Running Head: PRIMARY CARE PRACTICE 1

Primary Care Practice

Name

Affiliation

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Introduction

In the past few decades of primary care reform, it seems that significant achievements

have been made, but some mistakes are also attempted. What seems clear is that a moment of

reflection is taking place in all the health organizations of the different Autonomous

Communities, analysis, and different alternatives are being put on the table to reorient the

organizational structure of the model itself, with which it seeks above all to improve the

participation of professionals, increase their degree of motivation, reorient the offer of services

towards the satisfaction of the needs of the professionals and in this way to obtain effective and

efficient services and to gain credibility before the users, offering safe and quality services.

When analyzing the results obtained from primary care, it seems that only those services

aimed at chronic patients have been developed, some related to prevention, basically vaccination

and those aimed at the healthy child, leaving the ones related to health promotion. The promotion

of self-care and some of the prevention is in gray services, sometimes not valued by the

population, but of incalculable value for society and for the system of primary care itself. After

this period of development of Primary Care, where the provision has been based on a model of

work in interdisciplinary teams and in which the role of Community Nursing has undergone

major changes, especially in the field of competence and responsibility, which have allowed

improving the offer of services to the population. At this moment a new process of change is

required and is deemed necessary since some goals have been achieved and others still pending

(Atherly, Kralewski, Johnson & Brasure, 2003).

Administration Management of a Primary Clinic

The main administrative management of primary care would require:

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1. Work teams with individual specificity for each of the disciplines that constitute them.

2. A homogenous service portfolio that guarantees the equitable provision of services to the

population.

3. A tolerable level of problem-solving.

4. Acceptable accessibility.

5. A good degree of user satisfaction with the professionals.

6. The incorporation of a quality model supported by the continuous improvement of quality as

an extended evaluation and feedback methodology in a constant cycle of PDCA (Plan, Do,

Check, Act), whose starting point has to do with a model of management supported in contracts

programs or management contracts, with a strategy based on the agreement of objectives and in

the evaluation of their compliance.

However, mistakes are part of the process of learning and improving, and this has

generated some weaknesses that have hindered the development of the organization and our

position as service providers. Demand in the growing medical consultation without any scientific

justification, the ratios of patients per family doctor decrease and sometimes they are below

average and not been expanded and yet demand grows. The truth is that in reality it seems that

the measurement of indicators of the number of patients has been prioritized, such as the

frequency of the number of patients per professional, or the number of home visits, which has

meant an indirect incentive for greater frequency and no real work has been done to increase the

capacity to solve problems and self-manage the population’s own resources (Cotton, 2006).

Services in Primary Care

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Other professionals of the Primary Care team feel demotivated when the doctor

apparently looks like everything in a health center, and that is what the outreach campaigns

show, always see your doctor or at the most, get to your health center. On rare occasions, it is

addressed to citizens or to another type of service or professionals that are also part of the

primary care. This generates some demotivation to the staff, due to the fact that nobody counts

on them and others ignore them because sometimes they are assigned duties of skills that they do

not have. The complaint system of the medical professionals and the bureaucratization should be

transparent and easily approachable by the patients and attendants alike. High pharmaceutical

consumption should be restricted, and medications must give on a need basis so there are

minimum chances of addiction to the patients further it will be cost-effective for the healthcare

service providers (Hall, 2006).

The term clinical management contains, on the one hand, the concept of management,

which refers to the use of resources and another clinic, which is the activity dedicated to the care

of patients. It is a process of organizational redesign whose objective is to incorporate health

professionals in the management of the resources used in their own clinical practice, a definition

that is harmonized in the practice of Nursing and, precisely, in care management. The aim is to

decentralize decisions on the management of the resources used in practice and provide the care

units with the capacity and tools to plan and manage their activities and, therefore, promote their

autonomy and responsibility. A necessary innovation tool in the management of services and in

order to improve their efficiency, effectiveness, and efficiency is based on the premise of the

professionals’ capacity. Under the philosophy of clinical management, actions of prevention,

promotion of care, care and rehabilitation are tackled in an integrated manner and, therefore, it is
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put on the table that such management of resources can be carried out both from the practice of

doctors and from that of the nursing professionals (Easton & Baker, 2015).

Staff and Service Quality

Among the instruments attributed to this tool is support in a structured knowledge of the

needs of the population served, the use of the best available scientific knowledge, an integrated

and participatory practice model and the use of evaluation tools. Nursing services currently

establish their mission in three areas: increase personal self-management through work in daily

care, achieve a balance between the needs of care and the ability to meet them, through routine

care and management of uncertainty it produces, above all, in situations of fragility or special

vulnerability. With this framework, which encompasses the offer of nursing services in the

community environment and together with the commitment acquired with the system by which

the nurses have committed themselves to provide adequate care to achieve an efficient system

and therefore, sustainable, it seems logical that from the nursing services are proactive (Roblin,

Vogt & Fireman, 2003).

When considering the application of clinical management in primary care and the way in

which the participation of nurses in it must be determined, if the theory is rigorously followed, it

asserts that clinical management has its application in the face of the problems more frequently

they are emerging today in society, which requires strategies for the integration of the care

process and the adequate management of resources with full involvement of professionals. With

this premise, if there is a clear situation of applicability in our environment, it is the vulnerability

that generates dependence. The help of the nurse who has valid ways to help in relation to the

results suited to the condition and circumstances of the patient can play an important role in the
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service of primary care. It is therefore to develop training for the nurse sees the patient as a

person and works with him because he needs nursing assistance; the problem and the mission of

the service are framed (Schlosser, 2003).

Thus, the focus of a clinical management unit led by community nurses integrated into a

health center structure, which would be focused on providing integrated and continuous care to

the problems of care dependency, also incorporating a new focus on the result expected and that

is related to the different conceptions of the term health, which we already know is different for

each one and that has to do with cultural codes and what their different meanings imply. The

objectives of primary care and its practical applications have to do with the search for the

implication and co-responsibility of all the professionals that integrate it and to promote a

management system oriented to work in integrated processes and with the search for continuous

improvement concept (Cotton, 2006).

Resource Management in Primary Care

The current structure of the Primary Care in the case of the clinical management units

within the hospital services is the application of the tools provided by the clinical management

applied in the model of the structure of the health centers. It constitutes a project of continuous

improvement of the main assistance processes, in an environment of decentralization of

decisions, budgetary responsibility, and coordination between the different providers that share

the care of citizens with dependency problems. It is a strategy to allow the evidence to clinical

practice and to apply the techniques of total quality to the management of Primary Health Care.

Care is understood, therefore, as a continuum linked to the patient and considers both the clinical
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aspects, values and wishes of the patient, as well as accessibility, linking social and health care,

as well as the role of the different care areas (Roblin, Vogt & Fireman, 2003).

It would be an adequate use of resources, personal and system based, for better care for

patients and their caregivers. It has some advantages: the autonomy of the management,

improvement of the relationship, it is motivating and entails an improvement of the information

or knowledge management. Thus, we would be faced with a problem whose causes are found in

some health problems that produce consumption of resources, both in the hospital and socio-

health environment and in the field of Primary Care and that, undoubtedly, requires the

application of the integrated process management for different assumptions. Likewise, it requires

the procedure of the coordination and cooperation protocol, patient safety and the application of

case management as the path that users travel within the system and to which the nurses

accompany through the planning and management of the patients. From the application of this

tool, there are already experienced in the primary care environment, as with the figures of the

liaison nurses or hospital case managers.

Clinical management includes guarantees of continuity of services at the time of hospital

discharge, continuity of care for the follow-up of care plans on weekends and holidays, enabling

the management of services, dependent on health centers. It also allows the integration of care at

the home of patients, either private or in homes for the elderly, which makes it possible to

establish a strategy to guarantee the safety of patients, in terms of aspects of therapeutic

compliance or self-medication strategies. The caregivers and their needs cannot be forgotten,

given that it is a phenomenon that every day supposes more difficult situations, both due to the

advanced age of many caregivers, as well as for their own morbidity and the duration and

complexity of care independence. From a clinical management tool, it can be allowed that
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strategies to innovate in those that facilitate the relief of fatigue of caregivers are implemented,

or supported in what has to do with the problems of a family coping in situations of high

dependency (Schlosser, 2003).

Conclusion

The Primary Health Care is in a moment of change as a result of the reflections that the

experts are seeking for its sustainability. With regard to management, the key lies in adequately

focusing the world of micro-management, which encompasses the technical tasks of organizing

services, and mobilizing the people who must carry them out, or the classification that allows

differentiation the functions of financing, assurance, purchase, and provision. By achieving the

coordination and incentive necessary to be involved and concentrate all efforts to achieve

common objectives, we will have a guarantee of success in the search for excellence in health

care. Clinical management fits into this proposal, which opens up a range of opportunities

(Stephens, 2016).

There are already experiences of clinical management in some Autonomous

Communities, but the proposal that is made has to do with these units being led and managed by

community nurses and oriented towards a specific approach to solving specific problems. For

this reason, the proposal focuses on the implementation of a structure that addresses the

processes around the care unit focused on care management, the design of integrated processes

based on coordination, the cooperation between levels and sectors and the management of the

necessary resources to achieve results related to the individual concept of health. The nurses are

trained to lead and manage these clinical management units aimed at satisfying the care needs of

dependent persons and their caregivers. This management or administrative process is

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compatible with the work in comprehensive care and in a model of the health center and of

Primary Care teams.

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References

Atherly, A., Kralewski, J., Johnson, C., & Brasure, M. (2003). Developing Rural Primary Health

Care Service Areas: An Analysis of Patient Migration Patterns. Health Care Management

Review, 28(2), 189-197. doi: 10.1097/00004010-200304000-00009

Cotton, J. (2006). Creating an integrated palliative care service. Primary Health Care, 16(9), 21-

23. doi: 10.7748/phc.16.9.21.s25

Easton, G., & Baker, R. (2015). Seven Days a Week, 8 AM to 8 PM. Journal Of Ambulatory

Care Management, 38(1), 16-24. doi: 10.1097/jac.0000000000000048

Hall, G. (2006). Drug management of hypertension in primary care. Primary Health Care, 16(3),

27-31. doi: 10.7748/phc2006.04.16.3.27.c600

Roblin, D., Vogt, T., & Fireman, B. (2003). Primary Health Care Teams. Journal Of Ambulatory

Care Management, 26(1), 22-35. doi: 10.1097/00004479-200301000-00003

Schlosser, J. (2003). Commentary on “Primary Health Care Teams”. Journal Of Ambulatory

Care Management, 26(1), 36-38. doi: 10.1097/00004479-200301000-00004

Stephens, M. (2016). Obesity Management in Primary Care. Primary Care: Clinics In Office

Practice, 43(1), i. doi: 10.1016/s0095-4543(16)00004-x