Why it is so important to have a primary care physician

• Americans with primary care received more cancer screenings, influenza vaccines and more recommended
• Those with primary care had better patient experience, overall access to health care
• Primary care means having a regular source of care and following the four "Cs" of primary care

CHICAGO — The US health care system is generally focused on hospitals and specialized care. The value of primary care remains unclear and controversial, partly because of limited research.

A new Northwestern Medicine study was the first to directly compare the quality and experience of ambulatory adult care with or without primary care. It found that Americans receiving primary care received significantly more high-quality care – such as cancer screenings and recommended influenza vaccines – and reported better patient experience and better access to health care, compared to those who did not have primary care.

"People who have primary care are fundamentally different from those who do not, they tend to be older, better insured, whiter, etc.," said Dr. Jeffrey Linder, lead author of the study and head of general internal medicine and geriatrics at the department of medicine. "Our progress was to look at health care for Americans who were otherwise as similar as possible – but who had primary care or not."

The study will be published on January 28 in JAMA Internal Medicine.

What is considered "primary care"?

To determine whether study participants were receiving primary care, scientists asked them to provide the name of a physician to whom they "usually address if [they] are sick or need a counseling [their] "If they were able to identify such a doctor practicing outside the emergency department, they would be considered to have a" usual source of care. "

In addition, study participants were asked to answer "yes" to the four "Cs" of primary care:

1. First contact (new health problems)

2. Comprehensive (ie preventative health care, such as general checkups, exams and immunizations)

3. Continuous: (that is to say, persistent health problems)

4. Coordinated (that is, reference to other health professionals when needed)

Scientists badyzed data from a nationally representative survey of the US population and adjusted their badysis to compare Americans to health conditions, demographics, and other similar factors. They then applied a statistical technique to control for potential confounding factors, such as socio-economic status, physical health and mental health, in order to make comparisons between virtually equivalent patients.

Investigators found that while all respondents received the same amount of care, primary care Americans received many more "high value" services, such as recommended cancer screenings, diagnostic tests and prevention tests. , diabetes care and counseling. People receiving primary care also reported better access to health care and improved experience, compared to those who do not.

However, primary care patients were also slightly more likely to receive low-value care, especially unnecessary antibiotics.

"We still have work to do to optimize the amount of high-value care and minimize the amount of low-value care we deliver to patients," Linder said.

Overall, the authors concluded that policy makers and health system managers seeking to increase value should consider investing more in primary care.

"This study clearly shows why America needs more front-line care," said Dr. David Levine, first author, general internist and medical instructor at Brigham Hospital and Women's Hospital. and at Harvard Medical School.

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