Nav: Home

The need to reinvent primary care

March 24, 2017

Primary care is "first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system." High-quality primary care has been associated with improved population health, lower costs, and greater equity. Despite this evidence, primary care has been consistently under-resourced, accounting for just six to eight percent of US health care expenditures. Newer payment models introduced under the Affordable Care Act raised expectations, but even those modest gains appear threatened under the new administration in Washington. It is unrealistic to anticipate a significant influx of resources into primary care anytime soon. A special issue of the Journal of General Internal Medicine, just published, takes a look at primary care today.

Thus, at least in the short term, physicians, patients and policymakers interested in supporting a more comprehensive, dynamic and thriving primary care sector in the United States cannot depend wholly on the federal government. Fortunately, there is still much that can be done. We need to look to new models that deliver a better care experience, achieve better population health outcomes, and control costs. In short, we need to reinvent primary care.

In this issue of the Journal of General Internal Medicine, six articles review the current landscape of primary care innovation; stimulate thinking on new directions for primary care; and begin to construct an agenda for energetic reform. In the first article, Ellner and Phillips provide a roadmap for primary care reinvention. In the next piece, Shrank discusses how new primary care delivery models, harnessed to changing consumer expectations, can lead to more patient-centered care. An article by Hochman and Asch contrasts two divergent approaches to caring more effectively for vulnerable, high-need, high-cost populations: specialized clinics and complex case management. Kroenke and Unutzer review the body of evidence supporting collaborative care models for improving quality of mental health services delivery in primary care. Young and Nesbitt offer hope that technology can extend the reach and enhance the effectiveness of PCPs as they strive to manage the health care needs of a defined population. Finally, Cassel and Wilkes focus on one aspect of the primary care workforce development problem: nurturing student interest in primary care during medical school.

The common thread in these six articles is the importance of preserving and supporting trusting, longitudinal relationships between patients and competent, caring primary care physicians who are committed to their well-being. Other relationships are also vital, including those involving office staff, subspecialists, mental health consultants, and complex care management teams. An accompanying editorial by Kravitz and Feldman concludes that systems that support and nurture these human relationships will thrive; those that ignore them will ultimately falter.
-end-
References:

1. Journal of General Internal Medicine, Volume 32, Issue 4, April 2017, Special Issue on Primary Care: https://link.springer.com/journal/11606/32/4/page/1

2. The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine. https://www.sgim.org/

Springer

Related Health Care Articles:

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Health insurance changes, access to care by patients' mental health status
A research letter published by JAMA Psychiatry examined access to care before the Patient Protection and Affordable Care Act (ACA) and after the ACA for patients grouped by mental health status using a scale to assess mental illness in epidemiologic studies.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
More Health Care News and Health Care Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.