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When it comes to primary care, neither patients nor practitioners are satisfied with current trends. A new vision of primary care—one built on a clinically and economically sound foundation—offers substantial benefits to both physicians and their patients.
Although primary care is expected to be safe, effective, patient-centered, timely, efficient, and equitable, it often is not. Research indicates that patients’ overall satisfaction with primary care is limited and that substantial numbers of primary care practitioners report dissatisfaction with their field and concerns about its future. Today’s primary care system is also troubled financially.
A paper by John Griffith, Kyle Grazier, and Scott Ransom proposes to remedy these problems with a new vision of primary care. They reference successful business models as a way to revolutionize primary care via improvements in marketing (both to patients and caregivers), logistic support functions, clinical practice functions, and financial management. The authors believe that, to achieve success, the new primary care system must:
The authors’ plan for primary care offers patients an expanded network of prevention and care opportunities that go beyond the traditional doctor’s office and emergency department. Care would be accessible through multiple mechanisms (such as voice phone, email, websites, and geographically and temporally convenient sites), but would also be coordinated so that patients are directed along the most clinically effective path.
In the proposed new model, primary care physicians would use information technology, local nurse clinicians, and midlevel providers to optimize interactions with all patients while serving as the primary consultants for patients with complicated care needs. These physician-managers would assure the adoption of contemporary and evidence-based care for all patients and oversee an appropriate continuum of care from outpatient to inpatient to hospice.
The authors envision clinical management that would use technology to optimize prevention and treatment. Standardized electronic medical record would reduce errors and coordinate multiple caregivers while wireless and hand-held devices would provide faster, more extensive communication. Evidence-based protocols and measures would optimize the management of common chronic diseases. Increased training and “service excellence” approaches would improve the quality of the patient experience and enhance receptiveness to clinical advice.
Although financial gain for the twenty-first century primary care practice would occur through improved efficiencies in logistic and business office functions, most financial gain would come as a result of revised clinical care—improved prevention, reduced unnecessary and futile treatments, improved management of chronic disease, and improved patient satisfaction with service and reliability.
Finally, the authors provide practical strategies and a checklist for existing systems who want to adopt a twenty-first century approach to primary care. Included in their list of “must haves” are: