Despite the greater emphasis health policymakers are placing on the continuity of care that comes from an ongoing relationship with a primary care physician, recent research shows that many patients either do not have a usual source of health care or rely on a facility instead of a specific physician.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care used data from the Medical Expenditure Panel Survey collected between 1996 and 2012 to track the nature of care patients received. Just over 40 percent of patients cited a facility rather than an individual clinician as their usual source of care, according to the one-page report,(www.graham-center.org) and one in five respondents could not name a usual source of care. They were not asked specifically if they had a primary care physician, nor to identify their usual source of care.
"Individuals with a usual source of care and health insurance are more likely to access care when needed and to seek preventive care services," the authors noted.
Andrew Bazemore, M.D., M.P.H., director of the Graham Center and one of the report authors, said what is most striking about the research is the level of respondents who reported not having any usual source of care at all.
"These relationships are associated with good health outcomes, and we're finding a sizable proportion of Americans who may be missing out," he said.
Patients with an established relationship with a physician report better health outcomes and lower overall costs, and a key tenet of family medicine is that continuity of care requires a patient to meet with the same physician over time. It is a message that the Academy, in concert with seven other family medicine organizations, is carrying to patients, payers and policymakers through the Health is Primary campaign.(healthisprimary.org)
Bazemore suggested several reasons for the decline in personal interactions with a usual physician, notably the consolidation of practices by large networks and the increasing number of physicians who are employees of a medical center. Another possible reason is that digital-age consumers may be less likely to attach themselves to a physician.
"We don't know whether the growing use of facilities reflects in part a movement to team-based care where a patient can get a lot of care in one place," Bazemore said. "We also currently lack evidence to know whether facilities can replicate the benefits derived from years of a personal relationship with a physician."
Bazemore said the Graham Center will continue to explore the issue in greater depth.