In the first systematic study of what Americans value in primary health care, patients overwhelmingly endorsed the importance of primary care physicians, according to new research headed by the University of California, San Francisco. Almost all of the patients surveyed said they valued having a primary care physician who could coordinate their care and serve as a first point of contact.
Ratings of primary care physicians revealed high levels of patient trust, confidence, and satisfaction.
The study also found, however, that nearly a quarter of patients felt their primary care physician or medical group limited their access to specialists. Perceived barriers to specialty care led to dissatisfaction with primary care physicians and lower levels of trust. The study appears in the July 21 issue of the Journal of the American Medical Association (JAMA).
"Our study is an endorsement of primary care," said Kevin Grumbach, MD UCSF associate professor and chief of the Department of Family and Community Medicine at San Francisco General Hospital Medical Center. "Patients value primary care physicians, but don't want managed care plans forcing primary care physicians to be "gatekeepers" who ration their access to specialists." Grumbach is the principal investigator of the study.
In order to assess attitudes about the ease of receiving specialty care, the researchers targeted patients who were likely to need referrals. The 7,718 respondents had one of three age-related medical conditions - congestive heart failure, prostate disease, or stomach ulcers - and had a mean age of 67. They belonged to one of ten large medical groups in California.
The researchers were impressed at the very high rates of approval given to primary care physicians, said Grumbach. Ninety-four percent of patients valued having a primary care physician who knew their medical history and 89 percent valued the role of primary care physicians in coordinating referrals.
Some managed care groups use financial incentives and other "gatekeeper" policies to limit specialty referrals, said Grumbach, who is also director of the UCSF Center for California Health Workforce Studies and research director of the UCSF Center for the Health Professions. This can weaken the relationship between primary care physicians and their patients and potentially result in poorer quality of care, said Grumbach.
"Policymakers should consider these results in light of the current debate over 'Patients Bill of Right' legislation," said Joe Selby, MD, MPH, director of the Division of Research at Kaiser Permanente Medical Program of Northern California. "Patients want protection from overly restrictive policies that limit access to care. But they don't necessarily want to return to a haphazard system that reduces their primary care physician's role as a coordinator of specialty services."
The authors reported the following survey statistics:
- 75 to 91 percent of patients preferred to seek initial care from their primary care physicians rather than a specialist.
- 85 percent of patients reported trusting their primary care physician to do their best all or most of the time.
- 23 percent of patients felt their primary care physician or medical group interfered with their desire to see a specialist.
- Patients who had trouble getting referred were twice as likely to report low confidence and nearly three times more likely to report low trust with their primary care physicians than patients who did not experience barriers to referrals.
In addition to Grumbach, co-authors include Charles Quesenberry, PhD, Alison Truman, MS, and Connie Uratsu, BA, all with the Division of Research, Kaiser Permanente Medical Care Program of Northern California; Cheryl Damberg, PhD, Pacific Business Group on Health; and Andrew Bindman, MD, director of the UCSF Center for Primary Care Research at SFGHMC.
Journal
JAMA