Boston, MA -- A new study by investigators at Brigham and Women's Hospital examines the impact of having first-contact, comprehensive, coordinated and continuous care. Known as primary care, the value of this kind of care has been hotly debated. In a nationally representative survey of more than 70,000 adults with and without primary care, investigators found that primary care resulted in more high-value care, slightly more low-value care, and a better health care experience for patients. Their results are published in JAMA Internal Medicine.
"These results point to how restructuring U.S. health care through a primary care-first approach could lead to substantially improved health care. If you have a primary care relationship, you have a better experience with care, better access to care, and a 10 percent increase in things like high-value cancer screening, diabetes care and counseling," said corresponding author David Levine, MD, MPH, MA, a physician investigator in the Division of General Internal Medicine and Primary Care at the Brigham. "Patients who don't have this continuous relationship, and instead have fractionated care, lose out on high-value care and a better care experience."
Levine and colleagues conducted their analysis on U.S. adults aged 18 or older who participated in the Medical Expenditure Panel Survey. They compared the experiences of 49,286 patients with primary care to 21,133 adults without primary care. They identified underused services likely to benefit a patient (high-value care) and services considered either inappropriate or of little to no benefit (low-value care).
The team found:
- Of patients with primary care, 78 percent received high-value cancer screening (e.g., colorectal screening or mammography) compared with 67 percent without primary care.
- Patients with primary care received more recommended diagnostic and preventive testing (e.g., influenza vaccine, blood pressure readings).
- Counseling, especially smoking cessation counseling, was higher among patients with primary care.
- Patients received similar rates of low-value care, apart from antibiotics. Eleven percent more primary care patients received antibiotics inappropriately than patients without primary care.
- Of patients with primary care, 79 percent reported an excellent global rating of their health care compared with 69 percent without primary care.
The team reports that, overall, Americans' use of primary care was relatively low, with about one-quarter of patients not having primary care even though most had health insurance. The researchers also note that primary care was associated with worse care for heart failure and pulmonary disease. However, they point out that this may be due to the relatively small number of respondents without primary care who had these diseases and that many of these patients were co-managed by specialists.
"We've seen a trend in people opting for less primary care suggesting that the American health care system doesn't place much value on primary care," said Levine. "However, our study finds that the primary care relationship can lead to better quality care and a better experience for patients. There's more to health care than a one-time interaction that isn't comprehensive. Having continuity that accounts for the whole person is much more important than anyone thought previously."
Funding for this work was provided by the Institutional National Research Service Award
(T32HP10251) from the National Institutes of Health and the Ryoichi Sasakawa Fellowship Fund.
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