According to the American Medical Association, "primary care is that provided at first contact with a patient." The setting is an office or ambulatory center. The provider is a doctor or other professional under a doctor's supervision. Primary care providers (PCPs) are either doctors, nurse practitioners or physicians' assistants. They diagnose and treat the most common illnesses. In health care, the word "primary" also can mean first level of care or first cause of illness. The purposes and functions of primary care are evolving.
Three Levels of Care
PCPs recognize three levels of care. Primary care, the first level, emphasizes the whole patient and offers continuing, integrated care. Subsequent levels arise as specialists are brought in. Secondary care is provided by clinicians with expert knowledge and skills in specialized areas, such as bone or brain, radiology or surgery, dermatology or endocrinology, ambulatory or hospital care. Tertiary care, or the third level, is the most advanced level and is frequently offered at hospitals or research facilities.
Qualities of Good Primary Care Provider
Your PCP should be a healer, adviser and quarterback, referring you to others, but maintaining a comprehensive overview of your health. The ideal provider is someone who relates to a variety of patients and families over many years and understands economic, social and communal aspects, the "first causes," that underlie medical problems.
PCP skills include rapid completion of histories and physicals, early recognition of symptoms of disease, efficient diagnoses, preventive care and prompt referrals.
Popular Misconception
Many people think the only place to find primary care is through a health maintenance organization (HMO). The HMO is a business model. The incentive to make money rests on number of visits, not quality of care. Office visits become so brief that, according to studies, patients are treated without sufficient information.
You don't need to join an HMO to get good primary care. It is available from many sources: individual doctors, group medical practices, clinics and other organizations. The major problem is a shortage of primary care doctors and expanding demand.
Expert Insight
Dr. Julio Frenk at Harvard University writes that primary care previously was confused with primitive care for poor people. He says illness no longer is simply a series of episodes, when patients either recover or die. People live with chronic disease for a long time. He says health care has become a human right and that society has to clarify its priorities in health care using modern methods. As participants in the health enterprise learn how all parts of a system relate to the whole, and how they interact, primary care becomes more coordinated, comprehensive and integrated.
Patient-Centered Primary Care and You
Profound transformations in science, telecommunications and knowledge management have not only increased human longevity, but have created unprecedented organizational complexity. Medical stakeholders must now see the forest and the trees. This has led primary care practitioners and their professional organizations to develop patient-centered primary care.
Look for more partnerships between practitioners, patients and families. You can expect health decisions that more closely follow patients' wants, needs and preferences. More patients will receive both education and support necessary to their own care.
The Medical Home
A national coalition of powerful health care stakeholders is testing out a model of care that diminishes the barriers keeping doctors from practicing primary medicine. The Medical Home is a group of pilot projects in more than 20 states sponsored by the Patient Centered Primary Care Collaborative. In addition to placing patients at the center of care, it has a more reasonable system of payment based on what doctors actually do rather than the number of office visits. The projects are demonstrating a better quality of life for both the patient and the practitioner. If the Medical Home takes hold, likely because it is based on lessons learned from experience and has deep and broad support, you can expect the primary care physician shortage to ease and better health care experiences all around.
References
- JAMA: Definitions from the American Medical Association are found in the JAMA Evidence Glossary
- Vanderbilt University: Description of a Primary Care Clerkship
- National Academies Press: Envisioning the National Health Care Quality Report
- Elselvier.com: Reinventing primary health care: the need for systems integration
- ACHP: Crossing the Quality Chasm, Alliance of Community Health Plans
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