Hidden Benefits of Relationship-based Primary Care

The term Primary Care may have lost some of its meaning, because so many providers of first-point-of-contact care label what they do as primary care. Yet brief encounters for evaluation and treatment of acute medical issues by doctors who have never seen their patients before are only a small component of what primary care offers, so we shouldn't expect such services to deliver all the benefits of Primary Care.?

Even more important, when the acute care is delivered by a doctor who knows their patient, the doctor is more likely to identify the true problem, and the patient is more likely to trust their doctor and follow the treatment recommendations.?

In other words, episodic-care telehealth providers and urgent-care clinics are unable to deliver the benefits of relationship-based, comprehensive Primary Care.?

So what is Primary Care?

Here are the characteristics of relationship-based Primary Care:?

1. First point of contact. This is the one feature that is common among all services that describe themselves as primary care.?
2. Comprehensive care. True primary care encompasses not just the immediate issues but also addresses underlying health risks, manages ongoing health concerns and delivers all needed preventive health care.?
3. Continuous care. This leads to an ongoing relationship of trust.?
4. Patient-centered care. Good primary care doctors consider their patients holistically, including physical, emotional, and social factors. They assess and understand their patients well, so they can tailor their recommendations and treatments to each person's individual preferences.?

What does Primary Care do?

Good primary care includes all of the following:

1. Acute Care: Addressing sudden, short-term illnesses or injuries, such as a cough, cold, flu, minor infections, and minor injuries.
2. Preventive Care: Regular health screenings, immunizations, and counseling on lifestyle changes to prevent illnesses.
3. Chronic Disease Management: Ongoing care for chronic conditions such as diabetes, hypertension, asthma, and heart disease.
4. Health Promotion: Educating patients about healthy lifestyles and disease prevention.
5. Coordination of Care: Referrals to and coordination with specialists and other healthcare services as needed.

As this list shows, the fundamental characteristics of good primary care are based on an established relationship of trust between a patient and their doctor. This isn't possible in any setting where the patient sees a different doctor at each visit.?

What are the measured benefits of Primary Care??

It turns out that the benefits of having an ongoing relationship with a PCP are well documented: People who have a PCP get more preventive care [1] (including vaccinations [2]), their overall healthcare costs are significantly lower, and people who have better access to primary care doctors live longer.?

In a large study of ambulatory care, each primary care outpatient visit was associated with a $720/year lower healthcare expense; for the highest risk patients (top 10%), the average reduction was an astonishing $16,406 per visit [3].?Even in less sick and lower-risk populations, the benefits of relationship-based Primary Care are significant.

By one estimate, each increase of 10 PCPs per 100,000 people leads to an average increase in lifespan of 51.5 days [4]. In areas that have fewer PCPs, especially rural areas,?people do not live as long. Of all regions designated primary medical “health professional shortage areas (HPSAs)” (< 1 PCP/3,500), ? are rural [5]. If people in underserved rural areas had access to 1 PCP per 2,200 (as they do in urban areas), they would live 188 days longer [5].

We have good reason to set a high priority on expanding everyone's access to primary care.?

PCPs are in short supply

Today, we have many areas of the country with too few PCPs [5]. The Association of American Medical Colleges (AAMC) projects that by 2034 the shortage will rise to 18–48k primary care doctors [6]. The increased need for primary care is driven chiefly by a growing population that is aging, and there simply aren't enough PCPs to manage the rising demand. To make matters worse, PCPs are leaving clinical practice or retiring early. In the face of relentless pressure to increase productivity and work longer hours, doctors are burning out. Increased administrative burdens, and more time with the electronic health record (EHR) are making it worse.?

Virtual primary care is an important solution

Virtual primary care enables the delivery of more convenient, effective, and affordable health care to everyone, including to those who otherwise have no access to primary care.?

Virtual primary care connects patients with their PCP via video and audio, with options for asynchronous text interactions between visits. Patients can see their doctor from the comfort and security of their home, without the inconvenience, expense, and time required to see the doctor in an office. And the virtual visit is less expensive than in-office visits [7].

Can Virtual Primary Care deliver all the benefits of Primary Care? The short answer is yes, for most people, most of the time, Virtual Primary Care delivers all the available benefits of comprehensive relationship-based Primary Care. I'll leave a more detailed discussion and documentation of how we know this to be true to my next article.?

Summary

• Acute episodic care offers only a small fraction of the benefits of true primary care.?
• Telehealth providers offering only acute visits are not delivering Primary Care?
• The key characteristics of Primary Care include all of the following: First point of contact care, comprehensive care, continuous care, and patient-centered care
• The components of Primary Care include health promotion, preventive care, coordination of care, chronic disease management (and acute care).?
• The benefits of having a relationship with a PCP are observable, measurable, and large?
• Only a small fraction of people are better served by an office-based doctor (Officologist)?
• Most people who choose to get their Primary Care virtually get additional benefits beyond what is offered by officeologists

References?

[1] Quality and Experience of Outpatient Care … JAMA Intern Med 2019;179(3):363-372 ??

[2]?Surveying the Effect of the COVID-19 Pandemic on Public Confidence in Vaccines and Vaccine Messengers, AAFP

[3] The Effect of Primary Care Visits on Total Patient Care Cost? J Prim Care Community Health 2022

[4] Association of Primary Care Physician Supply … JAMA Intern Med 2019;179(4):506-514 ?

[5] Does Primary Care Availability Mediate the Relationship … J Prim Care Community Health 2022?

[6] The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 AAMC ?

[7] Features and pricing, HealthTap