AAFP to Senate Committee: Primary Care Key to Public Health

December 04, 2017 03:13 pm News Staff

The AAFP recently outlined its major priorities for improving public health outcomes through action on fronts that include the primary care physician shortage, the opioid crisis and mental health care access in a detailed statement to the Senate Health, Education, Labor and Pensions Committee.

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The statement(8 page PDF) addressed a wide range of interconnected issues and was delivered to coincide with a Nov. 15 hearing(www.help.senate.gov) titled "Encouraging Healthy Communities: Perspective from the Surgeon General" that included testimony from Surgeon General Jerome Adams, M.D., M.P.H. Specifically, the Academy's statement highlighted important initiatives that should receive funding and legislative support.

Overall, legislators should remember that community health entails more than just treatment and prevention. It requires addressing social factors such as environment and lifestyle decisions that primary care physicians are particularly well-placed to help patients with, given their long-term relationships.

"The benefits of primary care do not just accrue to the individual patient. Primary care also translates into healthier communities," the statement read. "The dose of primary care can even be measured -- an increase of one primary care physician per 10,000 people is associated with an average mortality reduction of 5.3 percent, or 49 fewer deaths per 100,000 per year."

Story Highlights
  • The AAFP recently gave a statement to the Senate Health, Education, Labor and Pensions Committee detailing public health initiatives that should receive funding and legislative support.
  • The statement noted that by 2035, the nation will need an additional 33,000 primary care physicians to keep pace with an increasing and aging population.
  • The AAFP warned the committee that ongoing budget cuts to social programs pose a threat to public health.

An initial step lawmakers should take is addressing the primary care physician shortage. Citing a study published in Annals of Family Medicine,(www.annfammed.org) the AAFP noted that by 2035, the United States will need an additional 33,000 primary care physicians to keep pace with an increasing and aging population. Further, the statement cited a May 2017 report(www.gao.gov) from the Government Accountability Office that said although the total number of U.S. medical residents increased by 13.6 percent from 2001 to 2010, the number expected to enter primary care decreased by 6.3 percent.

One way to continue building the pipeline is to maintain funding for the Teaching Health Center Graduate Medical Education program and the National Health Service Corps, both of which address the disproportionate share of residents who train in the Northeast and in urban areas. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas, the AAFP noted.

This lack of access to primary care has consequences for patients in rural areas up to and including shorter life spans. The statement pointed out that the CDC has said part of the solution is greater patient access to basic primary care interventions such as high blood pressure screening; early disease intervention; and promotion of tobacco cessation, physical activity and healthy eating.

Because many essential public health initiatives require consistent federal support, the AAFP also warned the committee that budget cuts to social programs pose a threat to public health, especially among patients who only recently began to obtain necessary medical care.

"Growing federal funding cuts potentially create a domino effect of damage that ultimately will harm the health of America on both an individual and community-wide basis," the statement read. "Reducing funding for agencies that oversee the health care industry -- 17 percent of the U.S. economy -- destabilizes the foundation of services on which patients depend."

Opioid addiction is another pressing health crisis, and the AAFP took the opportunity to reiterate its pledge, made in concert with more than 40 stakeholder groups, to prepare more than 540,000 physicians and other health care professionals to complete opioid prescriber training. The organizations also are working to double the number of physicians certified to prescribe buprenorphine for opioid use disorder treatment from 30,000 to 60,000, as well as to double both the number of clinicians who prescribe naloxone and the number of health care professionals who are registered with state prescription drug monitoring programs.

Legislators also need to increase access to mental health care, the AAFP said, noting that more than 43 million Americans experience some form of mental illness, and patients with chronic disease and individuals dealing with adverse socioeconomic factors are at greater risk. While commending Congress for passing the Mental Health Parity and Addiction Equity Act of 2008, the AAFP noted that barriers still exist to the integration of primary care and mental health care. The statement highlighted the importance of facilitating this integration because people with mental or substance abuse disorders were more likely to receive treatment through primary care.

The statement also reminded legislators that chronic diseases are the leading causes of mortality and morbidity among U.S. adults and that primary care is uniquely suited to addressing this situation.

Key to reversing the spread of chronic disease is to focus more energy on prevention and patient education efforts instead of on treating illness and disease, said the statement. Reducing chronic disease begins with better care management and expanding community support programs that help patients access healthy foods, exercise more and experience a safe environment.

"Making strides in this area will require a serious commitment to patient education, health care access and community support," the AAFP said.