The family doctor – old-fashioned or the key to a healthy future? (Part 2)

The Family Doctor

The Family Doctor in 1948. Source: Nedhardy.com

Is the family doctor who provides ongoing care a thing of the past? Not really.

In part 1 I mentioned the three types of continuity of care: informational, management and relational continuity. Continuity in primary care results in improved patient health outcomes and satisfaction. Evidence also shows that primary care, in contrast to specialty care, is associated with a more equitable distribution of health.

Receiving care from one general practitioner is beneficial for a variety of health outcomes. For example, relational continuity reduces both elective and emergency admissions. In other words, the rate of hospital admissions drops when people have their own GP.

6 mechanisms that improve our health

Primary care researcher Barbara Starfield identified six mechanisms that, alone and in combination, may account for the beneficial impact of primary care on population health:

  1. Primary care increases access to health services for relatively deprived population groups
  2. The quality of clinical care by primary care physicians is at least similar to specialist care for specific common diseases
  3. The positive impact of primary care on prevention
  4. The beneficial impact of primary care on the early management of health problems
  5. The accumulated contribution of primary care characteristics to whole-of-person care
  6. The role of primary care in reducing unnecessary or inappropriate specialty care.

Barbara Starfield

Barbara Starfield: “(…) good primary care is associated with better health outcomes, lower costs, and greater equity in health.” Source: Wonca

Starfield: “There is now good evidence, from a variety of studies at national, state, regional, local, and individual levels that good primary care is associated with better health outcomes (on average), lower costs (robustly and consistently), and greater equity in health.”

General practice can deliver long-term, cost-effective continuity of care. A visit to the GP is on average ten times cheaper than a visit to the emergency department. Dr Sebastian Seidel mentioned at a Senate Inquiry last month that GP services in Australia cost taxpayers only $250 per person a year – cheaper than car insurance.

In Australasia, chronic conditions account for about 85% of the total burden of disease, and in 9 out of 10 deaths a chronic disease was a contributing factor.

Unfortunately there is currently inadequate support for the continuity of care required to improve outcomes for patients with complex or multiple chronic conditions and comorbidities.

The Australian government is developing a National Strategic Framework for Chronic Conditions and recently, the Primary Health Care Advisory Group has investigated options into the reform of primary health care to support patients with complex and chronic illnesses. The group’s reform paper is complete and handed to the Federal Health Minister. It will be very interesting to see what happens next.

Conclusion

Although I am more than likely biased, it is obvious to me that primary care has a lot to offer. Continuity of care by general practitioners and their teams has many proven benefits as outlined in part 1 and part 2 of this blog post series.

GPs see about 85% of Australians each year but general practice spending represents less than 8% of the overall government healthcare budget. What we need is better aligned funding that supports primary care practitioners to deliver long-term quality care.

A sustainable health system should free up GP teams and other health practitioners to deliver coordination and integration of care across disciplines, especially for people living with complex and chronic health conditions. Looking at the reform processes that are under way in Australia, we may be getting closer to a better and more sustainable solution.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

4 thoughts on “The family doctor – old-fashioned or the key to a healthy future? (Part 2)

  1. Pingback: The family doctor – old-fashioned or the key to a healthy future? (Part 1) | Doctor's bag

  2. I am a visiting optometrist who works in outback NSW, and has worked in a town in NSW pop. 3000 with three excellent but over-worked GPs. My patients in a small outback village, when asked “Who is your GP?” would answer “The Royal Flying Doctor Service”, in other words, whoever is rostered on to the RFDS clinic on the day of the clinic. Fragmented care? No, because the town’s rural/remote nurse oversees their health status and continuity of care, keeping well-organized health records available to all GPs. My point is that it need not be the GP who oversees continuity of care, as in some places there is no single GP. A similar situation exists in eye and vision care in general. A competent and well-resourced optometrist can oversee vigilance for conditions like glaucoma and macula degeneration, and retinal microvascular disease in diabetics, reporting to the patient’s GP, and referring to ophthalmology with a note to the GP as needed.

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