Primary care physician

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A primary care physician is a physician who is primarily responsible for a patient's health. One of the tasks of the primary care physician is coordinating the many facets of a patient's health care.[1]

Studies of the quality of care provided by primary care physicians

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care. [2][3] However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians. [4]

Studies of the quality of preventive health care find the opposite results - primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination. [5] In health promotion counseling, a studies of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients [6] and to screen for breast cancer. [7]

Exceptions may be diseases that are so common that primary care physicians develop their own expertise. A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care, but at lower costs that orthopedic specialists. [8]

Factors associated with quality of care by primary care physicians include:

  • The more experience the primary care physician has with a specific disease. [9]
  • Physician group affiliation with networks of multiple groups.[10]

Collapse of primary care in the United States

The number of physicians entering primary care in the United States is dropping, probably in part due to making less income for the amount on time spend with patients.[11] The retainer model of compensation has been proposed to solve this problem.[12]


References

  1. ↑ Bodenheimer, T. (2008). Coordinating care -- a perilous journey through the health care system, N Engl J Med, 358(10), 1064-1071. DOI:10.1056/NEJMhpr0706165.
  2. ↑ Majumdar S, Inui T, Gurwitz J, Gillman M, McLaughlin T, Soumerai S (2001). "Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction". J Gen Intern Med 16 (6): 351-9. PMID 11422631.
  3. ↑ Fendrick A, Hirth R, Chernew M (1996). "Differences between generalist and specialist physicians regarding Helicobacter pylori and peptic ulcer disease". Am J Gastroenterol 91 (8): 1544-8. PMID 8759658.
  4. ↑ (2002) "Summaries for patients. Comparing the quality of diabetes care by generalists and specialists". Ann Intern Med 136 (2): I42. PMID 11928735.
  5. ↑ Rosenblatt R, Hart L, Baldwin L, Chan L, Schneeweiss R (1998). "The generalist role of specialty physicians: is there a hidden system of primary care?". JAMA 279 (17): 1364-70. PMID 9582044.
  6. ↑ Lewis C, Clancy C, Leake B, Schwartz J (1991). "The counseling practices of internists". Ann Intern Med 114 (1): 54-8. PMID 1983933.
  7. ↑ Turner B, Amsel Z, Lustbader E, Schwartz J, Balshem A, Grisso J. "Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex". Am J Prev Med 8 (2): 78-85. PMID 1599724.
  8. ↑ Carey T, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D (1995). "The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project". N Engl J Med 333 (14): 913-7. PMID 7666878.
  9. ↑ Kitahata M, Koepsell T, Deyo R, Maxwell C, Dodge W, Wagner E (1996). "Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival". N Engl J Med 334 (11): 701-6. PMID 8594430.
  10. ↑ Friedberg et al., “Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?,” Journal of General Internal Medicine 22, no. 10 (October 21, 2007): 1385-1392, http://dx.doi.org/10.1007/s11606-007-0234-0 (accessed September 28, 2007).
  11. ↑ Singer, N (3/19/2008). For Top Medical Students, an Attractive Field. New York Times. Retrieved on 2008-03-31.
  12. ↑ Centor RM, Vega CP (03/20/2008). The Retainer Model or Single Payer -- What Will Save Primary Care?. Medscape. Retrieved on 2008-03-31.
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