Direct access, primary care, and autonomous practice

Question 1

definition: The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing within the context of family and community.

Answer 1

primary care

Question 2

definition: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient’s illness/injury.

Answer 2

differential Dx

Question 3

(true/false) The role of primary care practitioner is consistent with the expectations of education and practice as stated in the official documents of the APTA and CAPTE

Answer 3

true

Question 4

What primary care models have successfully paved the way for direct access?

Answer 4

Military
kaiser permanente (Large HMO structure)
VA (large hospital system)
Mercy health system (community hospital setting)

Question 5

90% of family physician training is in what setting? How long must they be in a musculoskeletal training?

Answer 5

outpatient ( >1 month of MSK experience)

Question 6

(true/false) family physicians do not have a heavy psychosocial focus.

Answer 6

false

Question 7

General internists have an emphasis of caring for what type of patients? How long of MSK training do they need? Do they have outpatient training/practice experience)

Answer 7

hospitalized patients (no MSK requirements and no outpatient practice)

Question 8

Nurse practitioners are grads of what training program? Who are typically their instructors?

Answer 8

RN; instructors are typically nurses, not MDs

Question 9

(true/false) nurse practitioners have prescriptive authority in all states

Answer 9

true

Question 10

(true/false) nurse practitioners can function independently

Answer 10

true (they are the closest to being a provider)

Question 11

RNs require a _____ degree.

Answer 11

bachelors

Question 12

LPNs require a ___ degree

Answer 12

associates

Question 13

Nurse practitioners require a ___ degree.

Answer 13

masters

Question 14

Physician assistants receive a _____ or ___ degree after graduate school.

Answer 14

bachelors or masters

Question 15

Who are the typical instructors for physician assistant students?

Answer 15

PAs (some MDs)

Question 16

(true/false) PAs have prescription authority in all states.

Answer 16

false (most states)

Question 17

(true/false) PAs can function independently.

Answer 17

False (only functions under the supervision of an MD)

Question 18

Who has more autonomy, NPs or PAs?

Answer 18

NPs

Question 19

How many years after undergraduate phase does a NP need in graduate school?

Answer 19

2 years

(undergrad 2-4 years)

Question 20

How many years after graduate school does an MD need to be in a fellowship?

Answer 20

3-5 years

Question 21

While in casualty situations, PTs manage patients in the ___ category.

Answer 21

minimal (“walking wounded”)

Question 22

Who augments the otho dept in mass casualty situations? Why?

Answer 22

a. PTs –> considered as a tactical admin

b. frees up surgeons and expedites access for patients with MSK/neuro MSK conditions

Question 23

How many PTs are in the army?

Answer 23

300+

Question 24

How many PTS are in the air force?

Answer 24

150

Question 25

How many PTs are in the navy?

Answer 25

90

Question 26

How many PTs are in the marine corps?

Answer 26

0

Question 27

With Kaiser permanente, PTs are part of the _______ care team.

Answer 27

primary

Question 28

In kaiser permanente model, PTs were recognized as experts in ___ conditions.

Answer 28

MSK

Question 29

__-__% of patient visits to adult primary care were MSK related

Answer 29

20-25%

Question 30

What are the 4 methods to see a PT in the kaiser permanente model?

Answer 30

- physician referral - joint consult with PT and MD - triaged to PT with calling or walk-in to a medical station - triaged after calling a medical advice line

Question 31

What are PT patient requirements for the kaiser permanente model?

Answer 31

- 18 to 65 y/o - non-industrial injury/ non-3rd party liability - afebrile - no chest or abdominal pain - not seeking medical intervention - willing to see a PT instead of an MD or NP

Question 32

What are the PT adult primary care staff guidelines in the kaiser permanente model?

Answer 32

- minimum of 4-6 years of OP ortho experience - demonstrate continued education in ortho - team communication skills

Question 33

What is the largest health system in the US?

Answer 33

VA

Question 34

What is the typical patient population for the VA?

Answer 34

older population with complex, multiple, medical problems

Question 35

What are the 3 methods to see a PT in the VA model?

Answer 35

- ED - primary care clinics - telephone triage systems

Question 36

What preparations do PTs need for the VA?

Answer 36

> 4 months experience in a primary care internship program

Question 37

What primary care model developed a model of education for physicians by PTs during clinical care of patients with NM conditions?

Answer 37

mercy health system

Question 38

What are the characteristics of autonomy?

Answer 38

- Independent, self determined judgment - Responsibility and acceptance of risk - Ability to refer and collaborate - Recognition of need for consult - Clinical decision making independent of financial considerations - PT governance and control of PT practice

Question 39

(true/false) Acute care in indiana is highly regulated

Answer 39

true --> 1 of 2 states that have no form of direct access