Defining Tertiary Care for Neurological Diseases

Defining Tertiary Care for Neurological Diseases

By John W Henson IV
Director, Neurology

Health care for patients with neurological diseases in the United States occurs across mul­tiple levels, ranging from primary to tertiary care and, less common­ly, quaternary care.

The World Health Organization has defined primary care as the point where first medical contact occurs, and where coordination and continu­ity of medical services is managed. Primary care focuses on a broad range of ser­vices, rather than the diagnosis and treatment of diseases of a specific organ system, and thus primary-care providers (PCPs) have varying levels of comfort in the treatment of neurologi­cal disorders.

Secondary care is provided by specialists, such as general neurologists, who focus on dis­eases affecting a specific organ system, usually upon referral by a PCP. Both primary care and secondary care are provided in an outpatient setting or a general hospital setting.

Tertiary neurological care is provid­ed by subspecialists who treat a subset of conditions that affect the nervous system. Examples include neurologists who specialize in movement disorders and neurosurgeons who operate on brain tumors. Neurological tertiary care is provided in specialized health-care centers where groups of subspecialists from the spectrum of neurological diseases work side by side to offer a multidisciplinary array of diagnostic, and medical and surgical treatment options to patients with advanced cases of common neurological diseases or to those with rare conditions. Quaternary care is a further re­finement of tertiary care that in­cludes research into specific neu­rological diseases.

A major goal of the Swedish Neuroscience Institute is to pro­vide the highest level of tertiary neurological care to patients in the Pacific Northwest. “Eight new providers joined the SNI staff in August of this year,” noted Marc R. Mayberg, M.D., and David W. Newell, M.D., co-executive directors of SNI. “We have added specialty care in neurotology, functional radiosurgery, neuromuscular diseases, neuro­anesthesiology and neuropsychiatry, and we have expanded our existing programs in mul­tiple sclerosis, stroke, pediatric neurosciences, stereotactic and functional neurosurgery, and general neurology.”

In a move towards quaternary care, SNI offers many novel investigational treatments, including a new clinical trial using deep brain stimulation for treatment-resistant depression. SNI is also gaining experience with initiatives to move tertiary care into primary-or second­ary-care settings. These initiatives employ di­rect patient care and virtual care through tele­health to the three million people in the urban Puget Sound area, and to patients throughout the Pacific Northwest.

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