Respond to the students discusion post below: “The US healthcare system has fail

Respond to the students discusion post below:
“The US healthcare system has failed patients, communities, and healthcare professionals. Decades of inflated cost, redundant, ineffective, inferior quality, unsafe and low value care plague our nation. As a result, the US has yielded the worst health outcomes than any other developed country. A proposed transformation in the approach to population health, provoked the design of the Patient Centered Medical Home. The term “medical home” was conceived by the American Academy of Pediatrics. Later, the World Health Organization designated primary care as the base for the medical home (Robert Graham Center [RGC], 2007). In the 1990s, the Institute of Medicine influenced family practice to create medical home prototypes and by 2004, the American Academy of Family Physicians, American Osteopathic Association, American Association of Pediatrics and American College of Physicians disseminated the PCMH model with seven consensus driven core concepts: personalized physician, physician directed team-based care, holistic comprehensive care, quality and safety focus, augmented access, and reform payment schemes.
By state executive order in 2007, the Pennsylvania State government approved the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission enacting the Chronic Care Initiative with a priority strategic goal of disseminating the PCMH model (Primary Care Collaborative [PCC], 2022). House Bill 1655 in 2014 established the Patient Centered Medical Home Advisory Council charged with implementing plan for statewide medical home design. As of March 2019, there were approximately 1,111 PCMH transformed medical practices.
We can herald the success of the Patient Centered Medical Home model as we witness program growth throughout the nation region by region. However, once healthcare access across the board is achieved, the following challenge of care coordination remains.
As an acute care nurse practitioner, experience with PCMH is extremely limited. However, anecdotally discordant, fragmented patient care with over ED utilization, frequent hospital admission, and bypassing of primary care providers is witnessed daily. Outside of the PCMH, there is little communication between PCP, emergency department, hospitalist, or specialists, particularly during off peak hours. Patients are triaged in urgent care centers, then referred to emergency departments due to minimal resources for comprehensive evaluation, and later discharged from the emergency room without clear instructions for follow-up except “call your PCP as soon as possible to make an appointment.” Low-level emergency room visits account for 15% of nonurgent emergency department assessments, resulting in overcrowding and ER diversion with unfortunate treatment postponement and blocks for the acutely ill (Pearson et al., 2018). Investigations point out common themes in nonurgent ER visits including dissatisfaction with PCP, related to long waits, inconvenient office hours or suboptimal rapport.
Formal, streamlined, standardized processes for primary care office notification are not in place. Consequently, there is PCP unawareness and loss of opportunity to manage patients effectively as well as over, under and delayed treatment. The statistics suggest two-thirds of 141 million ER visits resulted in recommendation for continuation of care with outpatient provider with further evidence showing inadequate patient post-ED visit PCP follow-up (Chou et al., 2018).
More insidious is the out of hours phone calls from patients demanding antibiotics due to irritative lower urinary tract symptoms without evidence of toxicity. Outside of clinic hours, urology primarily functions as a surgical service. Therefore, without evidence of mechanical genitourinary tract obstruction, infection is a medical problem and not mitigated by surgical maneuvers. Patients will circumvent the primary care office, seeking prescriptions for antibiotics. Many of these patients have recurrent UTI and evidence of multidrug resistance. Of note, MDRO is now considered a major public health dilemma by the Canadian and American Urological Associations and Infectious Disease Society of America urging for antimicrobial stewardship (Hickling, 2021). Treatment regimens are approved by multiple on-call urology clinicians without face-to-face evaluation or availability of final sensitivities. Like habits of narcotic pursuing patients, often individuals with recurrent UTI, make numerous supplications from divergent sources for antimicrobials. A recent study of non-visit related urology antibiotic prescriptions demonstrated of greater than 1700 telephone encounters, 75% of prescriptions were for antibiotics with 33% clinical self-reported symptom-based UTI diagnosis and 15% of cases where urine cultures were absent (Akbar et al., 2019). Imprudent UTI handling is both clinically inappropriate and ethically compromising for the practitioner.
The PCMH model is a noble effort to provide comprehensive, inclusive care with cost containment given a protracted era of exorbitant healthcare related spending with consistently reduced patient and population outcomes. However, care coordination is limited to internal events and constrained by current operational capacity. Eighty-six percent of healthcare expenditures are related to chronic illness and not acute derangements (Almalki et al., 2018). Factors such as patient preference and health literacy, convolute matters even further. Shared decision making with the consideration for patient preference is a basic tenet in contemporary healthcare schemes. The evidence may show an increase in patient satisfaction due to desire for control but does not strongly associate collaboration alone with improved patient knowledge, understanding of clinical context, the capacity for sound judgment or ability to engage profoundly (Muscat et al., 2020).
In the matter of the Patient Centered Medical Home, all principles must work equally with harmonization and special attention to access and coordination of care if ever to attain projected aims and desired gains of the healthcare community. In the example of recurrent UTI, office hour expansion, enhanced technological support, increased patient education, unambiguously assigned roles and fitting specialist consultation may provide remedy. Unfortunately, these circumstances require multi-prong evidence-based tactics to problem solving tempered with realism and common sense.