Defining Tertiary Care for Neurological Diseases
August 20, 2010
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., co-executive director 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.