Primary Care

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Primary Care Networks in a Time of Pandemic

Primary care networks in the UK bring together general practices and community providers to develop new services for patients and to provide better integration of health and social care services and sustainability in primary care. While still relatively new, their trajectory is likely to be influenced by COVID-19–related adaptations they have made over the course of the pandemic.

Sarah Parkinson, Judith Smith

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Doing More with Less: Lessons from Cuba's Health Care System

High U.S. health care costs do not yield corresponding health outcomes for its citizens. But Cuba, for less than a tenth of U.S. costs, has attained comparable outcomes on many indicators, such as life expectancy and infant mortality. Cuba prioritizes primary care and prevention and addresses social determinants of health.

Claire E. O'Hanlon, Melody Harvey

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Beyond Medication Reconciliation: The Correct Medication List

Primary care clinicians are expected to reconcile a patient's medications at every visit. In practice, this has failed to have a demonstrable effect on patient outcomes. What is needed is not merely a reconciled list, but the correct list.

Adam J. Rose, Shira H. Fischer @ShiraFischer, et al.

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Moving Outpatient Care into the Community

A prominent feature of NHS England policy, “moving care into the community” means that care traditionally provided in hospitals is moved into primary care, such as general practice. This can benefit patients, but it is also important to look at the costs.

Celine Miani, Eleanor Winpenny

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Need a Doctor Now? Solve the Acute Care Crisis

Many Americans struggle to receive acute care when they need it. The health care system is not focused on meeting unscheduled needs. Reforming acute care delivery will require making it a policy and research priority.

Mahshid Abir, Brendan G. Carr

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Can a Nurse Practitioner Replace a Physician?

The VA is considering expanding the role of nurse practitioners in order to provide veterans timely access to primary-care services. Research has shown that nurse practitioners working in collaborative settings can provide high-quality care.

John N. Mafi, Bruce E. Landon

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Can Hospital Services Work in Primary Care Settings?

Shifting health care from hospitals to the community will only be justified if patient satisfaction and convenience is valued above costs to the NHS, or if this shift reduces health care costs in the long term.

Celine Miani, Eleanor Winpenny

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Nature and Nurture: What's Behind the Variation in Recent Medical Home Evaluations?

As demonstrated in Pennsylvania, conveners of medical home pilots are drawing from their early experiences to refine their intervention designs and improve their effectiveness. Such a learning process is likely to be a critical part of successfully implementing any new model of payment and care delivery.

Mark W. Friedberg, Connie Sixta, et al.

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More Long-Term Health Conditions, Poorer Health Care Experiences

Patients with multiple long-term health conditions are more likely to report poorer experiences in primary care than those with fewer health problems. A patient-centered model that takes into account the severity of disease — and the impact of combinations of diseases, on patient quality of life and health care experiences — could make a difference.

Catherine L. Saunders, Charlotte Paddison

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Military Turns to Collaborative Care to Treat PTSD, Depression

Collaborative care has been an important part of Army efforts to reach out to those struggling with PTSD and depression. It has brought a science-based solution to an essential military problem and has helped thousands of men and women in uniform in ways that also nudge the larger mental health system toward greater effectiveness for all Americans.

Charles C. Engel

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RAND Helps to Develop From Coverage to Care, a New CMS Initiative

Health coverage is a means to an end: the aim is to help more Americans use their coverage to access routine primary care and preventive services. For many of the newly insured, however, the leap between obtaining insurance and establishing a regular source of care is substantial.

Laurie T. Martin, David M. Adamson

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Improving Physical Health Care for Adults with Serious Mental Illness

A promising strategy for helping adults with serious mental illness gain access to appropriate primary and preventive medical services is to integrate those services into a setting in which the population already receives care.

Deborah M. Scharf

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How to Avert a Doctor Shortage

Within the next decade, the United States may face a shortage of 130,000 physicians due to a growing, aging population and the anticipated demands of those newly insured under the ACA. This shortage can be alleviated by early creative interventions.

Michael D. Rich @michaeldrich

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Is There Really a Physician Shortage?

Large coverage expansions under the ACA have reignited concerns about physician shortages. These estimates result from models that forecast future supply and demand for physicians based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment.

David I. Auerbach

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The Future of the Health Care Workforce: RAND Researchers Well Represented in Health Affairs Special Issue

In 'Redesigning the Health Care Workforce,' a new special issue of the journal Health Affairs, RAND researchers contribute to several timely examinations of challenges, opportunities, and potential solutions relating to the future of health care staffing in the U.S. and abroad.

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Applying What Works to Reduce Non-Urgent Emergency Department Use

It is likely that communities with low rates of non-urgent ED use not only have better access to primary care, but patients who are educated about appropriate care seeking and convenient alternatives for acute care, writes Lori Uscher-Pines.

Lori Uscher-Pines

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Are You a 'Wise' Health Care Consumer?

To be wise purchasers of health care services, consumers need access to accurate and understandable information about health plans and providers. They wrongly assume that more expensive providers are better than less expensive ones, despite inconsistent evidence that there is any link between health care cost and quality.

Ramya Chari, Arthur L. Kellermann

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Caring for the Uninsured: What Role Do Emergency Rooms Play?

Absent from the discussion about health care during the first debate between President Barack Obama and Governor Mitt Romney was any mention of one of the main providers of care for America's uninsured: emergency rooms. What does research tell us about the use of ERs and the relevant implications on health care access and cost?

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Attempts by States to Save Money by Locking Medicaid Enrollees out of the ED Are Likely to Backfire

In a recent article in the New England Journal of Medicine, we argue that attempts by states to save money by seeking to lock Medicaid enrollees out of the emergency department are likely to backfire. We argue that a better solution is to reverse what for many years has been a trend of shrinking access to primary care for Medicaid beneficiaries.

Robin M. Weinick

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Emergency Departments, Medicaid Costs, and Access to Primary Care—Understanding the Link

The fact that many ED (emergency department) visits could be managed in primary care settings does not mean that such care is available, write Arthur L. Kellermann and Robin M. Weinick.

Arthur L. Kellermann, Robin M. Weinick

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The Primary Care Physician and Health Care Reform

Increased health care coverage raises issues in addition to cost containment. Increased coverage will mean increased demand for primary care physicians, writes Robert Brook.

Robert H. Brook, Roy Young