Researchers in the US compared the healthcare experiences of patients with and without a primary care doctor.
In the USA, the healthcare system is mostly organized around specialist doctor care in hospital settings. However, in many other countries, primary care forms the basis of the healthcare system. Individuals visit a generalist primary care doctor in an outpatient setting as their initial, regular point of contact for health issues, with specialist referral as necessary.
Despite several reports recommending an increase in the primary care approach in the USA, its value there is still debated. Researchers at the NorthWestern University studied a large group of American adults with and without a primary care doctor to compare their healthcare experiences. They recently published their findings in JAMA Internal Medicine.
Healthcare in the US mostly organized around specialist care in hospitals
The researchers used data from the US Medical Expenditure Panel Survey (MEPS) to compare the health experiences of over 49,000 adults with and over 21,000 adults without a primary care doctor between 2012 and 2014. The MEPS is a comprehensive, nationally representative annual survey collecting detailed information about individuals’ background, health insurance, health conditions, health service usage and treatments.
The researchers defined individuals with a primary care doctor as those in the survey who named a particular doctor as their “usual source of care” outside of the emergency department, who they visit if they are sick or in need of healthcare advice. They also checked further MEPS responses to determine if these individuals were receiving the four “C”s of primary care from the named doctor: first contact care (consult on new health problems), comprehensive care (advice on illness, immunization and screening), continuous care (ongoing care for chronic health issues) and coordinated care (referrals to other health professionals as needed).
The researchers developed several measures of clinical quality (such as cancer screening, immunization, avoidance of overuse of imaging or antibiotics) and patient experience (such as doctor-patient communication, access to doctor) to assess healthcare value and experience. They compared these measures via MEPS responses of individuals with and without primary care doctors.
Individuals with a primary care doctor receive more “high-value” care
All study participants received a similar amount of care, but those with a primary care doctor received significantly more “high-value” services such as recommended cancer screenings, diagnostic and preventive testing, diabetes care and counselling. Those with a primary care doctor also reported better healthcare access and experiences compared to those without. On the other hand, those with a primary care doctor also received slightly more “low-value” care, such as the use of unnecessary antibiotics.
The researchers concluded that individuals with a primary care doctor had a better overall healthcare experience, with significantly more high-value care. However, they also noted that there is more work to do to minimize low-value unnecessary care. They suggest that policymakers should consider increasing investment in primary care. Dr. David Levine, a lead author on the study commented, “This study provides clear evidence for why America needs more primary care.”
Written by Julie McShane, Medical Writer
- Levine DM, Landon BE, Linder JA. Quality and experience of outpatient care in the United States for adults with or without primary care. JAMA Intern Med 2019;179(3):363-372. Doi:10.1001/jamainternmed.2018.6716.
- NorthWestern University, Press release: 28 Jan 2019. Why it’s so important to have a primary care doctor. https://www.eurekalert.org/pub_releases/2019-01/nu-wis012519.php