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  • Title: What is primary care?
    Journal: J Public Health Policy; 1983 Jun; 4(2):129-34. PubMed ID: 6885995.
    Abstract:
    This discussion of primary care directs attention to quality of care and the primary care team. Primary care is the care provided by the 1st person the patient sees who has been trained in health care. The answer to the question of who should provide primary care should be based on the tasks and responsibilities which must be met. These are: correct diagnosis as the precondition for treatment; appropriate treatment to restore maximum possible restoration of function; relief of pain and suffering and alleviation of anxieties associated with illness; appropriate referral for specialized diagnostic, treatment, and rehabilitation services; management responsibility for the overall health of the patient; preventive services, i.e., immunization, multiphasic screening for early detection, and preventive supervision; and health education and advice for health promotion, disease prevention, treatment and rehabilitation. The need for highly trained primary care practitioners is illustrated by a study conducted by Ciocco, Hunt, and Altman as part of the 1946 survey of group practice by the US Public Health Service. In each of 16 medical groups, they abstracted the records of 200 new patients to obtain data on the services received for a period of 14 days following admission. When they compared the 5 groups with the greatest average amount of hospital training of physicians with the 5 groups with the lowest amount, siginificant differences were found. There were more general examinations among patients of the groups in the high set, 46% against 36%, and there were fewer patients for whom no examination was recorded. Significant differences were also found in treatment between the high and low sets. The study implications were clear. The old style general practitioner can hardly be considered competent to provide a high quality of primary care, yet these were the primary care practitioners that the United Mine Workers Association (UMWA) medical care program encountered in the mining areas. The United Mine Workers program was part of a widespread initiative in the US after World War 2 to go beyond payment for medical care in order to achieve for working class families the quality of care enjoyed by the upper and middle classes, i.e., to move from the general practitioner system to the pediatrician internist system. The entire movement toward group practice prepayment after World War 2, including the UMWA program, was a quest for equity in health care. In developing countries, primary care by less qualified persons is essential, but the latter need continuing education, supervision, and support from more highly qualified personnel. Effective primary care requires the development of new types of primary care teams based on the needs and possibilities of today.
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