Patients are responsible for their own health to the extent that they are capable—that is, to the extent that they have the knowledge and skills that allow them to participate in improving their health. Patients must also be responsible in their use of resources when they need health care.
The committee believes that these attributes of primary care are highly desirable and achievable over time. It also believes that the degree to which current primary care practices match these attributes varies considerably. However, the committee did not want to propose a limited definition of primary care that sets goals that might be more immediately achievable by most practices but does not present challenging goals for the future. Neither did the committee want to establish a commendable but ideal definition of primary care that would bear little relationship to current realities.
In the committee's judgment, all practices deserving the primary care label can aspire to many of the attributes in the near term; indeed, some may already be there. In the spirit of continuous quality improvement, however, the committee believes that all primary care activities must strive toward a fuller realization of these attributes. The pace of accomplishment will vary depending on a practice's starting point, its circumstances, and its resources.
The committee has already indicated its belief that the achievement of the desired attributes of primary care will be easier in some form of integrated delivery system serving a defined population than in isolated practices without a defined member population. A major advantage of integration lies in providing infrastructure support for personal health care services and for developing systems of accountability. Such arrangements often do not exist in many primary care settings and may be a long time in coming. In the meantime, every practice can move toward meeting the goals of primary care.
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Alpert, J.J., and Charney, E. The Education of Physicians for Primary Care. Publ. No. (HRA) 74-3113. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1973.
Fry, J., ed. Primary Care. London: Heineman, 1980.
IOM (Institute of Medicine). A Manpower Policy for Primary Health Care: Report of a Study. Washington, D.C.: National Academy Press, 1978.
IOM. Community-Oriented Primary Care: A Practical Assessment. Volume I. The Committee Report. Washington, D.C.: National Academy Press, 1984.
IOM. Medicare: A Strategy for Quality Assurance. Volume I. K.N. Lohr, ed. Washington, D.C.: National Academy Press, 1990.