Primary Care Provider

In the United States, the primary care provider (PCP) has been placed in the position of coordinator of care for many patients,particularly those enrolled in managed care health plans.In many parts of the world the general practitioner function in this role.The PCP should be an integral part of the care of a child with a complex chronic condition.The importance of this is that the PCP is in a position to be the advocate for child and family and to ensure that there is access to the care that is indicated to allow optimal growth and physical and mental development.The PCP considers all the opportunities for care for the whole child and family.This implies that they are in the best position to provide a broad approach to care.If the family is able to define an individual whois able to provide ongoing continuity of care and it is an individual with whom they have good rapport, it is an excellent basis for optimal management.If the PCP ndertakes the role of coordinator of care, there will need to be a commitment to providing the resources that are necessary.This will involve time and money, because the time needed to provide care for a child with a chronicillness may be considerable and may not be reimbursed at an appropriate level.

The role of the primary care provider and the involvement in the care of health management of children has been proposed to be at differenf levels.Although this was inspired in the era before managed care and could theoretically be updated, it does provide a framework for provision of care.

Level 1 care is routine health maintenance for healthy children.This may exclude children with chronic conditions who will be referred to another level either because the practitioner  is unwilling or unable to provide an appropriate level of care.

Level 2 care is the perfomance of task-oriented care which is independent of primary care but  can supplement this.Examples include provision of specific care that the subspecialist requests but does not implement, such as immunizations or ordering laboratory tests.In the managed  care environment this may be invoked or forced by the managed care gatekeepers so that costs can be saved.

Level 3 care is when the primary care provider is the central figure in the care of the child with a chronic disorder.The provider is experienced in management of the more complicated child but will refer for specialty care as ondicated.It required a greater knowledge base and commitment than routine healthy  child management.

Level 4 care represents comprehensive primary healthy care incorporating the complex requirement of the chronic condition and its relationships with the child and the family.Of necessity, the practitioner will have broad knowledge of the chronic condition as well as the ability to provide excellence of primary care.The provider will utilize subspecialty expertise and acces community resources that are indicated.The practitioner works with the specialist without relinquishing care to them.

Level 5 care means that the primary provider becomes the case manager for the family of the child with a chronic condition.This involved facilitating a short- and long-term plan of care and assisting in the implementation of this plan.The primary care provider is the advocate for the patient and family and evaluates the outcome.This level of care requires coordination and communication between all parties,meaning the patient and family, to the specialist and the health care professionals involved in the provision of care.

Other clinicians including physician assistants and nurse practitioners may provide primary care.Although they often work under the supervision of a physician, their roles are increasingly becoming independent and they provide much of the ongoing care that is important in the management of chronic illness.They also provide much of the education that is necessary to allow the family to understand the condition and the implications of treatment.