• the majority of personal health care needs, which include physical, mental, emotional, and social concerns;
  • a sustained partnership between patients and clinicians; and
  • primary care in the context of family and community.

Value Of Primary Care

The committee's case for primary care (see Chapter 3) is made in two ways. The first concerns the value of primary care for individuals. The committee uses fictional scenarios to illustrate the terms in the definition and argues that primary care (a) provides a place to which patients can bring a wide range of health problems; (b) guides patients through the health system; (c) facilitates ongoing relationships between patients and clinicians within which patients participate in decisionmaking about their health and health care; (d) opens opportunities for disease prevention and health promotion as well as early detection of disease; and (e) builds bridges between personal health care and patients' families and communities.

The second way to approach the question of the value of primary care is by recourse to empirical evidence. The committee amasses considerable evidence that primary care improves the quality and efficiency of care and expands access to appropriate services; it also forms an important bridge between personal health care and public health, to the advantage of both.

The Nature Of Primary Care

The complexity of primary care is reflected in six core attributes explored in Chapter 4 of the report:

  1. Excellent primary care is grounded in both the biomedical and the social sciences.
  2. Clinical decisionmaking in primary care differs from that in specialty care.
  3. Primary care has at its core a sustained personal relationship between patient and clinician.
  4. Primary care does not consider mental health separately from physical health.
  5. Important opportunities to promote health and prevent disease are intrinsic to primary care practice.
  6. Primary care is information intensive.

In the committee's view, no health care system can be complete without primary care. In the United States, the time is right for primary care to undergo more systematic and creative development and to expand as the foundation of



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