Americans with primary care receive significantly more high-value care, slightly more low-value care, and report better healthcare experience.
As policy makers and other healthcare stakeholders continue to work toward improving value in care, a new study suggests they consider investment in primary care. The study, published in JAMA Internal Medicine, found that Americans with primary care receive significantly more high-value care, slightly more low-value care, and report better healthcare experience.
According to the study researchers, until this point, the value of primary care has remained unclear and debated in the United States, with no large, randomized controlled trials evaluating the impact primary care has on quality of care and patient experience.
The study relied on data from the Medical Expenditure Panel Survey from 2002 to 2014, with the researchers focusing on 2012 to 2014. To determine if respondents were engaged in primary care, the researchers assessed whether they reported having a physician they typically go to if they are sick or need advice about their health. Respondents were asked further if they would visit their usual source of care for new health problems, preventive health care, ongoing health problems, and referrals to other professionals when needed.
Based on survey responses, there were a total of 49,286 adults with and 21,133 adults without primary care included in the analysis. Those who engaged in primary care were more likely to be insured, as well as more likely to be female, white, more frequent smokers, poor, and have a high chronic disease burden.
Value of care was gauged based on 5 categories: cancer screening, diagnostic and preventive testing, diabetes care, counseling, and medical treatment.
While approximately 78% of respondents engaged in primary care were considered to have received high-value care, 67% of respondents not engaged in primary care were considered to have received high-value care. The researchers observed that respondents with primary care received more high-value care in 4 of the 5 categories, with the largest difference being seen in colorectal cancer screening and mammography.
“For the relatively small number of patients with heart failure or pulmonary disease, respondents with primary care received less high-value care,” noted the researchers. “For example, those with primary care received fewer β-blockers in heart failure and fewer controller medications in poorly controlled asthma.”
Low-value care was observed in similar rates across the 2 groups, with approximately half of respondents engaged in primary care receiving low-value cancer screening compared to the 44% of those without primary care. Within cancer screening, only low-value prostate cancer screening differed significantly.
“Respondents with or without primary care used healthcare with a similar frequency, including similar mean numbers of annual office visits, annual emergency department visits, and annual hospital admissions,” explained the researchers.
However, despite these similar rates, respondents engaged in primary care reported better experience; 79% of respondents with primary care reported an excellent rating of their healthcare compared to 69% of those not engaged in primary care. Physician communication was also more highly rated among those engaged in primary care (64% vs 54%), as was reported access to care (59% vs 52%).
Levine D, Landon B, Linder J. Quality and experience of outpatient care in the United States for adults with or without primary care [published online January 28, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.6716