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Primary Care

Primary care providers are often the first point of contact for patients attempting to navigate a complex health care delivery system and seeking referrals to specialists. RAND has explored the increasing use of emergency departments as a primary care setting, the influence of primary care on health care spending, shared decisionmaking between patients and primary care providers, the emergence of retail health clinics, and more.

Journal Article
Barriers and Facilitators to Optimal Fluoride Varnish Application
Guidelines recommend that children under age six receive fluoride varnish (FV) in medical settings. However, application rates remain low. This study aimed to update understanding of barriers and facilitators to guideline concordant FV application.
Dec 6, 2023
Journal Article
Effect of a Peer Comparison and Educational Intervention on Medical Test Conversation Quality: A Randomized Clinical Trial
Results of this initial trial suggest that future interventions to improve medical test conversations and reduce test overuse might focus on easing physician adoption barriers and leveraging patient-clinician relationships.
Nov 13, 2023
Tool
CLARO Implementation Manual: Strategies and Supports for Successful Implementation of the CLARO Intervention
This manual describes how to implement the Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO) intervention, which adapts the Collaborative Care Model for adults with opioid use disorder and depression and/or PTSD.
Nov 13, 2023
Journal Article
Vertical Integration of General Practices with Acute Hospitals in England: Rapid Impact Evaluation
This study drew on previous research into NHS hospitals taking over running general practices, and evaluated whether hospital-run practices affect patient satisfaction and attendance, including for patients with long-term conditions.
Nov 2, 2023
Journal Article
Findings from an Organizational Context Survey to Inform the Implementation of a Collaborative Care Study for Co-occurring Disorders
This study surveyed primary care and behavioral health staff from 13 clinics implementing a collaborative care intervention for opioid use disorders co-occurring with PTSD and/or depression as part of a multisite randomized controlled trial.
Aug 17, 2023
Essay
A Promising New Program Treats Co-Occurring Mental Health and Opioid Use Disorders
People who have an opioid use disorder and either clinical depression or PTSD are hard to reach, hard to treat, and hard to hold onto. A new collaborative care model called CLARO aims to help patients who otherwise might disappear into the cracks of the U.S. health care system.
Jul 3, 2023
Journal Article
The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity
This retrospective cohort study evaluated the quality and cost implications of receiving primary care from nurse practitioners (NPs) compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service physician rate (pay parity).
May 16, 2023
Journal Article
Changes in In-Person, Audio-Only, and Video Visits in California's Federally Qualified Health Centers, 2019-2022
The decline in audio-only visits from the early pandemic peak appears to coincide with the return of in-person visits rather than growth in video visits.
Apr 25, 2023
Journal Article
Methodology for a Six-State Survey of Primary Care Nurse Practitioners
To overcome the limitations of administrative data, we fielded a cross-sectional, mixed-mode (mail/online) survey of primary care NPs in six states to collect data directly from NPs on their clinical roles and practice environments.
Apr 12, 2023
Journal Article
Surveying Primary Care Nurse Practitioners: An Overview of National Sampling Frames
The purpose of this article is to provide an overview of national sampling frames that can be used by researchers interested in surveying or studying the U.S. primary care nurse practitioner workforce.
Apr 12, 2023
Journal Article
Practice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse Practitioners
This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington.
Apr 12, 2023
News Release
Audio-Only Telehealth Remains Common At Many Safety Net Clinics
In August 2022, more than two years into the COVID-19 pandemic, audio-only telehealth visits still accounted for 1 in 5 primary care visits and 2 in 5 mental health care visits at safety net clinics in California.
Apr 11, 2023
Tool
CLARO Intervention User Manual: A Guide for Care Teams and Individual Practitioners
The Collaboration Leading to Addiction Treatment and Recovery from Other Stresses research study advances collaborative care treatment for patients who have opioid use disorder with major depressive disorder and/or posttraumatic stress disorder.
Mar 10, 2023
Journal Article
Screening for Opioid Use Disorder and Co-Occurring Depression and Post-Traumatic Stress Disorder in Primary Care in New Mexico
This study helps quantify the extent of diagnostic and treatment service gaps for opioid use disorder and co-occurring mental health disorders in primary care settings serving rural and socioeconomically disadvantaged patients in New Mexico.
Mar 10, 2023
Journal Article
Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis
Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6–12 months to maintain behaviors and scores.
Mar 9, 2023
Journal Article
User-centered Design of a Scalable, Electronic Health Record-Integrated Remote Symptom Monitoring Intervention for Patients with Asthma and Providers in Primary Care
The objective of this article is to determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers.
Jan 27, 2023
Journal Article
Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient-Doctor Communication
We designed a patient- and provider-facing intervention to improve medical test conversations.
Jan 27, 2023
Journal Article
Reasons Primary Care Practices Chose Patient Experience Surveys During Patient-Centered Medical Home Transformation
In 2008–2017, 15–18% of U.S. primary care practices sought or maintained patient-centered medical home recognition. We interviewed a sample of 105 of these practices to determine why patient experience surveys were chosen.
Dec 7, 2022
Journal Article
Poor Self-rated Mental Health and Medicare Beneficiaries' Routine Care-Seeking
This cross-sectional study assessed the relationship between self-rated mental health (SRMH) and infrequent routine care among Medicare beneficiaries and investigated the roles of managed care and having a personal doctor.
Nov 8, 2022
Report
A Scoping Review of Guidelines and Quality Measures to Screen for Social and Caregiver Support and Cognitive Impairment in Primary Care
The authors conduct a review to identify measures, guidelines, and tools that (1) assess social support, the need for caregiver support, and the need for referral to social services and (2) screen for cognitive impairment among high-risk patients.
Nov 2, 2022

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RAND Topic:
Primary Care

Research conducted by

RAND Health Care

Researcher Spotlight

Jonathan S. Levin

Policy Researcher

Jonathan S. Levin (he/him) is a policy researcher at the RAND Corporation. He uses mixed methods to examine access, costs, and quality in public insurance programs, health care consolidation, prescription drugs, and treatment patterns for individuals with mental illness and substance use…
Rachel O. Reid

Physician Policy Researcher and Director of Health Care Division Public Sector Team

Rachel Reid is a physician policy researcher at the RAND Corporation and Director of the RAND Health Care Division Public Sector Team. A practicing primary care physician, her research focuses on measuring cost, quality, and value in health care. She has particular interest in the primary care…

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