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Putting Patients Front and Center

Increasingly, patients expect physicians to consider their needs and treat them as partners in medical decisions. Still, "patient-centeredness" has yet to become the norm in primary care.

The article A 2020 Vision of Patient-Centered Primary Care (Journal of General Internal Medicine, Oct. 2005) offers a perspective on what it will take to achieve this ideal. The plan advanced by Karen Davis, Ph.D., Stephen C. Schoenbaum, M.D., and Anne-Marie J. Audet, M.D., builds on an earlier essay, A 2020 Vision for American Health Care, a broad prescription for improving insurance coverage, access to care, and quality.

Davis and her colleagues set out seven attributes of patient-centered primary care:

  • Superb access to care
  • Patient engagement in care
  • Clinical information systems
  • Care coordination
  • Integrated and comprehensive team care
  • Routine patient feedback to doctors
  • Publicly available information on physician practices.

The authors acknowledge that—to physicians feeling pressed for time and financially constrained—this list may seem overwhelming. But they point to evidence from the Commonwealth Fund's 2003 National Survey of Physicians and Quality of Care that patient-centered practices are becoming more common. For example, three-fourths of primary care physicians make same-day appointments available, and about half have patient reminder systems. More resource-intensive practices, such as use of electronic medical records or patient surveys, are less common.

Ensuring that all Americans have a medical home would be an important step toward creating a patient-centered care system, the authors say. In addition, pay-for-performance contracts could encourage primary care practices to measure and improve their quality of care.

"With appropriate leadership and policy changes," the authors conclude, "all Americans could receive primary care that is truly patient-centered."

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