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Primary Care Access Doesn't by Itself Equal Better Treatment, Dartmouth Study Says

By John Reichard, CQ HealthBeat Editor

September 9, 2010 -- Despite strong evidence that primary care doctors can play a key role in providing high-quality care, access to primary care doesn't by itself assure better treatment outcomes, says a study released Thursday by Dartmouth College researchers.

The study found that "neither a greater supply of primary care physicians in an area nor a regular visit to a primary care clinician is, by itself, a guarantee that a patient will get recommended care or experience better outcomes." The study was based on data between 2003 to 2007 on patients in the traditional Medicare program.

The study doesn't dispute the importance of primary care, which many analysts say is key to a more efficient system that better manages chronic illnesses. But its message is that more careful attention should be paid to the services primary care physicians actually deliver and to improving their efforts to coordinate the treatment services received by the patient.

"Primary care clinicians, whether they are general internists, family practiced physicians, pediatricians, physician's assistants or nurse practitioners, are trained to care for the whole patient," the study notes. "They can diagnose and treat a wide variety of illnesses, help patients avoid getting sick, and ensure that they get the specialty care they need. For chronically ill patients in particular, primary care clinicians serve a crucial role as coordinators of specialty care."

During the period studied, 78 percent of Medicare enrollees had at least one visit to a primary care clinician during a given year, the study said. However, regional differences in that regard were large.

The rate of primary care visits ranged from 60 percent of beneficiaries in the Bronx to 90 percent in Florence, South Carolina, a difference of about 50 percent between the highest and lowest cost regions, the researchers said.

But access didn't necessarily correlate to quality. As examples, the study looked at such measures as the percentage of women that get a mammogram at least once every two years. In doing so for women of ages 67-69, it found no relationship between rates of breast cancer screening and the amount of primary care delivered. Similarly, it found no relationship between rates of A1c testing, which tracks management of diabetes by assessing blood sugar levels, and the amount of primary care delivered.

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