Why it is so important to have a primary care physician

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 access.

"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 and Geriatric Internal Medicine in 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 was released today, Jan. 28, in JAMA Internal Medicine.

What is considered "primary care"?

To determine whether study participants had primary care, scientists asked them to provide the name of a physician they usually referred to. [they] are sick or need a counseling [their] health ". If they were able to identify such a doctor who was 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. Complete (ie preventative health care, such as general checkups, exams and immunizations)
3. Continuous: (that is, persistent health problems)
4. Coordinated (that is, referrals to other health professionals as 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, Americans receiving primary care received significantly more "high value" services, such as recommended cancer screenings, diagnostic and preventive 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 number of high value care and minimize the number of low value patient care we provide," said Linder.

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 the United States needs more front-line care," said Dr. David Levine, lead author, general internist and medical instructor at Brigham and Women's Hospital and Harvard Medical School.