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.
KeywordsPrimary care Patient-centered care Healthcare reform Team Institute of Medicine
- 1.Starfield B. Primary care: balancing health needs, services and technology. New York: Oxford University Press; 1998.Google Scholar
- 8.Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.Google Scholar
- 11.Institute for Healthcare Improvement (IHI). http://www.ihi.org/resources/Pages/Changes/PatientCenteredCare.aspx. Downloaded 2 Sept 2017.
- 12.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
- 14.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
- 15.Porter ME, Teisberg EO. Redefining health care. Boston: Harvard Business School Press; 2006.Google Scholar
- 16.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.
- 21.Medscape Physician Compensation Report. 2017. http://www.medscape.com/slideshow/compensation-2017-overview-6008547. Accessed 5 Sept 2017.
- 22.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
- 23.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.Google Scholar
- 24.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/
- 26.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.
- 29.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
- What is Patient-Centered Care? New England Journal of Medicine Catalyst, January 2017. https://catalyst.nejm.org/what-is-patient-centered-care/
- Why Physicians Kill Themselves: https://www.tedmed.com/talks/show?id=528918