It should be noted that, in the past few years, some of the problems and challenges observed in primary care have been addressed; nevertheless, many of them remain critical. Overall, the difficulties in healthcare are related to variable quality, decisions made on different levels, shortage or burnout of the personnel, and so on (West, Dyrbye, & Shanafelt, 2018). The purpose of this paper is to discuss such fundamental challenges in primary care as physician burnout, quality documentation and reporting, and deficiencies of electronic health records.
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The latest evidence-based research suggests that physician burnout is one of the most pressing issues observed in healthcare, which also affects other stakeholder groups. In particular, the requirements posed by the current healthcare system accompanied by personnel shortage add additional stress on physicians (West, Dyrbye, Erwin, & Shanafelt, 2016). As a result, specialists cannot focus on providing the best of care to their patients, which leads to distrust in medical professionals. Physicians do not possess the required level of autonomy to be able to function autonomously and address the needs of their patients.
Research suggests that providers are the party, which limits the autonomy of medical professionals. They are forced to request tests for patients that they do not need because this is one of the requirements of service providers (Shanafelt, Swensen, Woody, Levin, & Lillie, 2018). This leads to costs growing while specialists cannot be autonomous in their decision-making and cannot apply their intuition when handling patients. Moreover, researchers believe that physicians are overloaded with paperwork, which needs to be offloaded to the auxiliary personnel or improved to make filling it out less time-consuming.
Physician burnout affects nursing practice directly since physicians and nurses are in close contact with each other when providing patient care. In addition, physicians need to offload documentation burden to the nursing personnel (Linzer et al., 2015). Meanwhile, nurses are also overloaded with responsibilities, and many healthcare institutions are significantly understaffed, which leads to greater burnout among nurses as well. It may be assumed that to resolve this healthcare challenge in primary care, it is important that facilities are staffed properly. Physicians should be restored in autonomy, and documentation needs to be offloaded in a way that it does not become a burden for physicians or nurses.
Quality Documentation and Reporting
Quality documentation and reporting is another challenge observed in primary healthcare. It is clear that accurate and timely documentation is essential for effective care. It is an official record of all patient information, which is then used by all healthcare professionals who are handling a patient (Sinsky & Bodenheimer, 2019).
The complexity of the issue lies in the fact that medical professionals are required to report any information a patient, their family, or another health care institution shares either during a personal contact or via means of communication. Documentation is a record of tests, procedures, therapies, and other services provided to a patient. According to research, inaccurate or misleading patient information affects the plan of care directly, which can lead to medical errors and increased expenditures as a consequence (Sinsky & Bodenheimer, 2019).
As applied to nursing, the main difficulties in terms of documentation and reporting are related to the need to ensure medical records are accurate and complete. Given the current settings in healthcare institutions, understaffed nursing personnel is faced with the responsibility to record a wide range of information (Lemetti, Stolt, Rickard, & Suhonen, 2015). Their workload is increasing dramatically, which affects the quality of records. Nurses do not have enough time to keep documentation neat. In addition, patients’ admission is growing while the number of nurses remains the same or falls, which implies more workload for the staff. Also, some healthcare institutions face situations of the recording material shortage, which also has a direct impact on the plan of care since some information may be skipped.
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Electronic Health Records Deficiencies
Even though Electronic Health Records (EHR) have several advantages, they also have particular deficiencies. Researchers note that one of the main disadvantages is that with a power outage, EHRs become completely inaccessible. Moreover, EHR of a hospital patient can be destroyed partially or completely if the main computer that stores the database is damaged (Cifuentes et al., 2015). EHRs contain sensitive information, and nurses are requested to update it with every patient visit. The workload of nurses is often inadequate, and they may enter inaccurate or incomplete information (Bell et al., 2017).
EHRs allow accessing patient information easily, which implies that nurses also need to discuss privacy concerns and other ethical dilemmas with clients. In addition, research suggests that nurses often need to transfer patient information from a paper-based system, which may result in data loss or inaccuracies. All that is likely to lead to medical errors, which is undesirable for both patients and healthcare providers.
Thus, it can be concluded that there are several challenges observed in primary care. Physicians often experience burnout due to increased workload, documentation burden, and loss of autonomy. Medical professionals are responsible for quality documentation and reporting as part of their work routine. The use of EHRs poses an even greater degree of responsibility for all healthcare professionals. These clinical healthcare problems inevitably affect nursing practice and require particular attention from the side of the professional community.
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Cifuentes, M., Davis, M., Fernald, D., Gunn, R., Dickinson, P., & Cohen, D. J. (2015). Electronic health record challenges, workarounds, and solutions observed in practices integrating behavioral health and primary care. The Journal of the American Board of Family Medicine, 28(1), S63-S72.
Lemetti, T., Stolt, M., Rickard, N., & Suhonen, R. (2015). Collaboration between hospital and primary care nurses: A literature review. International Nursing Review, 62(2), 248-266.
Linzer, M., Poplau, S., Grossman, E., Varkey, A., Yale, S., Williams, E., … Barbouche, M. (2015). A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: Results from the healthy work place (HWP) study. Journal of General Internal Medicine, 30(8), 1105-1111.
Shanafelt, T., Swensen, S. J., Woody, J., Levin, J., & Lillie, J. (2018). Physician and nurse well-being: Seven things hospital boards should know. Journal of Healthcare Management, 63(6), 363-369.
Sinsky, C. A., & Bodenheimer, T. (2019). Powering-up primary care teams: Advanced team care with in-room support. The Annals of Family Medicine, 17(4), 367-371.
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281.
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516-529.