The Uncertain Future of Primary Medical Care
2009; American College of Physicians; Volume: 151; Issue: 1 Linguagem: Inglês
10.7326/0003-4819-151-1-200907070-00012
ISSN1539-3704
Autores Tópico(s)Healthcare Systems and Technology
ResumoEditorials7 July 2009The Uncertain Future of Primary Medical CareDavid Mechanic, PhDDavid Mechanic, PhDFrom Rutgers, The State University of New Jersey, New Brunswick, NJ 08901.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-1-200907070-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The United States needs a strong primary medical care capacity as we engage the challenges of health care reform, expand insurance coverage, and constrain medical costs without sacrificing quality. Research over decades has repeatedly demonstrated that primary care services that provide continuing access to care are associated with superior population health outcomes (1, 2). Nonetheless, the future of U.S. primary care is uncertain, many clinicians report high levels of frustration and dissatisfaction, and careers in primary care are increasingly unattractive to new medical graduates. In this issue, Linzer and colleagues (3) studied 422 family practitioners and general internists in 119 ...References1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457-502. [PMID: 16202000] CrossrefMedlineGoogle Scholar2. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York: Oxford Univ Pr; 1998. Google Scholar3. Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al; MEMO Investigators. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151:28-36. LinkGoogle Scholar4. Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290:941-6. [PMID: 12928472] CrossrefMedlineGoogle Scholar5. Mechanic D. 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N Engl J Med. 2001;344:198-204. [PMID: 11172143] CrossrefMedlineGoogle Scholar11. Weissman JS, Blumenthal D, Silk AJ, Newman M, Zapert K, Leitman R, et al. Physicians report on patient encounters involving direct-to-consumer advertising. Health Aff (Millwood). 2004;Suppl Web Exclusives:W4-219-33. [PMID: 15452007] Google Scholar12. Alexander GC, Kurlander J, Wynia MK. Physicians in retainer ("concierge") practice. A national survey of physician, patient, and practice characteristics. J Gen Intern Med. 2005;20:1079-83. [PMID: 16423094] CrossrefMedlineGoogle Scholar13. Daniels N. Accountability for reasonable limits: can we meet the challenges? In: Mechanic D, Rogut LB, Colby DC, Knickman JR, eds. Policy Challenges in Modern Health Care. New Brunswick, NJ: Rutgers Univ Pr; 2005:238-48. Google Scholar14. Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA. 2009;301:2038-40. [PMID: 19454643] CrossrefMedlineGoogle Scholar15. Ginsburg PB, Maxfield M, O'Malley AS, Peikes D, Pham HH. Making Medical Homes Work: Moving From Concept to Practice. Policy Perspectives No. 1. Center for Studying Health System Change; 2008. Accessed at www.hschange.com/CONTENT/1030/?words= on 2 June 2009. Google Scholar16. Hing E, Burt CW. Characteristics of office-based physicians and their medical practices: United States, 2005-2006. Vital Health Stat 13. 2008;:1-34. [PMID: 18548968] MedlineGoogle Scholar17. Moore LG, Wasson JH. The ideal medical practice model: improving efficiency, quality and the doctor-patient relationship. Family Practice Management; 2007. Accessed at www.aafp.org/fpm/20070900/20thei.html on 2 June 2009. Google Scholar18. Eads M. Virtual office visits: a reachable and reimbursable innovation. Family Practice Management; 2007. Accessed at www.aafp.org/fpm/20071000/20virt.html on 2 June 2009. Google Scholar19. Pham HH, O'Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. 2009;150:236-42. [PMID: 19221375] LinkGoogle Scholar20. Mechanic D. Rethinking medical professionalism: the role of information technology and practice innovations. Milbank Q. 2008;86:327-58. [PMID: 18522615] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Rutgers, The State University of New Jersey, New Brunswick, NJ 08901.Grant Support: By the Robert Wood Johnson Foundation.Disclosures:Stock ownership or options (other than mutual funds): McKesson.Corresponding Author: David Mechanic, PhD, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 30 College Avenue, New Brunswick, NJ 08901; e-mail, [email protected]rutgers.edu. 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