s office/facility, a variety of clinics (walk-in, rapid access, ambulatory care), and the emergency department. If your primary care provider cannot manage your health issue and/or feels you need more in depth, specialized assessments, he or she will refer you to a specialist who provides secondary care. Secondary care occurs when a patient is sent to see a specialist (seeking a consultation), which usually requires a referral (e.g., from a physician, nurse practitioner, or midwife). The referring physician is required to send a detailed report about the patient to the specialist, concerning the reason for the referral, including lab and diagnostic tests. A specialist assists the primary care practitioner to diagnose a patient’s problem and orders the appropriate treatment, but the specialist’s involvement is usually short term. Secondary care may involve admission to a general hospital or referral to a highly specialized facility, which provides tertiary care. Highly specialized tertiary care also requires a referral. A cancer centre or cardiology centre, for example, would provide tertiary care. Other examples include facilities that specialize in treating burn patients, neurosurgery, complex mental health, and palliative care. In a tertiary care setting, the patient may receive care from the referring specialist or from another specialist (or both). Once care is considered complete, the patient may be sent back to the referring specialist, who will then discharge the patient back to his or her family doctor. Alternatively, the tertiary care centre itself may refer the patient back to the family doctor. Finally, quaternary care is an extension of tertiary care and even more specialized, sometimes involving experimental procedures. Hospitals that do research (often linked with universities) may provide this level of care. Case Example 3.4 shows how each level of care works in a practical scenario. SCIENCE HEALTH

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