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November 24, 1993

Primary Care as Part of US Health Services Reform

Author Affiliations

VA Medical Center Perry Point, Md

JAMA. 1993;270(20):2433. doi:10.1001/jama.1993.03510200038016

To the Editor.  —The recent article by Starfield and Simpson1 appropriately and eloquently calls for the embodiment of primary health care services as a cornerstone for a reformed US health care delivery system. The authors quite correctly lament the inattentiveness currently paid to primary care. However, in their recommendations to construct a primary care infrastructure, they are inherently self-defeating and exclusionary by implying that only physicians can provide primary care. The reliance on physicians is based on the restrictive interpretation of four characteristics of primary care developed by Starfield and Simpson: first-contact care, coordination, longitudinality, and comprehensiveness.2The recognition of other professions as primary care services would extend primary care's scope of patient service and management as well as broaden its base of support for inclusion into the health care delivery system. Dentistry, for one, plays a vital role in the provision of primary health care services and can