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Review: Primary Care: America's Health in a New Era

Donaldson MS, Yordy KD, Lohr KN, Vanselow NA; eds. 395 pages. Washington, DC: National Academy Pr; 1996. $42.95. ISBN 0309053994. Order phone 800-624-6242. Field of medicine: Primary care and health policy. Audience: Health policy specialists and physicians interested in primary care. Purpose: To provide a detailed definition of primary care and to make policy recommendations to improve primary care in the United States. Content: This book contains the results of a study on the future of primary care that was conducted by the Institute of Medicine. It begins by updating the definition of primary care that was developed by the Institute in 1978 and then discusses the value and process of primary care. Chapters on primary care delivery and workforce, training, and research needs are included. The book concludes with detailed recommendations for the improvement of primary care and a discussion of challenges to the implementation of those recommendations. Highlights: The most valuable chapter in the book defines primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Although this definition is more a statement of a vision for the future than a description of primary care as it now exists, it provides a valuable framework in which to analyze and work toward improving the quality of primary care. Most of the book is devoted to recommendations for improving primary care. Although no recommendation is made about the contentious issue of who should be considered a primary care physician, important recommendations on workforce policy, all-payer funding for graduate medical education, and the promotion of research in primary care are given. Limitations: Perhaps as a consequence of the book's emphasis on defining an ideal model of primary care and making policy recommendations, the least satisfying part of the book is the chapter documenting the value of primary care. This chapter relies heavily on anecdotes and contains only a brief and uncritical review of the literature. Context: Although not as scholarly as more academic volumes, such as Starfield's Primary Care, this report is devoted to constructing a policy agenda for primary care. The recommendations are worthy of the attention of policy-makers and practitioners involved in primary care. Reviewer: David Meltzer, MD, PhD, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Commentary: Because nearly every major U.S. health care organization provided testimony for the study, this report is likely to be widely cited. The fact that these organizations and others were usually given only 5 or 10 minutes to testify suggests that there was little room to probe deeply into the most difficult issues in primary care. Thus, the recommendations for further research deserve high priority.