Contents

Search

primary care

- Primary care provides both first contact for a person with an new health concern & continuing care of medical conditions, not limited by cause, organ system, or diagnosis - Primary care may be provided by a physician/medical doctor or a nurse practitioner - Most primary care physicians are specialized in internal medicine, family practice, geriatrics or pediatrics - Gynecologists may serve as primary care providers for women - Allergists may serve as primary care providers for patients with asthma - Nephrologists may serve as primary care providers for patients on renal dialysis - health care provided by a patient's family physician is more effective than health care provided another physician in reducing emergency department use [12] Notes: - workload for primary care physicians increased in the UK by 18% from 2007-2014 [3] - demand for clinical care coupled with more complex patient care, increasing administrative tasks, pressure to meet quality performance measures, & increasing documentation requirements contribute to increased workload [3] - preception among medical school graduates is that primary care is stressful, pressured, low-status, with excessive administration [3] - diagnostic uncertainty present in > 2/3 of primary care visits [4] - team-based or integrated primary care may reduce emergency department visits & hospitalizations among chronically ill [5] - greater access to & investment in primary care services are associated with higher healthcare system quality & lower costs - U.S. has not invested substantially in primary care - spending on primary care services is even lower for older patients & those with chronic health conditions [6] - optimal panel size unknown [7] - low-value care not associated with patient care experience ratings [10] - when a primary care physician leaves practice, patients might turn to urgent care or emergency departments to replace primary care visits [9] - quality improvement measures to integrate behavioral health into primary care has no effect on patient outcomes [11]

Related

annual physical examination; annual health examination

Specific

adult primary care (APC) home-based primary care (HBPC) senior health clinic care model

General

medical specialty

References

  1. Wikipedia: Primary care physician http://en.wikipedia.org/wiki/Primary_care_physician
  2. West CP and Dupras DM General Medicine vs Subspecialty Career Plans Among Internal Medicine Residents. JAMA. 2012;308(21):2241-2247 PMID: 23212502 http://jama.jamanetwork.com/article.aspx?articleid=1475191 - Schwartz MD The US Primary Care Workforce and Graduate Medical Education Policy. JAMA. 2012;308(21):2252-2253. PMID: 23212505 http://jama.jamanetwork.com/article.aspx?articleid=1475164
  3. Hobbs FDR et al. Clinical workload in UK primary care: A retrospective analysis of 100 million consultations in England, 2007-14. Lancet 2016 Apr 5; PMID: 27059888 - Thompson M, Walter F. Increases in general practice workload in England. Lancet 2016 Apr 5 PMID: 27059885
  4. Bhise V, Rajan SS, Sittig DF, et al. Electronic health record reviews to measure diagnostic uncertainty in primary care. J Eval Clin Pract. 2018 Apr 20; PMID: 29675888 https://psnet.ahrq.gov/resources/resource/31851
  5. Meyers DJ, Chien AT, Nguyen KH et al Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients. JAMA Intern Med. Published online November 26, 2018 PMID: 30476951 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2716186 - Bodenheimer T. Anatomy and Physiology of Primary Care Teams. JAMA Intern Med. Published online November 26, 2018. PMID: 30476958 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2716182
  6. Reid R, Damberg C, Friedberg MW. Primary care spending in the fee-for-service Medicare population. JAMA Intern Med 2019 Apr 15 PMID: 30985864 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2730351
  7. Paige NM, Apaydin EA, Goldhaber-Fiebert JD et al What Is the Optimal Primary Care Panel Size?: A Systematic Review. Ann Intern Med. 2020. Jan 21 PMID: 31958814 https://annals.org/aim/article-abstract/2759350/what-optimal-primary-care-panel-size-systematic-review - Sinsky CA, Brown MT Optimal Panel Size: Are We Asking the Right Question? Ann Intern Med. 2020. Jan 21 PMID: 31958815 https://annals.org/aim/article-abstract/2759351/optimal-panel-size-we-asking-right-question
  8. Bouck Z, Calzavara AJ, Ivers NM et al. Association of low-value testing with subsequent health care use and clinical outcomes among low-risk primary care outpatients undergoing an annual health examination. JAMA Intern Med 2020 Jun 8e201611 PMID: 32511668 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2766917
  9. Sabety AH et al. Changes in health care use and outcomes after turnover in primary care. JAMA Intern Med 2020 Nov 16; PMID: 33196767 PMCID: PMC7670398 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2773066
  10. Sanghavi P, McWilliams JM, Schwartz AL et al. Association of low-value care exposure with health care experience ratings among patient panels. JAMA Intern Med 2021 Jul; 181:941. PMID: 34047761 PMCID: PMC8261613 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780282
  11. Littenberg B, Clifton J, Crocker AM et al A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions. Ann Fam Med. 2023 Nov-Dec;21(6):483-495. PMID: 38012036 PMCID: PMC10681692 Free PMC article. Clinical Trial.
  12. Lapointe-Shaw L et al. Virtual visits with own family physician vs outside family physician and emergency department use. JAMA Netw Open 2023 Dec; 6:e2349452 PMID: 38150254 PMCID: PMC10753397 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813291