The Role of Primary Care in the U.S. Healthcare System

Instructor: Jennifer Pettigrew

Jennifer has a master's degree in nursing and been a clinical instructor for BSN students.

This lesson defines primary care, explains the role primary care providers play in the current healthcare system, and identifies the differences between primary, secondary and tertiary healthcare. It also explores current trends in primary care.

Role of Primary Care Providers

Imagine you are trying to enter an ancient city surrounded by a wall. There are gates in the wall to allow people to enter the city, but when you arrive at the first gate there is no gatekeeper to let you in. You go to the next gate and there's a woman there but she refuses to let you in, saying that you have to enter the main gate, but won't tell you where the main gate is. You wander from gate to gate, unable to enter or figure out where to go without the assistance. This is what healthcare can look like without a primary care team. Without having someone to coordinate your care and give you a roadmap of specialists and diagnostic testing to follow, it can be very difficult, if not impossible, to get in with the correct specialist. Furthermore, your failed attempts may result in unnecessary costs for tests and doctor's visits you don't need.

What Is Primary Care?

Primary care encompasses a broad spectrum of healthcare services and delivery models. It involves a whole-patient approach and takes into account a patient's physical and psychosocial health. Within the American healthcare system, primary care includes being a patient's main point of contact for their initial approach to the healthcare system as well as health education, health counseling, disease prevention and the identification of and differentiation of various illnesses.

Primary doctors are based in your community
Primary doctors are based in your community.

Your primary care physician might be an internal medicine doctor, family practice doctor, or pediatrician. You may also see a mid-level provider, a non-physician medical professional with the training to diagnose a treat health conditions under a physician's oversight. Examples of mid-level providers include nurse practitioners (NPs) and physician's assistants (PAs).

Primary care provides (PCPs) manage minor health issues as well as common chronic illnesses. A chronic illness is an illness that has a long (usually greater than 6 month) course. Many chronic illnesses have no cure, but can be managed with medications and lifestyle changes, and it is the primary care team that can most adequately coordinate a patient's access to the resources needed to make these changes, including referrals to specialists if needed. Specialists have additional training in a specific area and can provide more focused testing and treatment. Common examples of specialists include cardiologists (heart doctors), and pulmonologists (lung doctors).

Benefits of Primary Care

Despite accounting for the vast majority of patient-physician encounters, PCP costs represent only 6% or less of healthcare spending . PCPs tend to engage in more cost effective patient care by ordering fewer tests than their specialist counterparts. More cost effective care is becoming increasingly important as it is estimated that by 2025 healthcare will account for almost 25% of America's gross domestic product (GDP). The GDP is the sum of the value of all of the goods and services generated by a country in one year. It has also been noted that patients with regular access to primary care use the emergency department less, have better blood pressure control, lower mortality and a higher quality of life.

Secondary and Tertiary Healthcare

Referrals to specialists fall under the umbrella of secondary healthcare. When a patient is seen by more than one specialist they can run into problems when two or more doctors are all changing their medications at the same time. The specialists should work with the primary care team in order to coordinate the safest, most effective care for the patient as a whole. Tertiary healthcare usually takes place in a hospital or facility that has specialized equipment and specially trained personnel not available in all facilities.

Trends in Primary Care Access

In the 1960s and 1970s there was the beginning of a huge attitude shift in healthcare delivery due to the bioethics movement. Prior to this movement, there were cases of terminally ill patients, especially women, who may not have been told that they were dying for fear of upsetting them. The bioethics movement signified a move away from the doctor-knows-best attitudes of the past and a move towards increased transparency in healthcare and patient autonomy. This has allowed for more open patient-provider relationships.

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