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December 12, 1977

Primary Care

Author Affiliations

University of Kentucky College of Medicine Lexington

JAMA. 1977;238(24):2597. doi:10.1001/jama.1977.03280250023004

To the Editor.—  Having a personal interest in the evaluation of costs and outcomes in primary care,1 I read and reread the article of Wright et al (238:46-50, 1977) with interest and with difficulty in evaluation of the data.Under "Methods," they include "patients who came to the clinic with any complaint of acute illness. To me, this is a vague definition without some examples of problems included and excluded. Since a comparison of costs generated by five different groups of providers is made, I wonder if comparable percentages of various problems were treated by each group of providers. For example, could most of the viral upper respiratory infections have been seen by first-year residents and most of the fractures seen by faculty?I am perplexed by the high percentage of patients with acute problems with bad outcomes (almost 25% for the whole study). It would be my expectation