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Tuesday, July 26th 2011

Primary Care And ‘Health’

Much has been made of the lack of tertiarization (I’ll pretend that is a word) in American health care. The U.S. has a proportion of specialists to primary care physicians greater than any other western nation. Just over a third of U.S. physicians practice primary care.

Ratios of primary care physicians to specialists that more strongly favor primary care have, in the past [doc], to be strongly associated with lower mortality, higher compliance with health care and other positive outcomes.

But flipping through a Dartmouth Health Atlas project shows even amongst this long tenent there is a lack of consensus,

Rates of leg amputation, a serious complication of diabetes and peripheral vascular disease, also had no relationship with having at least one annual visit with a primary care clinician. And patients’ risk of leg amputation varied dramatically depending upon where they lived – there was a tenfold difference in the rate of leg amputation, ranging from 0.33 per 1,000 beneficiaries in Provo, Utah to 3.29 per 1,000 in McAllen, Texas.

The report also found that having an annual primary care visit did not keep patients out of the hospital for ambulatory care-sensitive conditions such as diabetes and congestive heart failure. There was a more than fourfold difference in the rate of ambulatory care-sensitive discharges among Medicare beneficiaries, ranging from 30.7 per 1,000 in Honolulu to 135.0 per 1,000 in Monroe, La.

It’s a complex issue for sure and certainly the sum of evidence seems to support benefits for more primary care physicians (even at the expense of specialists) but I thought the write up on the Dartmouth Atlas data was interesting.