What we need to know about primary, secondary, tertiary and quaternary care

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By Trisha Torrey

Medical professionals frequently talk about levels of care. They’re divided into the categories of primary care, secondary care, tertiary care and quaternary care. Each level is related to the complexity of the medical cases being treated as well as the skills and specialties of the providers.

Since you sometimes hear these words as a patient, their definitions can help you better understand exactly what doctors, nurses and other medical staff are referring to. It can help you navigate the medical system and recognize the level of care you’re receiving.

Primary Care: Essentials

Most people are very familiar with primary care. This is your first and most generalized stop for symptoms and medical concerns. For instance, you may see your primary care doctor when you notice a new symptom or are concerned that you contracted a cold, the flu or some other bacterial or viral disease. You may also seek out primary care for a broken bone, a sore muscle, a skin rash or any other acute medical problem. Also, primary care is typically responsible for coordinating your care among specialists and other levels of care. However, there are times when that doesn’t happen the way it should.

Primary care providers (PCP) may be doctors, nurse practitioners or physician assistants. There are some primary care specialties as well. For instance, OB-GYNs, geriatricians and pediatricians are all primary care doctors who just happen to specialize in caring for a particular group of people.

Studies have shown that primary care providers benefit the healthcare system as a whole by offering enhanced access to healthcare services, better health outcomes and a decrease in hospitalization and use of emergency department visits. Most health insurance policies require you to designate a primary care provider. In most cases, you can choose an OB-GYN, geriatrician or pediatrician for this role.

Secondary Care: Specialists

When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise in what is ailing you.

Specialists focus either on a specific system of the body or a specific disease or condition. For example, cardiologists focus on the heart and its pumping system. Endocrinologists focus on hormone systems and some specialize in diseases like diabetes or thyroid disease. Oncologists have a specialty in treating cancers and many focus on a specific type of cancer. Secondary care is where most people end up when they have a medical condition to deal with that can’t be handled at the primary care level. Your insurance company may require that you receive a referral from your PCP rather than going directly to a specialist.

There are times when problems with specialty care develop. One reason may be that you have been referred to the wrong kind of specialist. For example, your initial symptoms may indicate one thing when in reality it is another condition that requires a different specialist. You may also experience problems while seeing more than one specialist if each is treating a different condition. In these cases, your care may not be fully coordinated. The specialists should work with your primary care health team to ensure everyone knows what the other is recommending.

Tertiary Care and Hospitalization

Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise. At this level, you will find procedures such as coronary artery bypass surgery, renal or hemodialysis and some plastic surgeries or neurosurgeries. It also includes severe burn treatments and any other very complex treatments or procedures.

A small, local hospital may not be able to provide these services, so you may need to be transferred to a medical center that provides highly specialized tertiary level services.

Studies have shown that in the management of certain chronic conditions such as diabetes and chronic kidney disease, it is still important for the primary care provider to be involved when a patient enters tertiary care. Having the PCP involved may enhance long-term self-management by the patient.

Quaternary Care

Quaternary care is considered to be an extension of tertiary care. It is even more specialized and highly unusual. Because it is so specific, not every hospital or medical center offers quaternary care. Some may only offer quaternary care for particular medical conditions or systems of the body. The types of care that might be considered to be quaternary would be experimental medicine and procedures as well as highly uncommon and specialized surgeries.

The majority of the time you’ll only receive primary or secondary care. It is only when you have a severe injury, condition or disease that you’ll be moved to the higher levels. Being an informed patient will help you navigate the medical system and receive the care you need.

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