Fewer Americans receiving primary care
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The prevalence Americans with an identified source of primary care has decreased in recent years, according to a study published in JAMA Internal Medicine.
“We know that a person with a primary care relationship has better health outcomes, including high value care, mortality and experience,” David M. Levine, MD, MPH, MA, an instructor in medicine at Brigham and Women’s Hospital, told Healio Primary Care. “Fewer Americans with primary care means fewer Americans achieving these outcomes.”
Levine and colleagues evaluated data from a nationally representative survey that included 21,915 to 26,509 respondents each year from 2002 to 2015.
They found that the proportion of individuals in the United States with an identified source of primary care dipped from 77% (95% CI, 76-78) in 2002 to 75% (95% CI, 74-76) in 2015.
During the study period, the prevalence of those receiving primary care decreased for every decade of age except among those aged 80 years or older. The researchers said there were significant reductions in primary care among patients aged 30 to 39 years, 40 to 49 years, and 50 to 59 years. Among those aged 30 to 39 years, for example, the proportion of those who had primary care decreased from 71% in 2002 to 64% in 2015 (P < .001).
For those with no comorbidities, receipt of primary care decreased with age, according to the researchers. For instance, the prevalence of those aged 60 to 69 years with no comorbidities who received primary care dropped from 82% in 2002 to 73% in 2015 (P = .003). However, primary care remained stable among those with three or more comorbidities.
After adjusting for sociodemographic and clinical variables, the researchers found that the calendar year, being male, not having insurance, residing in the Southern U.S., and being a minority were associated with decreased likelihoods of having primary care.
Financial barriers and a shortage in primary care availability may be causing the changes in primary care use among Americans, the study authors noted.
Levine explained that incentivizing physicians to enter primary care with robust loan forgiveness and tuition-free medical school could help increase access to primary care in the U.S.
In addition, he said efforts are needed to rework payment systems to consider physicians’ cognitive work and to support investments in the technology required to run a successful primary care system. – by Erin Michael
Disclosure: Levine reports funding through Biofourmis to perform a machine learning study of home-based acute care monitoring.