Abstract
Primary care is the foundation of an effective and efficient health system. The more robust a nation’s primary care service, the better are the health markers seen in the population and the lower the comparative cost of healthcare. In the USA, primary care has been under stress for some time, under-supported financially with too small a physician workforce, and over-taxed by demands to impact the population as a whole. The Institute of Medicine (IOM) and other health policy leaders have attempted to remedy the quality problems of the healthcare system by calling for a reorganization of primary care into a medical home that is patient-centered, evidence based, offering improved access, better ongoing contact, and coordination of care. The IOM’s ten rules for the redesign of healthcare include some that are focused on systems change in the delivery of care and others that are focused on relationship change of doctors and their patients. The systems change rules have been easier to implement. The improvements associated with the change of the relationship of the physician and healthcare team to the patient have not been nearly as impressive. Therefore, it is in this area that the next steps to a more equitable delivery of healthcare must take place.
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Notes
- 1.
I use the word “doctor” to designate physicians, nurse practitioners, and physician assistants. It saves a lot of extra words, and it is what most patients call the person in the role of primary care provider anyway. I use “physician” when that is the only discipline indicated.
References
Starfield B. Primary care: balancing health needs, services and technology. New York: Oxford University Press; 1998.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.
Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995;274:1436–44.
Atlas SJ, Grant RW, Ferris TG, Chang Y, Barry MJ. Patient-physician connectedness and quality of primary care. Ann Intern Med. 2009;150:325–35.
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207–12.
Chassin MR, Galvin RW, the National Roundtable on Health Care Quality. The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280:1000–5.
Berwick D. What ‘patient-centered’ should mean: confessions of an extremist. Health Aff. 2009;28:w555–65.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
Barry M, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012;366:780–1.
Coleman EA, Parry C, Chalmers S, Min S. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–8.
Institute for Healthcare Improvement (IHI). http://www.ihi.org/resources/Pages/Changes/PatientCenteredCare.aspx. Downloaded 2 Sept 2017.
Shaller D. Patient-centered care: what does it take. Commonwealth Fund. 2007. http://www.commonwealthfund.org/publications/fund-reports/2007/oct/patient-centered-care%2D%2Dwhat-does-it-take
Crabtree B, Nutting P, Miller W, Stange K, Stewart E, Jae’n C. Summary of the National Demonstration Project and recommendation for the patient-centered medical home. Ann Fam Med. 2010;8(Supplement 1):S80–90.
Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The impact of primary care practice transformation on cost, quality, and utilization: a systematic review of research published in 2016. Patient-Centered Primary Care Collaborative and Robert Graham Center. 2017. https://www.pcpcc.org/resource/impact-primary-care-practice-transformation-cost-quality-and-utilization
Porter ME, Teisberg EO. Redefining health care. Boston: Harvard Business School Press; 2006.
Nielson M, Gibson A, Buelt L, Grundy P, Grumbach K. The patient-centered medical home’s impact on cost and quality. Patient Centered Primary Care Collaborative. 2015. PCPCC.org. Accessed 23 Sept 2017.
Blount A, Bayona J. Toward a system of integrated primary care. Fam Syst Med. 1994;12:171–82.
Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system. Arch Gen Psychiatry. 1993;50:85–94.
Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener J. Primary care: is there time enough for prevention? Am J Public Health. 2003;93:635–41.
Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3:209–14.
Medscape Physician Compensation Report. 2017. http://www.medscape.com/slideshow/compensation-2017-overview-6008547. Accessed 5 Sept 2017.
American Medical Association (AMA). Composition of the RVS update committee. 2018. https://www.ama-assn.org/about/rvs-update-committee-ruc/composition-rvs-update-committee-ruc
Wright B, Scott I, Woloschuk W, Brenneis F. Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine. JAMC. 2004;170:1920–4.
Shaffer, J. Physician and medical student depression and suicide. Non-Profit Quarterly. July 28, 2016. https://nonprofitquarterly.org/2016/07/28/physician-medical-student-depression-suicide/
Shanafelt TD, Hasan O, Dyrbe L, Sinsky C, Satele D, Sloan J, West CP. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600–13.
Brown KD. Precarious future for primary care. Boston Globe. June 23, 2015. https://www.bostonglobe.com/metro/2015/06/22/the-thinning-ranks-medicine-front-line/GdG27Z26BD1i5u4Fh6aM6H/story.html. Downloaded 5 Sept 2017.
Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med. 2018;178:1317–30.
Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q. 2014;3(4):1–122.
American Academy of Family Physicians (AAFP). Family physician burn out, well-being, and professional satisfaction. 2018. https://www.aafp.org/about/policies/all/physician-burnout.html
Resources
Patient Centered Care
What is Patient-Centered Care? New England Journal of Medicine Catalyst, January 2017. https://catalyst.nejm.org/what-is-patient-centered-care/
Physician Depression and Suicide
Why Physicians Kill Themselves: https://www.tedmed.com/talks/show?id=528918
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Blount, A. (2019). Getting to Patient-Centered Care. In: Patient-Centered Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-030-17645-7_1
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