Abstract
Person centered primary health care provides first contact care that is continuous, comprehensive, equitable, team-based, collaborative, coordinated, integrated, accessible, high value, and above all else person and family centered. Primary care by its very nature is integrative in design and process. It connects and coordinates care for the person and uses shared decision making to help value and respect the persons choices as they navigate through a complex and fragmented health care system.
Family Medicine and General Practice are foundational to primary care and are a person, family and community integrator but they also function as a healthcare systems integrator improving both the quality of care and the lowering of cost to both people and populations. It has been found that the better a country’s primary care system is, the better overall health care outcomes and lower per capita health care expenditures that country will have.
Evidence also demonstrates that person centeredness contributes to higher quality care. Continuity and comprehensiveness of care leads to better health outcomes, lower all-cause mortality, better access to care, less rehospitalization, fewer consultations with specialists, less use of emergency services, and better detection of adverse effects of medical interventions. The use of the relationship of trust established through family medicine, general practice and other primary care health professionals in shared decision making is an effective and efficient means to promote behavior change that results in the triple aim of better health, improved healthcare, and lower costs. The Seven Shared Principles of primary care are a wonderful reminder of the person-centered approach to primary care. Additionally, the rural paradigm of person-centered care puts people at the center of the healthcare system.
All nations must build a robust and vibrant person and family centered primary health care system based on the principles of continuity, comprehensiveness, and person centeredness with family physicians and general practice primary care physicians as its backbone. We must prioritize and rebalance healthcare systems to address the healthcare needs of the people that are served around these principles.
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References
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207–12.
Hart JT. The inverse care law. Lancet. 1971;297:405–12.
The World Health Report. Primary health care—now more than ever. 2008. http://www.who.int/whr/2008/en/.
The White House. Office of the Press Secretary. Remarks by the President at the Opening of the White House Forum on Health Reform. 2009. http://www.whitehouse.gov/the_press_office/Remarksby-the-President-at-the-Opening-of-the-White-House-Forum-on-Health-Reform.
Epperly T. Fractured: America’s broken health care system and what we must do to heal it. 2012. http://fracturedhealthcare.com/about/.
Albert Einstein. BrainyQuote.com. n.d. http://www.brainyquote.com/quotes/quotes/a/alberteins133991.html. Accessed 25 June 2015.
Beal AC, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the divide: how medical homes promote equity in health care: results from the Commonwealth Fund. Health Care Quality Survey; 2006–2007.
Mokdad AH, Marks JS, Stroup DF, Gereberding JL. Actual causes of death in the United States. JAMA. 2000;2004(291):1230–45.
IHI Triple Aim Measures. n.d. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/MeasuresResults.aspx.
Epperly T, Roberts R, Rawaf S, Van Well C, Mezzich J, et al. Person-centered primary health care: now more than ever. Int J Pers Cent Med. 2015;5(2):53–9.
Epperly T, Bechtel C, Sweeny R, Greiner A, Grumbach K, et al. The shared principles of primary care: a multistakeholder initiative to find a common voice. Fam Med. 2019;51(2):179–84.
Starfield B. Primary care: concept, evaluation, and policy. Oxford: Oxford University Press; 1992.
Institute for Healthcare Improvement. The IHI triple aim. 2018. http://www.ihi.org/engage/initiatives/Triple-Aim/Pages/default.aspx.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Millbank Q. 2005;83(3):457–502.
Medicare Claims Data. Area health resource file. Health Research & Services Administration, US Department of Health and Human Resources; 2003.
Ferrer RL, Hambidge SJ, Maly RC. The essential role of generalists in health care systems. Ann Intern Med. 2005;142:691–9.
Gulbrandsen P, Hjortdahl P, Fugelli P. General practitioners’ knowledge of their patients’ psychosocial problems: multipractice questionnaire survey. Br Med J. 1997;314:1014–8.
Jaturapatporn D, Dellow A. Does family medicine training in Thailand affect patient satisfaction with primary care doctors? BMC Fam Pract. 2007;8:14.
Kovess-Masféty V, et al. What makes people decide who to turn to when faced with a mental health problem? Results from a French survey. BMC Public Health. 2007;7:188.
Fiscella K, et al. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care. 2004;42:1049–55.
Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.
Chande VT, Kinane JM. Role of the primary care provider in expediting children with acute appendicitis. Arch Pediatr Adolesc Med. 1996;150:703–6.
Forrest CB, Starfield B. The effect of first-contact care with primary care clinicians on ambulatory health care expenditures. J Fam Pract. 1996;43:40–8.
Starfield B. Primary care: balancing health needs, services, and technology. New York: Oxford University Press; 1998.
Bindman AB, et al. Primary care and receipt of preventive services. J Gen Intern Med. 1996;11:269–76.
Shea S, et al. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med. 1992;327:776–81.
Franks P, Fiscella K. Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. J Fam Pract. 1998;47:105–9.
Regional Core Health Data Initiative. Washington DC: Pan American Health Organization. 2005. http://www.paho.org/English/SHA/coredata/tabulator/newTabulator.htm.
Shi L, et al. The relationship between primary care, income inequality, and mortality in the United States, 1980-1995. J Am Board Fam Pract. 2003;16:412–22.
Villalbi JR, et al. An evaluation of the impact of primary care reform on health. Aten Primaria. 1999;24:468–74.
Forrest CB, Starfield B. Entry into primary care and continuity: the effects of access. Am J Public Health. 1998;88:1330–6.
Weinick RM, Krauss NA. Racial/ethnic differences in children’s access to care. Am J Public Health. 2000;90:1771–4.
Friedberg MW, Rosenthal MB, Werner RM, Volpp KG, Schneider EC. Effects of a medical home and shared savings intervention on quality and utilization of care. JAMA Intern Med. 2015;175(8):1362–8. https://doi.org/10.1001/jamainternmed.2015.2047.
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? For The Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. N Engl J Med. 1996;334:1441–7.
Woodward CA, et al. What is important to continuity in home care? Perspectives of key stakeholders. Soc Sci Med. 2004;58:177–92.
Gill JM, Mainous AGI, Nsereko M. The effect of continuity of care on emergency department use. Arch Fam Med. 2000;9:333–8.
Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004;82:661–87.
Rothwell P. Subgroup analysis in randomized controlled trials: importance, indications, and interpretation. Lancet. 2005;365:176–86.
Freeman G, Hjortdahl P. What future for continuity of care in general practice? Br Med J. 1997;314:1870–3.
Miller MR, et al. Parental preferences for primary and specialty care collaboration in the management of teenagers with congenital heart disease. Pediatrics. 2000;106:264–9.
Rosenblatt RL, et al. The generalist role of specialty physicians: is there a hidden system of primary care? JAMA. 1998;279:1364–70.
Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician–patient relationships on the costs and use of health care by older Americans. Am J Public Health. 1996;86:1742–7.
Martin DP, et al. Effect of a gatekeeper plan on health services use and charges: a randomized trial. Am J Public Health. 1989;79:1628–32.
Parchman ML, Culler SD. Primary care physicians and avoidable hospitalizations. J Fam Pract. 1994;39:123–8.
Gadomski A, Jenkins P, Nichols M. Impact of a Medicaid Primary Care Provider and Preventive Care on pediatric hospitalization. Pediatrics. 1998;101:E1.
Hurley RE, Freund DA, Taylor DE. Emergency room use and primary care case management: evidence from four Medicaid demonstration programs. Am J Public Health. 1989;79:834–6.
Hjortdahl P, Borchgrevink CF. Continuity of care: influence of general practitioners’ knowledge about their patients on use of resources in consultations. Br Med J. 1991;303:1181–4.
Roos NP, Carriere KC, Friesen D. Factors influencing the frequency of visits by hypertensive patients to primary care physicians in Winnipeg. Can Med Assoc J. 1998;159:777–83.
Schafer WLA, Boerma WGW, Murante AM, Sixma HJM, Schellevis FG, Groenewegen PP. Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey. Bull World Health Organ. 2015;93:161–8.
Patient Engagement Framework. Healthwise. n.d. http://www.healthwise.org/solutions/patientengagement.aspx.
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Epperly, T., Wilson, C.R., Kidd, M. (2023). Person-Centered Family Medicine and General Practice. In: Mezzich, J.E., Appleyard, W.J., Glare, P., Snaedal, J., Wilson, C.R. (eds) Person Centered Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-17650-0_19
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