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The importance of primary care physicians as the usual source of healthcare in the achievement of prevention goals

Having a usual source of care enhances achieving clinical prevention goals for both children and adults. There is room for improvement, and differences between the practices of internists and family physicians suggest that slightly longer visits and having health insurance might contribute to achieving proven prevention strategies. 

Fryer GE, Dovey SM, and Green LA

The 1996 Medical Expenditure Panel Survey sponsored by the Agency for Healthcare Quality and Research is generalizable to the United States. In this survey respondents most often identified an individual generalist physician, typically a family physician, pediatrician, or internist as their usual source of care.

Having any usual source of care, either a facility or an individual provider, was uniformly associated with children less than six years of age obtaining their immunizations, and adults receiving preventive services during the past year:


  Have Usual Source No Usual Source
Children:    
DTP 97% 90%
Polio 96% 85%
Measles, Mumps, Rubella 92% 82%
Hepatitis B 80% 73%
Adults:    
Blood pressure check 83% 56%
Cholesterol Check 51% 23%
Flu Shot 30% 13%
General Exam 52% 28%
Man: Prostate Exam 36% 10%
Woman: Pap Smear 60% 47%
Woman: Mammogram 51% 29%
Woman: Any Breast Exam 65% 46%

 

Adults with a general internist as their usual source of care received more preventive care in 1996 than those with a family physician. This was the case for men and women:


  General Internist Family Physician
Blood Pressure Check 90% 83%
Cholesterol Check 66% 51%
Flu Shot 43% 30%
General Exam 62% 50%
Man: Prostate Exam 52% 35%
Woman: Pap Smear 60% 57%
Woman: Mammogram 60% 48%
Woman: Any Breast Exam 70% 63%

 

The reasons for these differences are uncertain. Provision of preventive care may be related to time spent with patients. According to the 1996 National Ambulatory Medical Care Survey (NAMCS), patient visits with general internists averaged 15.9 minutes, while visits with family physicians were 14.1 minutes, 13% shorter. Also, preventive care may be related to patients’ insurance status. According to the 1996 MEPS, only 5.5% of adult patients for whom general internists were the usual source of care were uninsured, but 12.2% of those of family physicians lacked insurance. This suggests that reducing non-insurance rates and adding a minute or two to visits might help close the gap between ideal targets for clinical preventive services and what is currently done.

 

Fryer GE, Dovey SM, Green LA. The importance of primary care physicians as the usual source of healthcare in the achievement of prevention goals. Am Fam Physician 2000;62:1968.

November 2000