Policy Center One-Pager

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 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.

See editorial on page 1984.

The 1996 Medical Expenditure Panel Survey (MEPS) sponsored by the Agency for Healthcare Quality and Research (AHQR; formerly the Agency for Health Care Policy and Research) can be generalized 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: Diphtheria-pertussis-tetanus 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 examination 52 28 Men: prostate examination 36 10 Women: Papanicolaou smear 60 47 Women: mammogram 51 29 Women: Any breast examination 65 46

General internist (%) Family physician (%) Blood pressure check 90 83 Cholesterol check 66 51 Flu shot 43 30 General examination 62 50 Men: prostate examination 52 35 Women: Papanicolaou smear 60 57 Women: mammogram 60 48 Women: Any breast examination 70 63

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:

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 percent shorter. Also, preventive care may be related to patients' insurance status. According to the 1996 MEPS, only 5.5 percent of adult patients for whom general internists were the usual source of care were uninsured, but 12.2 percent of patients of family physicians lacked insurance. This suggests that reducing noninsurance 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 being done.

From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 2023 Massachusetts Ave., NW, Washington, D.C. 20036 (phone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).

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