THE DIFFERENCE BETWEEN PRIMARY, SECONDARY AND TERTIARY HEALTH CARE
At some point or other, you may have heard health professionals talk about primary, secondary or tertiary health care. These terms, which are used throughout the world, refer to levels of care, for cases ranging from mild to serious.
The primary care level is the “gatekeeper”, the first point of medical consultation. As a patient you are usually seen by a primary care physician, also called a general practitioner or family physician. Primary care is provided at a doctor’s office, health center or Urgent Care center. The Emergency Room is also often a source of primary care for the un- or under-insured.
According to the New England Healthcare Institute, demand for primary care continues to grow as patients become older and sicker. At the same time, there’s an increasing shortage of general practitioners. To meet the demand, physicians are starting to utilize nurse practitioners and physician assistants.
Medical specialists and other health professionals, who typically don’t have initial contact with patients, provide secondary care. For example, a primary care physician might refer a patient to a cardiologist, rheumatologist, or a urologist or other specialty physician. Some secondary care physicians do not require a patient to have a referral from a primary care practitioner.
Another category of secondary care is hospital care, or acute care. The term covers care as an admitted patient in a hospital, a visit to a hospital ER, attendance in childbirth, medical imaging (radiology) services and care within an intensive care unit.
Physical therapists, respiratory therapists, speech therapists, occupational therapists and other allied health professionals often work in secondary care.
Patients being treated requiring a higher level of care in a hospital may be considered to be in tertiary care. Physicians and equipment at this level are highly specialized. Tertiary care services include such areas as cardiac surgery, cancer treatment and management, burn treatment, plastic surgery, neurosurgery and other complicated treatments or procedures.
A fourth level of care, quaternary care, is a more complex level of tertiary care. Uncommon, highly specialized and experimental treatments and procedures are considered to be at the quaternary care level.
List of Services Offered by Hospitals
Hospital Services may be defined as facilities and utilities offered by hospitals in the form of medical and surgical assistance, laboratory and pharmaceutical provisions, staff and specialists, advanced equipment etc.
In short, hospital services include anything and everything that hospitals offer to their recipients. Most of these depend on the hospital’s motto, customer requirements and expectations.
Depending on the type of hospitals, the services they offer vary. However, every hospital needs to provide some core and mandatory services.
Listed below are some common and most required hospital services offered by every healthcare institute.
One of the distinguishing factors that marks hospitals unique, with respect to other health facilities; such as, clinics and care centers is that they provide both inpatient and outpatient care provisions.
Every hospital needs to have ward allotment for patients suffering from severe illness and injuries. This enables care givers to monitor health conditions continuously and thereby, accurate treatment procedures can be opted for.
In India, hospitals provide different types of wards for patients. Some of these are; general wards, private wards, semi private wards etc. Depending on choice and costs, patients can opt for any type of ward. Modern hospitals are sufficiently equipped to provide huge comfort to patients and are no less, or sometimes better than homes.
Nurses employed by hospitals function as connecting bridges between doctors and the patients they treat. Nurses look after the overall well being of patients. They ensure that all health related instructions given by doctors are implemented and followed by patients.
Nurses are employed in different departments within hospitals. Specialized hospitals hire trained nurses who are technically sound to perform advanced tasks relevant to diagnosis, treatment and care of sick ones.
Every hospital therefore has a separate nursing department which forms a core segment of hospitalization.
Out patient Department( OPD):
Every hospital needs to have an OPD (Outpatient Department) as one of the core services rendered. A set of skilled doctors along with technicians must be available, who can assist patients in preliminary diagnosis and related treatments.
Doctors prescribe medicines or diagnostic tests to evaluate a patient’s health condition. They are also required to be available for follow up visits to monitor conditions and treatment procedures. Depending on the response, patients are either asked for admission or specialized services such as surgeries.
Intensive Care Unit(ICU):
Almost every hospital in India provides ICU facilities for patients suffering from adverse health conditions. ICUs need to be equipped with modern technical apparatus and skilled professionals who can render best services. Depending on the type of hospital and services they focus on, there can be different types of ICUs. Some of them are, Neuro ICU, Coronary Care Unit, Neonatal ICU, Psychiatric ICU etc.
Pharmacy and Diagnosis:
Most hospitals in India do maintain a pharmacy and diagnostic department of their own. This is a very important segment as easy and quick availability of medicines and other equipment required for treatment procedure is vital to render best healing services.
However, many times, hospitals do not guarantee the availability of all medicines that are being prescribed and therefore independent pharmacies are equally important. Further, 9 out of 10 hospitals maintain a separate laboratory and diagnostic section where related tests can be carried out. Again, similar to pharmacies, these diagnostic departments do not offer a wide variety of tests and analysis for patients.
These were the five most common services related to hospitalization. The more advanced a hospital is in rendering services, the more popular and desirable it becomes. Indian hospitals are aiming at becoming more advanced in providing best and upgraded amenities to patients that can ultimately enhance their treatment procedures. Thus, with upgraded hospital features, the health care system in India will be at the top of providing best medical solutions to the entire population.
Different Departments Required in a Hospital
- 1. DEFINITION OF HOSPITAL According to WHO, “Hospital is an integral part of social medical organization, the functions of which is to provide complete health care for the population both, curative and preventive and who reach out to the family and its home environment. The hospital is also a center for training of health workers and for bio-social research.” Another definition was given by WHO in 1963 by the expert committee stating that : “Hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturient. It may or may not also provide services for inpatient or an outpatient basis.”
- 2. CASUALTY This department, also known as the accident and emergency department, deals with patients who have been brought in by an ambulance in an emergency situation. Sometimes patients find their own way to this department in case they have had an accident or seek immediate treatment. This department works 24/7 and is equipped to deal with all sorts of emergencies. The patients are assessed according to the degree of injury or emergency and then provided immediate treatment before being sent to a specialized department for further treatment. The Platt Report in 1962 gave birth to the official title of “Accident and Emergency Service”. This report stated the provisions that are to be followed for the smooth functioning of this department.
- 3. ANESTHETICS Doctors in this department administer anesthesia for patients for various procedures and surgeries. They provide the following services: Acute pain services post surgery Chronic pain services for patients suffering from bone related illnesses like arthritis Critical care services for those suffering from trauma Obstetrics anesthesia and analgesia like epidurals during childbirth and anesthesia for C-sections.
- 4. CARDIOLOGY The department as the name suggests deals with problems of the human heart or circulation. It treats people on an inpatient and outpatient basis. Some of their procedures include: Electrocardiogram (ECG) and exercise tests to measure the heart function Ultrasound scan of the heart ( Echocardiogram) Scans of the carotid artery in the neck to determine risks of stroke 24 hour blood pressure tests Insertion of pacemakers Coronary angiography to see if there are any blocks in the arteries Medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology Cardiac surgery
- 5. CRITICAL CARE This department also known as the Intensive Care Unit (ICU) provides treatment for seriously ill patients. Certain patients need to be isolated and require close and individual medical attention. The ICU has very few beds and is usually manned by specialist doctors and nurses as well as consultant anesthetists, physiotherapists and dieticians. Patients can be transferred from any department to the ICU in case the patient’s condition gets worse.
- 6. EARS, NOSE AND THROAT As the name suggests, this department deals with ailments concerned with the Ear, nose and throat and it includes treatment of a variety of ailments like: General ear, nose and throat diseases Neck lumps Cancers of the head and neck area Tear duct problems Facial skin lesions Balance and hearing disorders Snoring and sleep apnoea ENT allergy problems Salivary gland diseases Voice disorders ENT surgical procedures
- 7. GERIATRICS This department is usually manned with doctors specialized in geriatric medicine. Since the elderly suffer from a range of illnesses and seek treatment for: Stroke Gastroenterology Diabetes Locomotor problems Continence problems Syncope Bone disease This department also provides a range of community services like home visits, mobile therapy units, palliative care, and this department is often linked to other community centers.
- 8. GASTROENTEROLOGY This department deals with bowel related-medicine. It is usually run by specialist consultants and they investigate and treat upper and lower gastrointestinal diseases, as well as diseases of the pancreas and bile duct system. It also involves endoscopy and nutritional services. Some sub specialties include: Colorectal surgery Inflammatory bowel disease Swallowing problems Special nurses are often posted in this department and they are capable of performing a wide range of bowel investigations.
- 9. GENERAL SURGERY This department as the name suggests includes a wide variety of surgical procedures that include: Day surgery Thyroid surgery Kidney transplants Colon surgery Laparoscopic cholecystectomy (gallbladder removal) Endoscopy Breast surgery Day surgeries see a lot of patients coming in for minor surgeries such as hernia repairs, piles, … These procedures are normally performed by general surgeons and do not normally require special surgeons.
- 10. GYNECOLOGY This department deals with the investigation and treatment of problems of the female urinary tract and reproductive system. Infertility, incontinence and endometritis are some of the problems investigated in this department. Other services include cervical smear screen and post-menopausal bleeding checks. This department usually has a special ward, day surgery unit, an emergency gynecology assessment unit and outpatient clinics.
- 11. HEMATOLOGY This department can be part and parcel of the hospital laboratory or work closely with the hospital laboratory. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases that affect the production of blood and its components, such as blood cells, hemoglobin, blood proteins, and the mechanism of coagulation. The laboratory work that goes into the study of blood is frequently performed by a medical technologist. Hematologists also conduct studies in oncology—the medical treatment of cancer.
- 12. MATERNITY/NEONATAL/PEDIATRICS All facilities concerning giving birth and child care are provided in this department. In some hospitals these can be divided into three different departments but most general hospitals provide this care under one department itself. Some of the facilities or treatments include: Childbirth Midwifery Antenatal and postnatal care Pregnancy check ups Surgical procedures on children or mothers
- 13. NEUROLOGY Neurology deals with the human nervous system. The doctors in this department investigate and treat patients for problems that affect their brain and spinal cord. Surgical procedures on the brain and spinal cord are extremely dangerous and require highly qualified and experienced doctors and nurses to provide such special care. Neurologists examine patients who have been referred to them by other physicians in both the inpatient and outpatient settings. A neurologist will begin their interaction with a patient by taking a comprehensive medical history, and then perform a physical examination focusing on evaluating the nervous system. Components of the neurological examination include assessment of the patient’s cognitive function, cranial nerves, motor strength, sensation, reflexes, coordination, and gait.
- 14. ONCOLOGY This department investigates and treats all kinds of cancers and provides a wide range of chemotherapy treatments and radiotherapy for cancerous tumors and blood disorders. This department is usually linked to all the other departments as referrals can be made when one department cannot diagnose the patient’s problem. This department also requires highly qualified and experienced doctors and nurses. Doctors also carry out tumor removal procedures which are then sent for biopsy to confirm whether the tumor is malignant or not.
- 15. OPHTHALMOLOGY This department deals with the investigation and treatment of eye problems of adults and children. Their services include: General eye clinic appointments Laser treatments Optometry Orthoptics Prosthetic eye services Ophthalmic imaging.
- 16. ORTHOPEDICS This department deals with problems that affect the musculoskeletal system. That includes treating bones, muscles, tendons, ligaments, and nerves. Services include bone setting, surgeries to repair damaged bones or ligaments or tendons, replacing bones like hip replacement, knee cap replacement … Other outpatient services also include treating fractures and dislocated joints, musculoskeletal injuries and soft tissue injuries.
- 17. UROLOGY This department is usually a surgical department led by surgeons that perform certain specific services like: Flexible cystoscopy bladder checks Urodynamic research Prostate assessments and biopsies Shockwave lithotripsy to break up kidney stones.
- 18. PSYCHIATRY This department deals with investigating and treating patients with a wide range of mental illnesses and disorders. Some services include: Providing psychosocial counseling Investigating, diagnosing and treating psychiatric illnesses Conducting IQ tests De Addiction services.