• suggests financing mechanisms that encourage good primary care rather than episodic interventions late in the disease process;
  • encourages support for training of a primary care workforce, sufficient in numbers to meet the needs for primary care, equipped with the skills and competencies that match the function as the committee has defined it, and prepared to work in the context of a team that includes primary care physicians, nurse practitioners, physician assistants, community health workers, and other health professionals;
  • favors enhancement of the knowledge base for primary care based on clinical and health services research; and
  • speaks to the development of primary care as a continually improving system in an era of rapid change through program evaluations, dissemination of innovations, and continued education of the clinician and patient.

The chapters of this report constitute a road map for reaching the committee's goals, as reflected in five assumptions. First, primary care is the logical foundation of an effective health care system because primary care can address the large majority of the health problems present in the population. Second, primary care is essential to achieving the objectives that together constitute value in health care—quality of care (including achievement of desired health outcomes), patient satisfaction, and efficient use of resources. Third, personal interactions that include trust and partnership between patients and clinicians are central to primary care. Fourth, primary care is an important instrument for achieving stronger emphasis on (a) health promotion and disease prevention and (b) care of the chronically ill, especially among the elderly with multiple problems. Fifth, the trend toward integrated health care systems in a managed care environment will continue and will provide both opportunities and challenges for primary care.

Definition Of Primary Care

The committee's definition of primary care (see Chapter 2), which the committee formally recommends be adopted (see Box S-1), is presented in terms of the function of primary care, not solely in terms of who provides it. The definition calls attention to several attributes that provide the structure within which the broad themes of this report are addressed. The critical elements include

  • integrated and accessible health care services;
  • services provided by primary care clinicians—generally considered to be physicians, nurse practitioners, and physician assistants—but involving a broader array of individuals in a primary care team;
  • accountability of clinicians and systems for quality of care, patient satisfaction, efficient use of resources, and ethical behavior;


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