Robert L. Ferrer, MD, MPH; Simon J. Hambidge, MD, PhD; Rose C. Maly, MD, MSPH
Acknowledgments: The authors thank Kevin Grumbach and Larry Green for their thoughtful critiques of earlier versions of the paper.
Grant Support: By the Robert Wood Johnson Foundation, under its Generalist Physician Faculty Scholars program, grants 045435 (Ferrer), 048472 (Hambidge), and 036833 (Maly).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Robert L. Ferrer, MD, MPH, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900; e-mail, email@example.com.
Current Author Addresses: Dr. Ferrer: Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.
Dr. Hambidge: Division of Community Health Services, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204.
Dr. Maly: Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, 924 Westwood Boulevard, Suite 650, Los Angeles, CA 90024.
Viewing primary care as merely one of the many niches in individual patient care fosters a narrow perspective that neither accounts for the full value of primary care nor offers proper guidance for reforming it. Instead, a systems view better articulates primary care's essential role in increasing the effectiveness and efficiency of other health care services. Primary care improves health care system functioning through such services as managing and triaging undifferentiated symptoms, matching patient needs to health care resources, and enhancing the system's ability to adapt to new circumstances. By acting as an appropriate filter for high-technology care, primary care helps ensure that it is appropriately applied, a major determinant of outcomes. Furthermore, because primary care is the most financially and geographically accessible arm of the health care system, it reduces socioeconomic and geographic disparities across the population. Even in the de facto health system that exists in the United States, these functions are necessary for the efficient, equitable, and sustainable delivery of health care and the adaptability and resilience of the system as a whole. As primary care reforms proceed, it will be important to explicitly consider how to support and strengthen its system-level benefits. Needed reforms include enabling universal access to primary care and providing the leadership, training, and infrastructure support to improve its performance as a central hub in the network of patients, clinicians, and communities. It is important that health systems realize the essential integrative function of primary care.
To manage a system effectively, you might focus on interaction of the parts rather than their behavior taken separately.
Table. Health Care Functions Provided by Primary Care
How should people be linked to primary care practices to promote the systems functions of primary care?
How should primary care be linked to other services within the health care system to optimize the functioning of the overall system?
How should primary care be linked to communities to best integrate community needs with health care system services?
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Ferrer RL, Hambidge SJ, Maly RC. The Essential Role of Generalists in Health Care Systems. Ann Intern Med. 2005;142:691–699. doi: 10.7326/0003-4819-142-8-200504190-00037
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Published: Ann Intern Med. 2005;142(8):691-699.
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