Primary care in the United States in crisis

f the list. These systems rarely collect information that allows management of a patient's needs over time or an assessment of the effects of care on patient health. Specifically, medical records should remain with the patient and be interactive for patients and providers alike.

4. Current health care systems must be reconstructed. The American health care system is a complex and fragmented set of providers, facilities and services that have been created based on requirements for reimbursement and the needs of providers. The system should be participant controlled, outcomes oriented, structured to address the needs of the population and focused on the ongoing relationship between a patient and primary care provider.

5. The health care financing system must support excellent primary care practice. Such changes must, at a minimum, include adequate reimbursement for primary care services such as performing a history and physical, counseling patients about their health, and being an advocate to guide patients through the health system.

6. Primary care education must be revitalized, with an emphasis on new delivery models and training in sites that deliver excellent primary care. Clinical training should occur in settings that provide high quality, continuous, patient-centered, outcomes-oriented, team-based care.

7. The value of primary care practice must be continually improved, documented and communicated. There must be a concerted, national effort to redesign, implement and evaluate new forms of primary care delivery.

Included in The Annals of Internal Medicine supplement devoted to the crisis in primary care in the United States are five reports:

    1) Primary Care Medicine Crisis: Reconstruction and Renewal: Gordon Moore, MD, MPH, professor of ambulatory care prevention at Harvard Medical School and Jonathan Showstack, PhD, MPH, UCSF professor of medicine and health policy.

    2) Defining the Future o

Contact: Maureen McInaney
University of California - San Francisco

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