Primary care in the United States in crisis

ry care providers are viewed by many patients as barriers to specialized care, rather than trusted partners and advocates who guide patients through their care.

The researchers also explain that the field of primary care has failed to hold its own among medical specialties. Fewer young physicians are choosing training in primary care. "Primary care must be able to justify its place in a system where specialist physicians, nurses and other providers are increasingly providing principal care and where patients often choose to go to non-traditional settings for their care," said Showstack.

The report derives from a Robert Wood Johnson Foundation sponsored summit held in October 2001 and attended by leaders in primary care and other health sectors. The leaders discussed the current and future challenges to primary care and developed new and innovative ideas about how primary care might meet the needs of our current and future population.

The researchers identified seven principles that can be used for the reconstruction of primary care and the health care system:

    1. Health care must be organized to serve the needs of patients. Much of the current organization of medical care is structured to accommodate incentives in the reimbursement system and the preferences of providers, often with patients' needs included only as an afterthought.

    2. The goal of primary care systems should be the delivery of the highest quality care as documented by measurable outcomes. The definition of quality should be based on definable outcomes. This will require research to establish appropriate indicators of primary care quality and the development of methods to identify, collect, and evaluate the most relevant information.

    3. Information and information systems are the backbone of the primary care process. Today's health care information systems were designed primarily in response to administrative needs, with reimbursement at the top o

Contact: Maureen McInaney
University of California - San Francisco

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