Decreasing Use of Primary Care: A Repeated Cross-Sectional Study of MEPS 2007-2017

National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity

“…We found that most adults in our study continued to have PCPs as usual clinicians, consistent with prior research on adults with serious illness and multiple chronic conditions having a generalist usual clinician . This finding, in light of well-established declines in primary care visit rates, may be consistent with evidence of PCPs and teams delivering longer and more comprehensive (if less frequent) visits and providing care outside of the context of visits, eg, through portal messages and telephone calls . In parallel, there was a small decrease in having a specialist as a usual clinician, such that the established increase in specialist visit rates may not be explained by more specialist usual clinicians .…”

“… 31 This finding, in light of well-established declines in primary care visit rates, may be consistent with evidence of PCPs and teams delivering longer and more comprehensive (if less frequent) visits and providing care outside of the context of visits, eg, through portal messages and telephone calls. 17 , 20 In parallel, there was a small decrease in having a specialist as a usual clinician, such that the established increase in specialist visit rates may not be explained by more specialist usual clinicians. 16 This raises the possibility that these additional visits may contribute to care fragmentation.…”

“… 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 However, among older adults with multimorbidity, per capita PCP visits decreased by 20% in the past decade, while specialist visit rates increased. 16 , 17 , 18 , 19 , 20 In light of these trends, it is unclear how access to a usual clinician has changed for older adults during this period and whether this care may be increasingly provided by specialist physicians.…”

“…Historically, usual clinicians have been primary care clinicians (PCPs) with specialties including family medicine and internal medicine . However, among older adults with multimorbidity, per capita PCP visits decreased by 20% in the past decade, while specialist visit rates increased . In light of these trends, it is unclear how access to a usual clinician has changed for older adults during this period and whether this care may be increasingly provided by specialist physicians.…”

Total and Out-of-Pocket Expenditures on Antihypertensive Medications in the United States, 2007–2019

“…Other hypotheses of the cause include the recommendations in the guidelines commissioned as the Eighth Joint National Committee or lower rates of primary care appointments. 5 Based on our study, it is unlikely that single agents will have appreciably higher OOPE compared combination pills. Finally, hypertension is a global problem, and additional research is warranted to investigate these findings in different countries and systems.…”