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Primary care improves quality of health care, patient experience

Patients receiving primary care were more likely to have high-value care and a better health care experience according to a study published in JAMA Internal Medicine.

“Ideally, well-functioning primary care should result in increased high-value care, reduced low-value care, and better patient experience and access to care,” David M. Levine, MD, MPH, MA, of the division of internal medicine and primary care at Brigham and Women’s Hospital in Boston, and colleagues wrote. “To date, however, individual-level empirical data on the impact of primary care are lacking.”

To determine if the receipt of primary care affected high-value care, low-value care or patient access and experience, researchers analyzed data from a nationally representative survey of adults with primary care (n = 49,286; mean age, 50 years; 55% women; 50% white) and without primary care (n = 21,133; mean age, 38 years; 42% women; 43% white), focusing mainly on the years from 2012 to 2014. Researchers considered participants as having primary care if they could identify a physician who works outside the emergency department that provides them with a usual source of care. The survey assessed demographic characteristics, health conditions and status, use of medical services, medications, cost, source of payments, health insurance coverage, income, employment, experience with care and access to care.

From the survey, researchers developed 39 clinical quality measures and seven patient experience measures that were aggregated into an overall patient experience rating, two experience composites and 10 clinical quality composites. The clinical quality composites included six high-value and four low-value services.

After propensity score weighting, researchers found that respondents with or without primary care had the same mean numbers of outpatient (6.7 vs. 5.9; 95% CI, –0.2 to 1.8), ED (0.2 for both; 95% CI, 0-0) and inpatient (0.1 for both; 95% CI; 0-0) encounters annually.

Those with primary care, however, filled more prescriptions (mean, 14.1 vs. 10.7; 95% CI, 2.0-4.7) and were more likely to have had a routine preventive visit in the past year (mean, 72.2% vs. 57.5%; 95% CI, 12.3-17.1) than those without.

Furthermore, researchers observed that those with primary care received more high-value care in four of five composites, including 78% receiving a high-value cancer screening compared with 67% without primary care (95% CI, 8.5-13).

On three of four composites, those with or without primary care received similar levels of low-value care, with primary care recipients reporting more low-level antibiotics (59% vs. 48%; 95% CI, 2.8-19.3).

 

Patients receiving primary care were more likely to have high-value care and a better health care experience.

Source: Adobe Stock

Researchers also found that individuals with primary care reported better health care access and experience, including physician communication, which was highly rated for 64% of those with and 54% for those without primary care.

Finally, researchers noted that these differences in quality and experience were essentially stable between 2002 and 2014.

“A more complete understanding of the association between receipt of primary care and the quality and experience of care, as well as how this has changed over time, could inform investments in and use of primary care,” the researchers wrote. “Policymakers and health-system leaders seeking to improve value should consider increasing investment in primary care.”

In a related commentary, Allan H. Goroll, MD, of the division of general internal medicine at Massachusetts General Hospital, Harvard Medical School, wrote: “[Essential to the full realization of primary care] is improved physician payment that more closely reflects the value created and closes the unconscionable gap with specialty proceduralist pay. Levine and colleagues have not only added importantly to the evidence base documenting primary care’s valuable contributions to U.S. health care delivery, but in doing so, have also shown where, with additional investment and practice reform, primary care can realize its full potential.” – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.