Rural vs. Urban Ancillary Services

Internet and ebooks for references.

 

WRITE A SYNTHESIS OF 3 CLASSMATES. See example below.

The concept of gatekeeping in healthcare is controversial. Sheena, Timothy, and Brooke attest to the fact that there are as many advantages to gatekeeping as there are limitations. The rationale behind the concept is that by controlling access to specialist services, the government can control healthcare costs. Sheena confirms that the informed gatekeeper, the primary care physician, determines patients whose conditions are beyond their scope, and therefore need specialist services. Ideally, this arrangement makes sense. Using the services of primary care physicians is less expensive than using specialist services at every instance (Wammes et al., 2014). However, in practice the situation has been less than straightforward. Brookes argues that primary care physicians are overworked because all patients have to consult the before being referred to specialists. Since the ratification of the Affordable Care Act (ACA), access to care has increased, thus significantly increasing the workload of primary care of physicians (Wishner & Burton, 2017). Timothy maintains that the use of gatekeepers is also a hindrance for individuals who require specialist attention on the go such as elderly patients. Visiting primary care physicians wastes time, thus increasing the likelihood of adverse outcomes. Lastly, the gatekeeping system is not popular among patients. It minimizes the autonomy of patients since they cannot choose when to seek specialist care (Greenfield & Majeed, 2016). For the gatekeeping system to succeed, authorities should look to minimize the impact of the limitations discussed. Increasing flexibility on groups of patients who can be exempted from seeking referral letters from primary care physicians would prevent unnecessary visits. Better communication between gatekeepers and specialists would also expedite the process.

Greenfield, G., Foley, K., & Majeed, A. (2016). Rethinking primary care’s gatekeeper role. Bmj354, i4803. https://doi.org/10.1136/bmj.i4803

 

Wammes, J. J. G., Jeurissen, P. P. T., Verhoef, L. M., Assendelft, W. J., Westert, G. P., & Faber, M. J. (2014). Is the role as gatekeeper still feasible? A survey among Dutch general practitioners. Family practice31(5), 538-544. https://doi.org/10.1093/fampra/cmu046

 

Wishner J. B. & Burton, R.A. (2017). How Have Providers Responded to the Increased Demand 

for Health Care Under the Affordable Care Act?

https://www.urban.org/sites/default/files/publication/94396/2001576-how-have-providers-responded-to-the-increased-demand-for-health-care-under-the-affordble-care-act_0.pdf

 

 

Yesenia’s post:

In the healthcare systems, providers require additional or ancillary services to assist their patients. Other services such as imaging, laboratory, or physical therapy help a provider diagnose and/or provide a long-term treatment plan. To understand the capabilities provided in certain areas, we must understand the difference between a rural and urban facility. Rural areas tend to be less populated, with a majority of the population classified as older. Healthcare facilities will be much smaller when compared to a facility in an urban area. Urban areas are considered the more populated areas.  In individual states, such as Rhode Island, rural facilities are not available (Hatten & Connerton, 1986). With that in mind, a smaller facility will most likely offer basic or less services than a larger facility. This generally means that for individuals in rural areas, not only will they travel to receive healthcare services, they may also have to travel farther to receive ancillary or specialty services due to their location. These barriers encourage individuals in rural areas to seek healthcare services when needed rather than on a routine basis (Georgetown University, 2019). Facilities in urban areas are more likely to have the ancillary service in the same facility or close by. This makes it easier for individuals in this area to seek and receive quality care. It creates fewer barriers for the patient, which will encourage more visits in the future. The most apparent solution to lessen the barriers for individuals in rural areas is to provide these ancillary services. That is easier said than done. My recommendation would be to set up traveling ancillary services. Reach out to rural areas and bring the services to them on a scheduled basis. This would encourage individuals with chronic conditions to abide by their treatment plans and encourage individuals to seek care regularly.

 

Ieshia’s post:

Ancillary services, or services such as home health or dialysis services can be challenging to obtain for those residing in rural areas. Although both rural and urban residents have unique challenges and disparities depending on the demographic, (as rural dwellers tend to be older, more likely to be uninsured, less educated or veterans, while urban dwellers have greater instances of poverty, mortality and depression)(Cyr, et al., 2019) rural residents are usually far from the proximity of needed health services.

I have worked in the dialysis field for greater that 20 years and it is not uncommon for patients which reside on the outskirts of the area to experience challenges in receiving their dialysis services. Not only are most traveling 30 minutes or more to treatments three times a week (since they do not have facilities in their towns) but they are often faced with the same dilemma should they need emergent services since there are only two major hospitals in the area. 

Additionally, cities with a larger patient base may have interventional clinics which service recurring health issues such as clotted accesses for dialysis patients, while smaller cities such as mine do not have these facilities forcing most of our patients to utilize the emergency department for outpatient services. 

To eliminate a lot of these disadvantages for rural patients, health care leaders should always seek to minimize the barriers facing these patients. For instance at our dialysis clinic we prioritize patient scheduling based on the transportation needs of our rural patients. If they are reliant on a transportation which can only bring them at a certain time we try our best to make sure they are scheduled into a time slot to suit their needs. Doing so helps to eliminates adverse occurrences such as missed treatments or increased hospitalizations.   

 

Jodyann’s post:

Ancillary services are specialty health care services with a wide range of diagnostic and supportive services provided to assist the work of doctors, nurses and other medical providers. Ancillary services are services that physicians may request to help treatment and diagnosis of an illness or injury.

Examples of Ancillary services include:

–          Chiropractic Services

–          Occupational Therapy

–          Physical Therapy

–          Radiology (x-rays and imaging)

–          Radiation Oncology (cancer care)

–          Respiratory Therapy

–          Speech/Language Pathology (speech, language, voice, fluency, cognition, and swallowing)  (US Department of Veteran’s Affairs.,2015)

How do ancillary services offered in rural and urban areas differ?

Ancillary services offered in rural and urban areas differ due to geographical locations of the health care service, making it harder to access care. Individuals residing in rural areas would have to travel frequently to be able to utilize services for their specialized care.

Regarding ancillary services, what are some disadvantages to consumers (patients) living in rural populated areas?

The disadvantages to patients living in rural populated areas who require ancillary services are that appointments to these specialties are limited, thus making it harder to be seen for care. Rural areas are more densely populated and access to an available ancillary health service facility can be limited if there are none with that requested specialty available in the area.

What recommendations would you provide as a health care leader to lessen these disadvantages?

For many individuals residing in rural areas with none or limited access to ancillary services, implementing and improving quality care to resources that are already available is recommended. Another recommendation would be to provide reliable transportation to and from the health care center for a minimum fee, that would afford patients the opportunity in their neighborhoods the opportunity to care. An integration of a general building housing majority of these services, like that of a clinic, would lead to better outcomes and values for patients as it would be for providers.

 
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