By Ike Señeres
As defined by Wikipedia, primary care refers to essential healthcare that is makes universal healthcare accessible to all individuals and families in a community. Although the definition of what is essential could still be debatable in this case, there is clearly no debate about the subject of accessibility. And not only that, there is no debate that primary care should not only be family based, it should also be community based. As far as I know however, there seems to be no clear definition of the space or gap between primary care and secondary care. Because of that, it seems that it is not common knowledge at what point primary care should end, and at what point secondary care should start. That may just be plain semantics, but the clear definition or the lack of it could mean life or death to some patients.
Maybe it is simply unique to this country that we live in, or maybe it has something to do with our culture, but apparently, we do not have a clear definition either as to when an outbreak could be defined as such, and at what point an outbreak becomes an epidemic. Thankfully, it is very easy to tell when an epidemic becomes a pandemic, but of course we always hope that we would never have to do that. No matter how it is done and no matter who gets to do it, I think that this should obviously be a numbers game. As I understand it, there seems to be an argument that an outbreak could already be declared, even if there is only one incident. I really do not know the wisdom behind that, but it seems to me that if it is going to be a numbers game, there should be a higher minimum number before a series of incidents could be declared as an outbreak. In connection with that, I think there should also be a minimum number of locations where outbreaks are reported, before it could be declared as an epidemic.
It seems very clear that the rationale for having urgent care centers is to have alternative locations where patients could be brought to, instead of bringing them directly to the emergency rooms of the regular hospitals. As far as this is concerned however, there is no question as to what point a patient should be referred to or transferred to an emergency room, because it is the attending doctor at the urgent care center who makes that decision. Similarly, we could perhaps assume that an emergency medical technician (EMT) or a paramedic on board an ambulance could also make the decision as to where he or she should bring the patient to, whether to an urgent care center or to an emergency room. Perhaps that would not even be a big issue if there two facilities are co-located in the same hospital, but that does not seem to be the case in most places.
There appears to be sufficient literature available, pointing to the fact that a primary care clinic could also function as an urgent care center, and vice versa. I think that that is a very practical idea, and I would like very much to know how that combination could be implemented here in the Philippines. As I understand it, a primary care clinic does not need much equipment but an urgent care center does, but what is the worth of money if we are talking about saving lives? As I see it, the costs of urgent care equipment are not beyond the reach of Local Government Units (LGUs) and even if these are, the LGUs have money anyway from their own local collections and on top of that, they all have significant shares of the Internal Revenue Allocations (IRAs). Granting that these LGUs really do not have the money, there are several government banks that could extend them loans, guaranteed by their IRAs.
If I would have my way on my lucky day, I would convert all Barangay Health Centers into urgent care centers, and needless to say, these should also function as primary care centers. As I understand it, urgent care centers are required to have the means of communications that would enable them to contact the emergency rooms in the event of the need to transfer. That should not be a problem nowadays because cell phones are everywhere, and so are landline phones and handheld radios. What could become a problem however are the means of communications between the ambulance units and the emergency rooms, while these are speeding en route to the hospitals. I am sure that there is a solution for that somewhere, and we could worry about that later. In the meantime, we should worry about upgrading the quality of the ambulance units, so that they could meet the new demands.