What is Primary Care?
Written by Chris G Dalrymple, DC, FICC   
Tuesday, February 05, 2019 06:16 PM

Primary care: “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” 

Primary Care is a term often used, and often abused. The word primary is from Latin primarius “of the first rank, chief, principal, excellent”; care is from Old English indicating “burdens of mind; serious mental attention.”  The term primary care is thought to date back to about 1920, when the Dawson Report was released in the United Kingdom to indicate centers intended to become the hub of regionalized services in that country.

Positive evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system; namely specialty care.

The formation of one after another specialty board in the early decades of the 20th century signaled the increasing specialization of the U.S. physician workforce. The GI Bill of Rights, which supported the further training of physicians returning from service in World War II, helped increase the specialization of many who had been general practitioners (generalists) before the war. At that time, general practitioners were those who lacked additional training after graduation from school, apart from a short clinical internship.

Concerned that the survival of generalists would be threatened by the disproportionate increase in the supply of specialists in the United States, family physicians, working with international colleagues, established standards for credentialing the new “specialty” of family practice. Thus, in the 1960s and 1970s, longer postgraduate training became part of generalist physicians’ preparation for practice.  

This recognition of a “specialty” of primary care resulted in two reports from the Institute of Medicine (IOM). These reports defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” 

Nearly all studies of specialist services concluded that there is either no effect or an adverse effect on major health outcomes from increasing the supply of specialists in the United States.  Compared with other industrialized nations, the United States already has a surplus of specialists, but not of primary care practitioners. 

Until recently, primary care could be assessed only by determining the type of physician who provided it.  A pervasive U.S. focus on “access” to health services rather than on the type of health services has detracted from the need to ensure that services are provided in the most appropriate places. The role of primary care in reducing unnecessary or inappropriate specialty care has resulted in much of the conflict within the health care system regarding who “gets” to make that determination.

Major challenges to primary care practice concern (1) recognizing and managing comorbidity, (2) preventing the adverse effects of medical interventions, (3) maintaining a high quality of the important characteristics of primary care practice, and (4) improving equity in health services and in the health of populations.

Historically, principles of delivery of medical care have been based on preventing and managing specific diseases. It is time to shift focus to practitioners who can provide integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

Chiropractic can certainly be a part of primary care.


Source:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/