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. 1995 Apr;30(1 Pt 2):253–273.

The efficacy of primary care for vulnerable population groups.

D Blumenthal 1, E Mort 1, J Edwards 1
PMCID: PMC1070053  PMID: 7721596

Abstract

This article reviews the existing literature on the efficacy of primary care with an emphasis on the evaluation of primary care for vulnerable populations: groups whose demographic, geographic, or economic characteristics impede or prevent their access to health care services. A significant portion of the literature derives from studies of poor and underserved populations. However, to construct a more complete evaluation of primary care services, the authors cite literature that has examined both advantaged and disadvantaged populations. Even then the literature is incomplete, at best. The article describes a definition of primary care suitable for policy analysis and formulation, reviews evidence on the efficacy of care that meets that definition, and concludes that widespread use of primary care services is likely to result in improved patient satisfaction and health status.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alpert J. J., Heagarty M. C., Robertson L., Kosa J., Haggerty R. J. Effective use of comprehensive pediatric care. Utilization of health resources. Am J Dis Child. 1968 Nov;116(5):529–533. doi: 10.1001/archpedi.1968.02100020533014. [DOI] [PubMed] [Google Scholar]
  2. Becker M. H., Drachman R. H., Kirscht J. P. Continuity of pediatrician: new support for an old shibboleth. J Pediatr. 1974 Apr;84(4):599–605. doi: 10.1016/s0022-3476(74)80689-x. [DOI] [PubMed] [Google Scholar]
  3. Brooks E. F., Johnson S. L. Nurse practitioner and physician assistant satellite health centers. The pending demise of an organizational form? Med Care. 1986 Oct;24(10):881–890. doi: 10.1097/00005650-198610000-00002. [DOI] [PubMed] [Google Scholar]
  4. Budetti P. P. Achieving a uniform federal primary care policy. Opportunities presented by national health reform. JAMA. 1993 Jan 27;269(4):498–501. [PubMed] [Google Scholar]
  5. Caplan E. K., Sussman M. B. Rank order of important variables for patient and staff satisfaction with outpatient service. J Health Hum Behav. 1966 Summer;7(2):133–137. [PubMed] [Google Scholar]
  6. Carey T. S., Weis K., Homer C. Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991 Jun;26(2):165–181. [PMC free article] [PubMed] [Google Scholar]
  7. Charney E., Bynum R., Eldredge D., Frank D., MacWhinney J. B., McNabb N., Scheiner A., Sumpter E. A., Iker H. How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics. 1967 Aug;40(2):188–195. [PubMed] [Google Scholar]
  8. Deprez R. D., Pennell B. E., Libby M. A. The substitutability of outpatient primary care in rural community health centers for inpatient hospital care. Health Serv Res. 1987 Jun;22(2):207–233. [PMC free article] [PubMed] [Google Scholar]
  9. Dietrich A. J., Marton K. I. Does continuous care from a physician make a difference? J Fam Pract. 1982 Nov;15(5):929–937. [PubMed] [Google Scholar]
  10. Dietrich A. J., Nelson E. C., Kirk J. W., Zubkoff M., O'Connor G. T. Do primary physicians actually manage their patients' fee-for-service care? JAMA. 1988 Jun 3;259(21):3145–3149. [PubMed] [Google Scholar]
  11. Dignan M. B., Hall M. B., Hastings D. W. Effect of increased access to health care on mortality from cardiovascular disease in rural Tennessee. Public Health Rep. 1979 Mar-Apr;94(2):186–192. [PMC free article] [PubMed] [Google Scholar]
  12. Ellwood P. M., Enthoven A. C., Etheredge L. The Jackson Hole initiatives for a twenty-first century American health care system. Health Econ. 1992 Oct;1(3):149–168. doi: 10.1002/hec.4730010303. [DOI] [PubMed] [Google Scholar]
  13. Fihn S. D., Wicher J. B. Withdrawing routine outpatient medical services: effects on access and health. J Gen Intern Med. 1988 Jul-Aug;3(4):356–362. doi: 10.1007/BF02595794. [DOI] [PubMed] [Google Scholar]
  14. Fleming G. V., Andersen R. M. The Municipal Health Services Program. Improving access to primary care without increasing expenditures. Med Care. 1986 Jul;24(7):565–579. [PubMed] [Google Scholar]
  15. Fletcher R. H., O'Malley M. S., Fletcher S. W., Earp J. A., Alexander J. P. Measuring the continuity and coordination of medical care in a system involving multiple providers. Med Care. 1984 May;22(5):403–411. doi: 10.1097/00005650-198405000-00004. [DOI] [PubMed] [Google Scholar]
  16. Franks P., Clancy C. M., Nutting P. A. Gatekeeping revisited--protecting patients from overtreatment. N Engl J Med. 1992 Aug 6;327(6):424–429. doi: 10.1056/NEJM199208063270613. [DOI] [PubMed] [Google Scholar]
  17. Freeman H. E., Kiecolt K. J., Allen H. M., 2nd Community health centers: an initiative of enduring utility. Milbank Mem Fund Q Health Soc. 1982 Spring;60(2):245–267. [PubMed] [Google Scholar]
  18. Fry J. An overview of primary health care. Int J Health Serv. 1976;6(2):309–314. doi: 10.2190/LW7A-JX5W-L53R-DAFN. [DOI] [PubMed] [Google Scholar]
  19. Goodrich T. J., Gorry G. A. The process of ambulatory care: a comparison of the hospital and the community health center. Am J Public Health. 1980 Mar;70(3):251–255. doi: 10.2105/ajph.70.3.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gordis L. Effectiveness of comprehensive-care programs in preventing rheumatic fever. N Engl J Med. 1973 Aug 16;289(7):331–335. doi: 10.1056/NEJM197308162890701. [DOI] [PubMed] [Google Scholar]
  21. Gordis L., Markowitz M. Evaluation of the effectiveness of comprehensive and continuous pediatric care. Pediatrics. 1971 Nov;48(5):766–776. [PubMed] [Google Scholar]
  22. Graversen P. H., Gasser T. C., Wasson J. H., Hinman F., Jr, Bruskewitz R. C. Controversies about indications for transurethral resection of the prostate. J Urol. 1989 Mar;141(3):475–481. doi: 10.1016/s0022-5347(17)40864-0. [DOI] [PubMed] [Google Scholar]
  23. Grossman M., Jacobowitz S. Variations in infant mortality rates among counties of the United States: the roles of public policies and programs. Demography. 1981 Nov;18(4):695–713. [PubMed] [Google Scholar]
  24. Hochheiser L. I., Woodward K., Charney E. Effect of the neighborhood health center on the use of pediatric emergency departments in Rochester, New York. N Engl J Med. 1971 Jul 15;285(3):148–152. doi: 10.1056/NEJM197107152850305. [DOI] [PubMed] [Google Scholar]
  25. Holoweiko M. Health-care reform: what does Hawaii have to teach? Med Econ. 1992 Feb 3;69(3):158-64, 171-2, 174. [PubMed] [Google Scholar]
  26. Hurley R. E., Freund D. A., Taylor D. E. Emergency room use and primary care case management: evidence from four Medicaid demonstration programs. Am J Public Health. 1989 Jul;79(7):843–846. doi: 10.2105/ajph.79.7.843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hurley R. E., Gage B. J., Freund D. A. Rollover effects in gatekeeper programs: cushioning the impact of restricted choice. Inquiry. 1991 Winter;28(4):375–384. [PubMed] [Google Scholar]
  28. Hurley R. E., Paul J. E., Freund D. A. Going into gatekeeping: an empirical assessment. QRB Qual Rev Bull. 1989 Oct;15(10):306–314. doi: 10.1016/s0097-5990(16)30308-6. [DOI] [PubMed] [Google Scholar]
  29. Klein M., Roghmann K., Woodward K., Charney E. The impact of the Rochester Neighborhood Health Center on hospitalization of children, 1968 to 1970. Pediatrics. 1973 May;51(5):833–839. [PubMed] [Google Scholar]
  30. Liptak G. S., Hulka B. S., Cassel J. C. Effectiveness of physician-mother interactions during infancy. Pediatrics. 1977 Aug;60(2):186–192. [PubMed] [Google Scholar]
  31. Lurie N., Ward N. B., Shapiro M. F., Brook R. H. Termination from Medi-Cal--does it affect health? N Engl J Med. 1984 Aug 16;311(7):480–484. doi: 10.1056/nejm198408163110735. [DOI] [PubMed] [Google Scholar]
  32. Martin D. P., Diehr P., Price K. F., Richardson W. C. Effect of a gatekeeper plan on health services use and charges: a randomized trial. Am J Public Health. 1989 Dec;79(12):1628–1632. doi: 10.2105/ajph.79.12.1628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McPhee S. J., Lo B., Saika G. Y., Meltzer R. How good is communication between primary care physicians and subspecialty consultants? Arch Intern Med. 1984 Jun;144(6):1265–1268. [PubMed] [Google Scholar]
  34. Moore G. T., Bernstein R., Bonanno R. A. Effect of a neighborhood health center on hospital emergency room use. Med Care. 1972 May-Jun;10(3):240–247. doi: 10.1097/00005650-197205000-00006. [DOI] [PubMed] [Google Scholar]
  35. Moore S. H., Martin D. P., Richardson W. C. Does the primary-care gatekeeper control the costs of health care? Lessons from the SAFECO experience. N Engl J Med. 1983 Dec 1;309(22):1400–1404. doi: 10.1056/NEJM198312013092239. [DOI] [PubMed] [Google Scholar]
  36. O'Connor P. J., Wagner E. H., Strogatz D. S. Hypertension control in a rural community. An assessment of community-oriented primary care. J Fam Pract. 1990 Apr;30(4):420–424. [PubMed] [Google Scholar]
  37. Okada L. M., Wan T. T. Impact of community health centers and Medicaid on the use of health services. Public Health Rep. 1980 Nov-Dec;95(6):520–534. [PMC free article] [PubMed] [Google Scholar]
  38. Patton L. T. Community health centers at 25: a retrospective look at the first 10 years. J Ambul Care Manage. 1990 Oct;13(4):13–21. doi: 10.1097/00004479-199010000-00005. [DOI] [PubMed] [Google Scholar]
  39. Reynolds R. A. Improving access to health care among the poor--the neighborhood health center experience. Milbank Mem Fund Q Health Soc. 1976 Winter;54(1):47–82. [PubMed] [Google Scholar]
  40. Roos L. L., Roos N. P., Gilbert P., Nicol J. P. Continuity of care: does it contribute to quality of care? Med Care. 1980 Feb;18(2):174–184. doi: 10.1097/00005650-198002000-00004. [DOI] [PubMed] [Google Scholar]
  41. Shea S., Misra D., Ehrlich M. H., Field L., Francis C. K. Correlates of nonadherence to hypertension treatment in an inner-city minority population. Am J Public Health. 1992 Dec;82(12):1607–1612. doi: 10.2105/ajph.82.12.1607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Shi L. The relationship between primary care and life chances. J Health Care Poor Underserved. 1992 Fall;3(2):321–335. doi: 10.1353/hpu.2010.0460. [DOI] [PubMed] [Google Scholar]
  43. Simborg D. W., Starfield B. H., Horn S. D., Yourtee S. A. Information factors affecting problem follow-up in ambulatory care. Med Care. 1976 Oct;14(10):848–856. doi: 10.1097/00005650-197610000-00005. [DOI] [PubMed] [Google Scholar]
  44. Sparer G., Anderson A. Utilization and cost experience of low-income families in four prepaid group-practice plans. N Engl J Med. 1973 Jul 12;289(2):67–72. doi: 10.1056/NEJM197307122890204. [DOI] [PubMed] [Google Scholar]
  45. Starfield B. H., Simborg D. W., Horn S. D., Yourtee S. A. Continuity and coordination in primary care: their achievement and utility. Med Care. 1976 Jul;14(7):625–636. doi: 10.1097/00005650-197607000-00008. [DOI] [PubMed] [Google Scholar]
  46. Starfield B., Scheff D. Effectiveness of pediatric care: the relationship between processes and outcome. Pediatrics. 1972 Apr;49(4):547–552. [PubMed] [Google Scholar]
  47. Starfield B., Simborg D., Johns C., Horn S. Coordination of care and its relationship to continuity and medical records. Med Care. 1977 Nov;15(11):929–938. doi: 10.1097/00005650-197711000-00007. [DOI] [PubMed] [Google Scholar]
  48. Sussman E. J., Rosen H. M., Siegel A. J., Witherspoon J. M., Nesson H. R. Can primary care deliver? J Ambul Care Manage. 1979 Aug;2(3):29–39. doi: 10.1097/00004479-197908000-00005. [DOI] [PubMed] [Google Scholar]
  49. Wasson J. H., Sauvigne A. E., Mogielnicki R. P., Frey W. G., Sox C. H., Gaudette C., Rockwell A. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984 Nov 2;252(17):2413–2417. [PubMed] [Google Scholar]
  50. Woolley F. R., Kane R. L., Hughes C. C., Wright D. D. The effects of doctor--patient communication on satisfaction and outcome of care. Soc Sci Med. 1978 Mar;12(2A):123–128. [PubMed] [Google Scholar]

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