Primary Care Management
Comprehensive primary care is the cornerstone for ensuring that patients receive optimal integration of all available medical services. Coordination of outpatient care by primary care physicians is critical for emphasizing preventive services, as prevention is a fundamental part of primary care. The advice of a primary care physician has been shown to have a positive influence on patients' behaviors, thereby not only helping individual patients enjoy a better state of health but also lessening the burden of disease that affects society and the health care system as a whole (Fiebach et al., 2007). Correctly applied primary care management also prevents “fragmentation of care and the hit-or-miss nature of patient self-referral to specialists and promotes comprehensive care, for the patient as a whole person, not merely a set of parts” (Jonas, 2003, p. 70). It is also believed that the level and quality of primary care provided (or lack thereof) is a clear indicator of the quality of the nation's health care delivery system altogether (Starfield, 1996).
The importance of proper primary care was recognized back in the 1960s, and emphasis was placed on revitalizing the role of the primary care physician in an attempt to raise the level of continuity of care and better address all needs of patients. The building of a trusting professional relationship between patient and physician was also emphasized as an essential part of primary care. This relationship that a patient optimally develops with his or her primary care physician allows the physician to develop a clearer understanding of the patient as well as his or her family. It also facilitates the physician's job of developing a plan for the patient's longterm health and wellness – a plan that recognizes the patient's physical, social, psychological, and spiritual dimensions.
Most visits that patients make to a physician's office or to a dental group are considered ambulatory care, including those for routine well adult and well child visits, sick visits, and consultations regarding specific signs and symptoms. Common preventive measures promoted by primary care physicians include personal lifestyle or behavioral changes, immunizations, prenatal screenings and services, and periodic physical examinations for the prevention or early diagnosis of various diseases. In the fast-paced, ambulatory primary care setting, other health care professionals commonly assist physicians, including nurse practitioners, advanced practice nurses, and physician assistants. Mundinger (2002) notes that these highly trained ancillary professionals can help to provide primary care services that are equal to those provided by physicians. Ambulatory care nursing has recently begun to evolve into an additional specialty area of the nursing profession to further support the needs of this popular outpatient setting. And nursing education programs are beginning to build didactic and clinical experiences into their curricula to ensure that future nursing graduates are proficient and well equipped to be successful in meeting the high-paced demands of the various ambulatory care settings.
Primary care physicians, whether in solo or group practice, still provide much of a patient's routine care today, but they also serve as a source of proper referrals to specialists in particular types of injuries and illnesses. Office-based physicians receive an estimated 787.4 million visits per year, or approximately three visits per person per year (Raffel & Barsukiewicz, 2002). These care providers are recognized as the ones who provide the majority of the important preventive care services, such as healthy lifestyle counseling, immunizations, and regular screening for illness detection (Raffel & Barsukiewicz, 2002). These services are all critical in allowing treatment interventions to take place before illnesses become more serious and also at a point when they are less costly to treat.