The Impact of Primary Care: A Focused Review
Scientifica
Volume 2012 (2012), Article ID 432892, 22 pages
In this focused review paper, Leiyu Shi of Johns Hopkins Bloomberg School of Public Health. aims to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities.
Leiyu Shi was a colleague of Barbara Starfield, collaborating with her on the Commonwealth Fund report Contribution of Primary Care to Health Systems and Health. He is director of the Johns Hopkins Primary Care Policy Center (PCPC). Dr Shi’s research focuses on primary care, health disparities, and vulnerable populations.
He concludes :
“Primary care is imperative for building a strong healthcare system that ensures positive health outcomes, effectiveness and efficiency, and health equity. It is the first contact in a healthcare system for individuals and is characterized by longitudinality, comprehensiveness, and coordination. It provides individual and family-focused and community-oriented care for preventing, curing or alleviating common illnesses and disabilities, and promoting health.
Many countries in the world have embraced primary care, using a variety of structures and models. Lessons from these countries could serve as case studies for the US healthcare system, which currently faces an imbalance between specialty and primary care as well as a significant shortage and inequitable distribution in the primary care workforce. Different types of indicators and tools have been developed to measure the function of primary care, the performance of providers and facilities, quality of care, and so forth, but the need for more indicators and more data continues. Patient-centered measurements are gradually replacing disease specific measurements to yield more accurate assessment of primary care.
In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health. Therefore, research suggests the need to increase the supply of primary care physicians in the USA. Further research is also needed to evaluate what models of primary care can produce the best health outcomes.
There are many factors determining quality of care, such as ease of access (including availability of after-hours care, length of office wait time, travel time to an appointment, and flexibility in selecting a PCP), clinical quality, interpersonal aspects, continuity, structure through which primary care is delivered, and insurance coverage. Although studies in international settings have compared quality of care in primary care and specialty care settings, the results were mixed, and further research is needed to elucidate how system-level factors, and certain policies may influence quality in the USA.
In addition, research has indicated that countries and regions more oriented to primary care have lower healthcare costs but better health outcomes, although further studies using formal cost-effectiveness methods need to be conducted. Cost-effectiveness of primary care has been tentatively established through a few interventions conducted in primary care settings, and adoption of health information systems in primary care settings may further yield financial gains.
Furthermore, better primary care is correlated with more equitable distribution of health within a population and can mitigate the adverse effects of income inequality, which is especially important in the USA where racial and ethnic minorities face greater difficulties accessing regular primary care. This in turn emphasizes the significant role of CHCs in the USA in providing primary care services to vulnerable groups and reducing disparities. CHCs in the USA are primary care facilities that provide family-oriented services to meet the healthcare needs of medically underserved populations. However, difficulties in recruiting primary care providers and maintaining financial viability are major challenges to the sustainability of CHCs, which subsequently influences primary care services available to and health outcomes for these underserved populations. Additionally, research on health disparities in children and migrant workers is still lacking and needs further attention.
Lastly, healthcare reforms aimed at strengthening the primary care system have been implemented in a number of countries, both developed and developing, and have generally proven to improve the healthcare system as a whole. The Patient Protection and Affordable Care Act (ACA) also emphasizes primary care in the USA. Future assessments focusing on the impact of the ACA on primary care, health outcomes, healthcare costs, and health disparities should be conducted to serve as an empirical basis for policy making in the future.”
(Thanks Ian Kamerman)
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