"Primary care is the bedrock of a good healthcare system, but this report is saying just having more primary care will not necessarily fix our quality of care," says another co-author, Shannon Brownlee, MS. Other report authors are David C. Goodman, MD, MS and Chiang-Hua Chang, PhD. "It means that healthcare policy should focus on improving the actual services primary care clinicians provide, and make sure their efforts are coordinated with other providers, including specialists, nurses and hospitals."
While improving care delivered by primary care clinicians holds promise for a patient's wellbeing, the "value of primary care can be eroded by episodic delivery that is uncoordinated with specialists and hospitals," the study says. "Thus, simply increasing access to primary care, either by boosting the number of primary care physicians in an area or by ensuring that most patients have better insurance coverage, may not be enough to improve the quality of care or health outcomes; nor is it likely to eliminate racial disparities."
Brownlee, a writer and senior research fellow at the New America Foundation, says she was surprised by the findings. "I think part of what is happening is the chaos factor"—primary care physicians working in isolated practices, with a lack of coordination with specialists, such as for diabetes or other medical conditions, she says.
"Was the heart attack patient prescribed aspirin and a beta blocker on discharge?" she asks rhetorically. Sometimes, or too often, that doesn't happen because of the lack of coordination, Brownlee says. "It is really crucial to keep track of a patient. If the patient only knows what is happening, you've got a big problem." Brownlee is a specialist in healthcare writing and has written "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer."
In essence, the Dartmouth study shows that "organization of the system is a big part of the problem," Brownlee says, adding that "simply throwing more physicians at a problem is not going to fix it."