The Characteristics of Primary Care
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2. Nice to Know:
Primary care refers to first-contact care that deals with the majority of health problems occurring for individual patients.
Primary health care is a broader concept that extends primary medical care to also address health issues in a community, using preventive and public health approaches.
Many groups have proposed criteria for judging good quality primary health care. For example, the WHO suggested that it should be
- General (patients have not been pre-selected according to their medical condition);
- Continuous (the same physician cares for same patient over time);
- Comprehensive (covers all conditions);
- Coordinated and Collaborative (doctors are linked to other sources of care and are the case-managers for that patient);
- Family-oriented (ideally, patient and other family members treated by same health care team); and,
- Community-oriented (responds to health needs of the community).
Likewise, the College of Family Physicians of Canada has proposed Four Principles of Family Medicine. These focus mainly on primary care - the narrower conception:
- The family physician is a skilled clinician. "Family physicians demonstrate competence in the patient-centered clinical method; they integrate a sensitive, skillful, and appropriate search for disease…"
- Family medicine is a community-based discipline. "Family practice is based in the community and is significantly influenced by community factors…"
- The family physician is a resource to a defined practice population. "The family physician views his or her practice as a 'population at risk', and organizes the practice to ensure that patients’ health is maintained whether or not they are visiting the office…"
- The patient-physician relationship is central to the role of the family physician. "Family physicians have an understanding and appreciation of the human condition, especially the nature of suffering and patients’ response to sickness. They are aware of their strengths and limitations and recognize when their own personal issues interfere with effective care…"
Dr. Ian McWhinney (U Western Ontario) has proposed nine characteristics of the Good Family Physician: Family Doctors . . .
- …are committed to the person rather than to a particular body of knowledge, group of diseases or special technique;
- …seek to understand the context of the illness;
- …see every contact with their patients as an opportunity for prevention or health education;
- …view their practice as a “population at risk”
- …see themselves as a part of a community-wide network of supportive and health care agencies;
- …should ideally live in the same community as their patients;
- …make house-calls to the pastient's home;
- …attach importance to the subjective aspects of medicine;
- …are managers of resources.
Finally, Dr. Peggy Leatt ( U Toronto) has proposed challenging criteria from the patient's perspective that will define the achievement of an integrated system:
How will patients know when an integrated health care system exists?
- do not have to repeat their health history for each provider encounter
- do not have to undergo the same test multiple times for different providers
- are not the medium for informing their physician that they have been hospitalized or undergone diagnostic or treatment procedures; been prescribed drugs by another physician; not filled a previous prescription; or been referred to a health agency for follow-up care
- do not have to wait at one level of care because of incapacity at another level of care
- have 24-hour access to a primary care provider
- have easy-to-understand information about quality of care and clinical outcomes in order to make informed choices about providers and treatment options
- can make an appointment for a visit to a clinician, a diagnostic test or a treatment with one phone call
- have a wide choice of primary care providers who are able to give them the time they need
- with chronic disease, are routinely contacted to have tests that identify problems before they occur; provided with education about their disease process; and provided with in-home assistance and training in self-care to maximize their autonomy
Links: Back to Primary Care
CANMEDS 2000: the roles of the contemporary physician
Romanow report (which talks of primary care)