PRIMARY CARE

The concept of primary health care was defined by the World Health Organization in 1978 as both a level of health service delivery and an approach to health care practice. Primary care, as the provision of essential health care, is the basis of a health care system. Seventy-five to eighty-five percent of the population seek primary health care yearly. It provides both the initial and the majority of health care services of a person or population. This is in contrast to secondary health care, which is consultative, short term, and disease oriented for the purpose of assisting the primary care practitioner. Tertiary care is for patients with unusual illness requiring highly specialized services. Primary care clinicians may be physicians, nurses, or various other health workers trained for the purpose. Countries with better provision of primary health care have greater patient satisfaction at lower costs and better health indicators.

While there are many definitions of primary care, the principles of accessible, comprehensive, continuous, and coordinated personal care in the context of family and community are consistent. Primary health care should be available to all people without the barriers of geography, cost, language, or culture. In primary care, all types of problems, at all ages and for both genders, are considered, including care for acute self-limited problems or injuries, the care of chronic diseases such as diabetes or AIDS (acquired immunodeficiency syndrome), the provision of preventive care services such as immunizations and family planning, and health education. Because primary health care is broad, it is information rich. Primary care clinicians coordinate care for patients among different service providers and for different patient concerns, responding to the fact that most patients have multiple problems. Continuity of care refers to the ongoing relationship between individual patients and primary care clinicians who are committed to the person, not a specific disease, body of knowledge, or specialized technique, and who recognize that physical, mental, emotional, and social concerns are related. Primary care clinicians, interested in the meaning of illness to the particular person, must negotiate care with that individual. A person's health is greatly influenced by the individual's family, culture, and community. Thus, the delivery of primary health care may be different for each individual and in different areas of the world.

The proportion of primary care physicians varies by country—for example, in Great Britain, it is 80 percent; in the United States, it is 32 percent. Primary care physicians in the United States consist of family or general practice physicians, general internists, and general pediatricians. Some primary care may be delivered by specialists, especially obstetrician-gynecologists, but it is not the focus of their practice. In the United States, primary care is also delivered by nurse practitioners and physician assistants. Considering all sources of primary care, there is still a lack of primary care providers in many areas of the country, particularly in the inner city and rural areas.

Valerie J. Gilchrist

(see also: Personal Health Services )

Bibliography

Institute of Medicine (1996). Primary Care: America's Health in a New Era. Washington, DC: National Academy Press.

McWhinney, I. (1986). "Are We on the Brink of a Major Transformation of Clinical Method?" Canadian Medical Association Journal 135:873–878.

—— (1997). A Textbook of Family Medicine, 2nd edition. Oxford: Oxford University Press.

Starfield, B. (1994). "Is Primary Care Essential?" The Lancet 344:1129–1133.

World Health Organization. Primary Health Care. Available at http://www.who.int/aboutwho/en/ensuring/primary.htm.

—— Primary Health Care Concepts and Challenges in a Changing World: Alma-Ata Revisited. Geneva. Unpublished document, WHO/SHS/CC/94.2.

primary care (pry-mer-i) n. comprehensive health care for individuals and families in the community provided through an integrated network of services covering the treatment of common illness and injuries, maternal and child health problems, the care and rehabilitation of people with long- and short-term handicaps and disabilities, and health education. In the UK the delivery of primary care is via GP services, PCT medical services, and alternative provider (e.g. private health company) medical services, as well as NHS walk-in centres and other community services outside the hospital service. It works best where there is a multidisciplinary team approach to care. Compare secondary care, tertiary care.