Primary Care

The entry point into the health system for most individuals, through a provider that delivers non-specialized, continuous, and coordinated care.

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

New OECD Report Highlights Expanded Primary Care Role for Nurses

Jan. 9, 2018

To meet population health care needs in developed countries, health systems must shift their focus from treating acute episodes to managing chronic conditions. With the rise of chronic care comes a new set of tasks that are more time-consuming and team-oriented. Policymakers in many countries are seeking to align the size and composition of their primary care workforce to meet these new needs, by expanding the role of advanced nurses.

Changing Antibiotic Prescribing in a Primary Care Network: The Role of Readiness to Change and Group Dynamics in Success

Oct. 11, 2017

Suratha Elango, Julia E. Szymczak, Ian M. Bennett, Rinad S. Beidas, Rachel M. Werner

In the American Journal of Medical Quality, Suratha Elango and colleagues, including Rinad Beidas and Rachel Werner, studied factors important to combating overuse of broad-spectrum antibiotics in outpatient pediatric practices. Primary care clinics in the Children’s Hospital of Philadelphia network completed surveys and then semi-structured interviews on barriers and facilitators to improving their antibiotic prescribing practices, perceptions and reactions to the initiative, and the climate surrounding its implementation.

Practices with a high willingness...

A ‘Newfound Passion for Advocacy’

Sep. 26, 2017

The American College of Physicians (ACP), representing 152,000 internal medicine physicians and medical students, has been front and center in the national debates on health care reform, according to Robert Doherty, the ACP’s Senior Vice President of Governmental Affairs and Public Policy. The ACP is the largest physician specialty society and second largest medical organization in the United States.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

Development and Validation of the Primary Care Team Dynamics Survey

Jul. 19, 2017

Hummy Song, Alyna T. Chien, Josephine Fisher, Julia Martin, Antoinette S. Peters, Karen Hacker, Meredith B. Rosenthal, Sara J. Singer

In Health Services Research, Hummy Song and colleagues develop and validate a survey instrument designed to measure team dynamics in primary care. The authors study 1,080 physician and non-physician health care professionals at 18 primary care practices participating in a learning collaborative to improve team-based care. They administer a cross-sectional survey addressing team dynamics, and assessed reliability and discriminant validity of survey factors, as well as the overall survey’s goodness-of-fit. They find that this model demonstrated adequate fit, scale reliability, and...

Continuity of Care in Infancy and Early Childhood Health Outcomes

Jul. 14, 2017

Elizabeth Enlow, Molly Passarella, Scott A. Lorch

In Pediatrics, Elizabeth Enlow and colleagues, including Scott Lorch, assess the relationship between provider continuity in infancy, and use of both urgent and preventative health services. Continuity of care is a key aspect of the patient-centered medical home and has been shown to improve pediatric outcomes. The authors hypothesize that increased provider continuity in infancy decreases urgent health care use and increases preventative services use in early childhood. They measured continuity across all primary care encounters during the first year of life for 17,773 infants...

Improved Availability and Quality of Care with Epilepsy Nurse Practitioners

Jun. 19, 2017

Chloe E. Hill, Bethany Thomas, Kimberly Sansalone, Kathryn A. Davis, Judy A. Shea, Brian Litt, and Nabila Dahodwala

In Neurology, Chloe Hill and colleagues, including Judy Shea and Nabila Dahodwala, investigate the quality of care delivered by nurse practitioner (NP)–physician teams developed to serve patients with epilepsy, and improve their appointment availability.  The authors observed a cohort of patients with epilepsy who were cared for by either an NP-physician team or a physician only. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures. The authors also looked at seizure frequency, presentations to the Emergency...

Market environment and Medicaid acceptance: What influences the access gap?

May. 1, 2017

Amy Bond, William Pajerowski, Dan Polsky, and Michael R. Richards

In Health Economics, LDI Fellow Amelia Bond and colleagues raise important questions about potential positive effects of provider and insurer concentration on primary care appointment availability for new Medicaid patients. The study assesses whether the two health care industry trends of expanding Medicaid and greater integration and consolidation among insurers and providers may have implications for each other.

Using “secret shopper” data on primary care physicians' real-world behavior, the authors observed provider willingness to accept new privately insured and...

The Role of Community Health Centers in Reducing Racial Disparities in Spatial Access to Primary Care

Apr. 20, 2017

Jane W. Seymour, Daniel E. Polsky, Elizabeth J. Brown, Corentin M. Barbu, David Grande

In the Journal of Primary Care & Community Health, Jane Seymour and colleagues, including LDI senior fellows Daniel Polsky and David Grande, investigate the role of community health centers in reducing racial disparities in access to care. Racial minorities are more likely to live in primary care shortage areas, which is of particular concern given the role of primary care in prevention, chronic disease management, and as an overall entry point to the health care system. The authors surveyed primary care practices in Philadelphia County and neighboring zip codes, identified...

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