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Jan 14, 2013

First Things First: Getting Primary Care Right

Author Affiliations

Author Affiliation: Division of General Internal Medicine, Department of Medicine, Uniformed Services University, Bethesda, Maryland.

JAMA Intern Med. 2013;173(1):13-14. doi:10.1001/jamainternmed.2013.1124

Given the broad agenda, high expectations, increasing patient complexity, growing evidence base, intensifying threats to provider work dissatisfaction, and the worsening workforce shortage of primary care physicians, there is an urgent need to fix the problems of primary care. Primary care has been marginalized, and our own professional societies have encountered numerous obstacles in advocating for the preeminence of primary care.

First, we need to define primary care, as the specialty focused on the primary and comprehensive health care needs of the patient. Because it is patient focused and not disease focused, the permutations of complexities of problems, presentations, and scenarios are infinite. From a health policy perspective, primary care is defined as care that is accessible, comprehensive, coordinated, continuous, and longitudinal. This framework has been helpful in studying and evaluating how primary care is delivered.1,2 We need to give highest priority in health care reform to making a system of primary care that serves as the prime interface of the most care for the most people.

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