Toward the Measurement of Primary Care

Holmes, Chris; Kane, Robert L; Ford, M.P.H. Daniel E.; Fowler, Jess

doi:10.2307/3349520

The Milbank Memorial Fund Quarterly. Health and Society

1978

DOI: 10.2307/3349520

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Toward the Measurement of Primary Care

Chris Holmes¹,

Robert L Kane²,

M.P.H. Daniel E. Ford³

et al.

Abstract: The renaissance of rhetoric about primary care--"continuous, coordinated, comprehensive, family-centered"--has paralleled the growth of entrants into formal training programs. The extent to which primary care is actually practiced this way has not been examined, nor have the routes to preparing for it. A preliminary set of measurements is suggested.

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Cited by 13 publications

References 11 publications

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Communication Failure in Primary Care

Cummins

Smith

Inui

1980

JAMA

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In a two-physician general practive within 80 km of two university medical centers, there were 4,367 patient visits in six months, from which 233 referrals (5.3%) were made to consultants. All referred patients were accompanied by referral material and a request for follow-up information. The overall rate of receiving follow-up information was 62%. Private specialists provided substantially more follow-up information (78%) than either university-affiliated emergency rooms (48%) or university-affiliated specialty clinics (59%). Patients requiring continuing medical supervision from the referring physician also fared poorly: follow-up information for them was provided only 54% of the time. The timeliness and method of providing follow-up information were examined and believed to be satisfactory when follow-up information was returned.

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Communication Failure in Primary Care

Cummins

Smith

Inui

1980

JAMA

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Do Families Get Family Care?

Murata

Kane²

1987

JAMA

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To determine the prevalence of family care, we measured the extent to which a subset of 732 families, from those enrolled in the Rand Health Insurance Experiment, perceive and use a single primary care physician. Although only 16.7% of these families had all members with a majority of their visits to the same physician, 45.4% identified a single primary care physician for all family members. (For older couples, this percentage reached 73.5%). An intermediate proportion of families had visits by all family members to a single physician. Children received less family care, but as families matured, family care increased for both children and parents. Our results suggest an inverse relationship between family care and education level. The availability of general-family practitioners, family income, insurance coverage, and population size were not significant determinants of family care. We conclude that family members share the perception of having a single "family physician," which is reflected in their patterns of utilization.

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An empirical definition of ?primary care?

Farrow¹,

Harrison²,

Kaluzny³

et al. 1980

J Community Health

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An operational definition of "primary care", useful to a wide variety of professionals, has eluded researchers since the term first gained popularity. This paper presents an activity-based definition of primary care derived from ratings of 59 representative health care activities by a group of state health administrators, a group of local health department directors, and a random sample of primary care physicians practicing in North Carolina. Thirty-one activities received ratings indicating they were considered core primary care services. Examination of differences in ratings among the three groups surveyed suggested that health department directors differ from the other two groups. Consideration of the variances of activity ratings within the groups emphasizes the unique response of the health department directors and identifies activities characterized by considerable disagreement. The study includes information necessary for researchers and practitioners to form an activity-based definition of varying scope. Definitions constructed from this information should be useful in planning the evaluation efforts that involve different groups of providers, since activities provide an objective basis for agreement. Repeating the approach outlined in the paper with other provider groups in other areas of the country should lead to better understanding of intergroup and regional differences in the concept of "primary care".

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Toward the Measurement of Primary Care

Cited by 13 publications

References 11 publications

Communication Failure in Primary Care

Communication Failure in Primary Care

Do Families Get Family Care?

An empirical definition of ?primary care?

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