The Importance of Primary Care Physicians as the Usual source of Health Care in the Achievement of Prevention Goals

One Pagers | Nov 01, 2000 Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD

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.

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:

Child Preventive Service
Have Usual SourceNo Usual Source
Child Preventive Service: DTPHave Usual Source: 97%
No Usual Source: 90%
Child Preventive Service: PolioHave Usual Source: 96%No Usual Source: 85%
Child Preventive Service: Measles, Mumps, RubellaHave Usual Source: 92%
No Usual Source: 82%
Child Preventive Service: Hepatitis BHave Usual Source: 80%
No Usual Source: 73%
Adult Preventive Service
Have Usual SourceNo Usual Source
Adult Preventive Service: Blood pressure checkHave Usual Source: 83%
No Usual Source: 56%
Adult Preventive Service: Cholesterol CheckHave Usual Source: 51%
No Usual Source: 23%
Adult Preventive Service: Flu ShotHave Usual Source: 30%
No Usual Source: 13%
Adult Preventive Service: General ExamHave Usual Source: 52%
No Usual Source: 28%
Adult Preventive Service: Man: Prostate ExamHave Usual Source: 36%No Usual Source: 10%
Adult Preventive Service: Woman: Pap SmearHave Usual Source: 60%No Usual Source: 47%
Adult Preventive Service: Woman: MammogramHave Usual Source: 51%No Usual Source: 29%
Adult Preventive Service: Woman: Any Breast ExamHave Usual Source: 65%No Usual Source: 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:

Adult Preventive Service
General Internist
Family Physician
Adult Preventive Service: Blood pressure checkGeneral Internist: 90%
Family Physician: 83%
Adult Preventive Service: Cholesterol CheckGeneral Internist: 66%
Family Physician: 51%
Adult Preventive Service: Flu ShotGeneral Internist: 43%
Family Physician: 30%
Adult Preventive Service: General ExamGeneral Internist: 62%
Family Physician: 50%
Adult Preventive Service: Man: Prostate ExamGeneral Internist: 52%
Family Physician: 35%
Adult Preventive Service: Woman: Pap SmearGeneral Internist: 60%
Family Physician: 57%
Adult Preventive Service: Woman: MammogramGeneral Internist: 60%
Family Physician: 48%
Adult Preventive Service: Woman: Any Breast ExamGeneral Internist: 70%
Family Physician: 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.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

Published in American Family Physician, Nov 1, 2000. Am Fam Physician. 2000;62:1968. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.