February 12, 2019

Why You Need a Primary Care Doctor

Health screenings and cancer prevention are just two reasons to have a doctor watching over your healthcare and advocating for you.

The family doctor is an endangered species. Even though health insurance companies recognize the value of having a single physician who is in charge of his or her patients' basic overall health and who coordinates referrals to specialists, fewer and fewer patients take the time to establish a relationship with a primary care physician.

The U.S. healthcare system is built around specialists and hospital-based care. As a result primary care tends to be undervalued.

People who had primary care providers were far more likely to receive high-value cancer screenings for colorectal and breast cancers.

“We are willing to pay more for specialized care, and we don’t have a government-funded system that pays primary care docs the way most European countries do,” David Levine, lead author of a new study, told TheDoctor. Levine and his colleagues compared the quality of outpatient care delivered in a primary care setting with the care patients received in a non-primary care setting.

Data for the study came from adults in the Medical Expenditure Panel Survey (MEPS). All were 18 years or older. Nearly 50,000 of the U.S. participants had primary care providers; over 21,000 people did not.

Patients' quality of care was measured based on how closely the care each group received followed the “4Cs” of primary care: Contact for new health problems; Comprehensive care for things like check ups and vaccines; Continuous care for ongoing health problems; and Coordinated care with specialists when necessary.

The researchers considered those primary care services that tended to be underused by patients and yet were likely to benefit them to be high-value care. Those services offered by primary care providers that were of little or no value to patients were considered low-value care.

They found 78 percent of people who had primary care providers received high-value cancer screenings such as colorectal cancer screening and mammography. Only 67 percent of those without primary care providers received these screenings. Patients with primary care providers also received more recommended preventive and diagnostic care like vaccinations and blood pressure checks than those who did not have a primary care provider.

Having a primary care provider also meant that a person was more likely to receive counseling, especially smoking cessation counseling. And 79 percent of those with primary care providers rated the quality of their care as ‘excellent’, compared to 69 percent of those without primary care.

“…[T]he ten percent bonus in the quality of care you receive is significant,” said Levine, a physician investigator in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital in Boston.

Everyone should have a primary care doctor, Levine believes, because they need one. Patients should take advantage of primary care services to the fullest extent possible, and self-advocacy should be an integral part of the patient-primary care provider relationship. For example, patients over 50 should talk to their primary care providers about colorectal cancer screening.

Levine and his colleagues are studying differences between those people who do and who do not have primary care, including why some people choose to have a primary care physician and others do not. “A lot of folks have insurance, but don’t have a primary care provider. We are trying to figure out why.”

The study and a related editorial are published in JAMA Internal Medicine.

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