Elsevier

Disease-a-Month

Volume 63, Issue 5, May 2017, Pages 105-114
Disease-a-Month

Urgent care medicine and the role of the APP within this specialty

https://doi.org/10.1016/j.disamonth.2017.03.001Get rights and content

Abstract

The field of urgent care medicine offers an additional medical pathway for patients who have immediate, but non-life-threatening, medical concerns. Urgent care medicine offers a more varied set of resources and services than a physician office setting, with more flexible hours. This gives patients an opportunity to not have to go to the emergency department for non-emergent care. As a newer specialty within the medical field, certain roles of healthcare providers other than physicians are becoming established, including the advanced practice provider (APP). An APP is a nurse practitioner or a physician assistant, who is licensed to treat under the supervision of a physician. Nurse practitioners’ (NP) and physician assistants’ (PA) role in urgent care is often seen as an effective, lower cost option to manage common acute minor illnesses seen in the community. Benefits to utilizing APPs in urgent care include decreasing costs to both the patient and health system, enhancing the physician's ability to see more patients, and decreasing wait times, all while continuing to maintain high standards of care. The goal of the authors within this publication is to discuss urgent care as a specialty and further explore the role of advanced practice providers within this setting.

Section snippets

Urgent care as a specialty

Urgent care centers offer services and resources to meet the needs of patients with immediate medical concerns and acute minor illnesses that are not life-threatening. The development of urgent care centers in the United States initially started in the early 1970s as an entrepreneurial endeavor of physicians seeking to serve patients with acute but not emergent medical needs.1 There was a period of time during the mid-1980s to 1990s when many urgent care centers were bought out by hospital

Urgent cares today

Currently, there are approximately 9300 urgent care centers in the United States.2 This number has increased from approximately 8000 in 2008 and continues to increase with about 50 to 100 new clinics opening each year.2 Currently, there is no minimum set of criteria that a facility is required to meet in order to be considered as an urgent care center. However, the UCAOA has listed out guidelines of services and supplies they recommend an urgent care center should offer in attempt to

APP role in the urgent care setting

As more urgent care centers are being developed throughout communities and as patient utilization of these facilities increases, the need to staff APPS in this setting is becoming necessary. The benefits of hiring an APP in urgent care are discussed in more detail later, but does include some of the following aspects: APPs are more cost effective, they allow the physician to see more patients efficiently, and their use leads to greater patient satisfaction due to decreased wait times.17

Nurse practitioner training for urgent care medicine

The Urgent Care Association of America (UCAOA) nor the AAUCM does not specify additional training or education required beyond that of the regulation board of primary care medicine.2., 23. Initial training of the nurse practitioner will be described in this section, since there is not a specific type of training necessary to work in this setting. Initial training includes obtaining your registered nurse (RN) licensure, prior to applying to a master's program to obtain the nurse practitioner

Physician assistant training for urgent care medicine

Physician Assistants are trained generally and are able to work in any field of medicine after successful completion of an accredited program, passing boards, and applying for a state license. There are currently 238 programs in the United States.32 Entrance into a program requires at least two years of undergraduate coursework with specific required classes including biomedical science, biology, microbiology, anatomy and physiology training and other classwork that is related to medicine and

Benefits of urgent care as a healthcare setting

As previously discussed, many patients are not satisfied with the way primary healthcare is currently operated.2 The most common hours of primary care operation is not conducive to working adults or children in school who need care outside of these timeframes. Additionally, many primary care provider offices are unable to fit in walk in appointments, leading patients to have to wait several days for an appointment that needs urgent, but not emergent, attention.

For this reason, patients who have

Benefits of utilizing APPs in urgent care

Multiple benefits exist in employing NPs and PAs in the urgent care setting to both patients and healthcare systems. These benefits include decreased wait times and decreasing costs, while maintaining high standards of care.

One way of utilizing APPs is in the emergency department extension of a fast track or urgent care. The thought process used here is that physicians can focus on more critical patients, while APPs focus on less life threatening conditions while maintaining throughput. This

Drawbacks to the urgent care setting

Although urgent care centers provide more convenient hours, accept walk-in appointments and provide shorter wait times, there are limitations to patient care. Unlike the emergency department, urgent care centers do not have the capability to care for more life-threatening illness. For example, if a patient presents to the urgent care with severe abdominal pain, the patient most likely will be referred to the emergency department since the urgent care likely does not have a CT scanner to further

Conclusion

Given the limited office hours of primary care physicians, long wait times and excess costs associated with emergency departments, many patients have begun to realize the benefits of receiving health care through urgent care settings. Due to the shortage of physicians, on top of cost constraints, APPs are seen as an optimal resource for staffing this growing healthcare field.46 APPs are trained to perform physical assessments, order diagnostic studies, and interpret results; all functions which

Conflict of interest

The author's have no conflicts or competing interests to disclaim.

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