Are the Academicians to Blame?

PEDIATRICS ◽  
1974 ◽  
Vol 54 (2) ◽  
pp. 249-249
Author(s):  
Michael K. Posner
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Primary Medical Care ◽  
Hidden Agenda ◽  
Vexing Problem

Although I should hate to sound cynical or even "anti-intellectual," Dr. David G. Nathan's solutions to the primary medical care problem seem to carry a hidden agenda.1 Is the problem an absence of available persons to deal with primary care or a crowd of weary old bones obstructing his view of the bench? In no other area of investigation would a researcher suggest that a particularly vexing problem be tackled by those no longer productive in the areas of their choice.

Clinical Psychology Interventions in Primary Care

2010 ◽  
pp. 601-618
Author(s):  
Leonard J. Haas
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Clinical Psychology ◽  
Psychological Services ◽  
Clinical Psychologist ◽  
Health Care Environment ◽  
Care Environment ◽  
Primary Medical Care ◽  
Case Examples ◽  
Effective Work

This chapter reviews the need for clinical psychology services that are integrated into the primary health-care environment and covers in depth the issues that an effective primary care clinical psychologist must understand to function effectively in primary care. These are understanding the primary medical care environment, recognizing the unique characteristics of primary medical care patients who seek psychological services, and the key treatment tactics and strategies necessary for effective work in a primary care environment. Recommendations are illustrated with numerous case examples adapted from the experiences of a veteran primary care clinical psychologist.

Viewpoint From the Division of Community Child Health

PEDIATRICS ◽  
1974 ◽  
Vol 54 (2) ◽  
pp. 251-251
Author(s):  
Joel Bass ◽  
Dorothea Johnson ◽  
Jacqueline Kirby ◽  
George A. Lamb ◽  
Janice C. Levy ◽  
...  
Keyword(s):  
Primary Care ◽  
Child Health ◽  
Medical Care ◽  
Medical Schools ◽  
House Staff ◽  
Teaching Hospitals ◽  
Primary Medical Care

We read with interest Dr. Nathan's comments on primary medical care (Pediatrics, 52:768, 1973), but feel compelled to add another viewpoint. One of the striking changes occurring today in teaching hospitals and medical schools is an increased awareness of and interest in primary care. Some institutions, including our own, have created residencies and fellowships in ambulatory pediatrics as a response to house staff interests and also in response to the needs of the surrounding community.

Training pediatricians for primary medical care

PEDIATRICS ◽  
1974 ◽  
Vol 54 (2) ◽  
pp. 131-133
Author(s):  
Jack G. Shiller
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Medical Care ◽  
Research Training ◽  
Medical Center ◽  
Memorial Lecture ◽  
Recent Issue ◽  
Primary Medical Care ◽  
Children's Hospital ◽  
Children’S Hospital

A recent issue of this Journal carried the Kenneth G. Blackfan Memorial Lecture delivered to the Children's Hospital Alumni Association in Boston on May 30, 1973.1 It was given by Dr. Cicely Williams and entitled "Health Services in the Home." In her message directed at pediatric academia, Dr. Williams essentially said, "Be off with your ultrascience, your superspecialists ... Give thought instead to the thousands who are sick ... Teachers, stop seducing the very best into your snare of enzymes, isotopes and transducers, leaving only a small group to replace our dwindling cohort of primary care deliverers." That very same issue carried a commentary entitled "Primary Medical Care and Medical Research Training" by Dr. David G. Nathan of the Children's Hospital Medical Center.2

The Informal Rationing of Primary Medical Care

1979 ◽  
Vol 8 (4) ◽  
pp. 489-508 ◽  
Author(s):  
Peggy Foster
Keyword(s):  
Primary Care ◽  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Medical Care ◽  
Social Services ◽  
Primary Medical Care ◽  
Wide Range ◽  
Primary Care Sector ◽  
Welfare Agencies

ABSTRACTAll social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.

scholarly journals Primary medical care continuity and patient mortality: a systematic review

2020 ◽  
Vol 70 (698) ◽  
pp. e600-e611 ◽  
Author(s):  
Richard Baker ◽  
George K Freeman ◽  
Jeannie L Haggerty ◽  
M John Bankart ◽  
Keith H Nockels
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Medical Care ◽  
Continuity Of Care ◽  
Coronary Heart Disease Mortality ◽  
York Academy ◽  
Cross Sectional ◽  
Primary Medical Care ◽  
Care Continuity ◽  
Quantitative Studies

BackgroundA 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care.AimThis association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care.Design and settingSystematic review of studies published in English or French from database and source inception to July 2019.MethodOriginal empirical quantitative studies of any design were included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies. Selected studies included patients who were seen wholly or mostly in primary care settings, and quantifiable measures of continuity and mortality.ResultsThirteen quantitative studies were identified that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality; a statistically significant protective effect of greater care continuity was found in nine, absent in two, and in one effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms, although these were not investigated.ConclusionThis review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policymakers and practitioners to counter this.

Restratification revisited: The changing landscape of primary medical care in England and California

2012 ◽  
Vol 60 (4) ◽  
pp. 441-455 ◽  
Author(s):  
Ruth McDonald
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Medical Model ◽  
Primary Medical Care ◽  
The Us ◽  
Improve Compliance ◽  
Primary Care Doctors

Restratification, a process which involves medical elites exerting control over members of their profession, was seen by the US sociologist Eliot Freidson as helping to maintain the continued dominance of the medical model and the profession’s ability to determine its own fate. Drawing on interviews with primary care doctors in England and California this article reports the emergence of new strata or elites, with groups of doctors involved in both surveillance of others and action to improve compliance in deficient individuals and organizations. The article compares responses of primary care doctors to these developments and explores the implications in the context of Freidson’s predictions.

scholarly journals Complements or substitutes? Associations between volumes of care provided in the community and hospitals

2021 ◽  
Author(s):  
Yiu-Shing Lau ◽  
Gintare Malisauskaite ◽  
Nadia Brookes ◽  
Shereen Hussein ◽  
Matt Sutton
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Fixed Effects ◽  
Community Care ◽  
Community Services ◽  
System Level ◽  
Hospital Services ◽  
Primary Medical Care ◽  
Fixed Effects Regression ◽  
Primary Care Activity

AbstractPolicymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

Clinical Psychology Interventions in Primary Care

2014 ◽  
pp. 607-625
Author(s):  
Leonard J. Haas
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Clinical Psychology ◽  
Psychological Services ◽  
Clinical Psychologist ◽  
Health Care Environment ◽  
Care Environment ◽  
Primary Medical Care ◽  
Case Examples ◽  
Effective Work

This chapter reviews the need for clinical psychology services that are integrated into the primary health-care environment and covers in depth the issues that an effective primary care clinical psychologist must understand to function effectively in primary care. These are understanding the primary medical care environment, recognizing the unique characteristics of primary medical care patients who seek psychological services, and the key treatment tactics and strategies necessary for effective work in a primary care environment. Recommendations are illustrated with numerous case examples adapted from the experiences of a veteran primary care clinical psychologist.

scholarly journals ANALYSIS OF PROVISION OF MEDICAL SERVICES TO THE POPULATION BY PRIMARY MEDICAL CARE DOCTORS IN THE CONDITIONS OF HEALTH SYSTEM REFORM: REGIONAL LEVEL

2020 ◽  
Author(s):  
Vasyl Matviyiv ◽  
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Medical Care ◽  
National Health ◽  
Primary Care Physicians ◽  
Free Choice ◽  
Medical Services ◽  
Primary Medical Care ◽  
Family Doctors

An important component of the development of the domestic medical system has been the reform of the primary level of health care facilities. The impetus for this was the adoption of the main draft laws, which significantly changed the distribution of funds for the financing of the medical sector in Ukraine. The article describes the percentage of the population that chose their primary care physician, analyzes the distribution of declarations by the number and structure of primary medical care providers who have concluded an agreement with the National Health Service of Ukraine in Ukraine and the Carpathian region. It was cleared up that both in Ukraine and in its regions the population had the right to choose primary care physicians among such specialties as family doctors, therapists and pediatricians, where as a result of compiling declarations the largest population in Ukraine chose family doctors in Transcarpathian, Lviv and Chernivtsi regionss, and the share of family doctors in these regions significantly exceeds the Ukrainian average in the country. It has been determined that an important factor is public awareness about the importance and necessity of electronic declarations. The study concludes that this, in its turn, has provided the population with a free choice of a therapist in urban areas or a family general practitioner in rural areas. It has been investigated that the population has a free choice to sign declarations with primary care doctors, and this allows each citizen to choose a doctor at his discretion, who, in turn, having the opportunity to provide services and receive a slightly higher fee according to the coefficients approved by the National Health Service of Ukraine. It has been concluded that patients have the opportunity to receive medical services from primary care physicians, as a result of which they can receive qualified medical care. Under conditions when in patients’ opinions medical care or services are not provided at the appropriate level, they can change doctors and automatically sign a declaration with another doctor.

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