Dana Gelb Safran, ScD
Acknowledgments: The author thanks Angela Li for dedicated assistance in the preparation of this article and Hong Chang, PhD, for analytic support.
Grant Support: The Massachusetts Study of Primary Care Performance and the Study of Choice and Quality in Senior Health Care was supported by grant R01 HS08841 from the Agency for Healthcare Research and Quality and grant 035321 from the Robert Wood Johnson Foundation. The Study of Choice and Quality in Senior Health Care was supported by grant R01 HS09622 from the Agency for Healthcare Research and Quality and the National Institute on Aging. A previous version of this article was commissioned by the Robert Wood Johnson Foundation for the Future of Primary Care Conference (held in Glen Cove, New York, October 2001).
Requests for Single Reprints: Dana Gelb Safran, ScD, Division of Clinical Care Research, The Health Institute, Tufts-New England Medical Center, 750 Washington Street, NEMC #345, Boston, MA 02111.
From the earliest definitions of the term primary care to the most recent, all have stressed that primary care is predicated on a sustained relationship between patients and the clinicians who care for them. Primary care differentiates itself from other areas of medicine by attending to the whole person, in the context of the patient's personal and medical history and life circumstances, rather than focusing on a particular disease, organ, or system. Finally, the primary care physician plays a distinctive role in integrating the care that patients receive from within and outside of the primary care setting.
Data obtained from patients over the past 15 years demonstrate that most Americans have a physician whom they consider to be their primary physician. This was the case well before the rules of managed care plans required patients to align themselves with a particular primary care physician and to allow that physician to coordinate all of their medical care. However, information from patients indicates that despite primary care relationships that endure over several years, the ideals of whole-person, integrated care are largely unmet in patients' primary care experiences. Moreover, considerable evidence indicates that the quality of primary care relationships has eroded over the past several years.
This article highlights the relative strengths and weaknesses of primary care, as experienced and reported by patients, and posits three areas that must be addressed for primary care to live up to the ideals of sustained partnerships providing whole-person, integrated care. These three areas involve the use of teams in medicine, the establishment of meaningful primary care partnerships, and integration of care in a delivery system that patients experience as increasingly fragmented.
Dana Gelb Safran. Defining the Future of Primary Care: What Can We Learn from Patients?. Ann Intern Med. 2003;138:248–255. doi: 10.7326/0003-4819-138-3-200302040-00033
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Published: Ann Intern Med. 2003;138(3):248-255.
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