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May 4, 2021

Implementing High-Quality Primary Care: A Report From the National Academies of Sciences, Engineering, and Medicine

Author Affiliations
  • 1The Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation, Washington, DC
  • 2Neil Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
  • 3Milbank Memorial Fund, New York, New York
JAMA. 2021;325(24):2437-2438. doi:10.1001/jama.2021.7430

Twenty-seven years ago, the Institute of Medicine launched a primary care consensus study that, at the time, seemed highly aligned with the country’s appetite for health reform and managed care.1 Primary Care: America’s Health in a New Era produced a primary care definition still used around the world; however, the report’s recommendations received no traction in the US. Similarly, a 2012 Institute of Medicine report on the integration of primary care and public health largely went unheeded.2 While primary care is uniquely positioned to support COVID-19 testing, tracing, and vaccination and to help address pervasive health and social inequities, primary care was not considered in congressional relief packages in 2020 and many practices may be closed when they are needed most.

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    2 Comments for this article
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    Continuity of Care
    Steven Yarows, MD, FASH, FACP | IHA
    I greatly appreciate the goals outlined in this article and support them. As an internist for 40 years I have learned that continuity of care for my patients is critical for proper cost-effective care. It is important to 'know your patient' and for the patient to have a relationship to their PCP when delivering complex, difficult care. Adherence is certainly better.

    There is a strong effort to break continuity of care by retail pharmacies, urgent care sites, and national telehealth companies (supported by insurance plans) that rapidly need to be stopped. These try to 'cherry
    pick' primary care and duplicate vaccinations and order excessive antibiotics.
    CONFLICT OF INTEREST: None Reported
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    Primary Care Not Being Provided in the US
    Phillip Shepard, MD | Retired Family Physician
    I graduated from a "top tier" medical school in 1968 that had no Family Practice (FP) Department. I had a three year FP residency at a community hospital, one of just 21 programs at that time. I served two years in the Army Medical Corps. I was Board certified. I went into private practice in rural Virginia and later in Montana. I practiced efficient, comprehensive longitudinal care. I ended my career teaching and working for the UNHCR in a "developing" country in Southeast Asia for 15 years. Emergency departments and "urgent care" clinics and polyclinics give people fragmented care. They overuse lab and imaging and referrals because these are revenue centers. The whole payment system favors this. The US has some of the worst health care statistics among developed countries. There are countries that have better health and spend far less. There needs to be change. Organizations like the AAFP, JAMA, internists, pediatricians and obstetricians-gynecologists need to get people educated about primary care, preventive medicine and public health.
    CONFLICT OF INTEREST: None Reported
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