Primary care utilization associated with increased high-value care

1. In this survey of patients in the United States, primary care was associated with improved patient experience as well as improvement in rates of high-value primary care.

2. Use of primary care was also linked to an increase in low-value antibiotic use, and no difference in need for emergency department use or in-patient encounters.

Evidence Rating Level: 3 (Average)

Study Rundown: Studies evaluating the utility of primary care have been limited. The current study sought to evaluate the effect of self-reported primary care access on health-care encounters, high- and low-value care, and patient reported experience with healthcare. The study found that primary care access did not lead to significant differences in outpatient, inpatient, or emergency department encounters. There was increase in high-value preventative care measures, but also an increase in the use of low-value antibiotics as well. There was an increase in low-value antibiotics, and no difference in other measures of healthcare utilization.  Patients’ reported improved experience and access to care with improved primary care.

The main strength of this study was the large sample size evaluated over time with the ability to use propensity score analysis to balance for sociodemographic and clinical characteristics. The main limitations of the study included the variability in defining appropriate primary care and the potential bias of patient reported data. Future studies may be planned to look into primary care utilization and mortality risk.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Managing patients with multimorbidity in primary care

In-Depth [survey]: This study uses data from the Medical Expenditure Panel Survey (MEPS) from 2002 to 2014 which included non-institutionalized adults in the United States who responded to the National Health Interview Survey. Primary care was defined by patient reposed experiences which correspond to the “4 C’s” of primary care: first-contact care that is comprehensive, continuous, and coordinated. Patients who answered “no” to the usual source of care question or questions designed to evaluate the “4 C’s” were excluded.

Patients with primary care were found to have no difference in healthcare utilization for outpatient visits (6.7 vs 5.9; difference, 0.8 [95%CI, −0.2 to 1.8]; P = .11), inpatient encounters (0.1 for both; difference, 0.0 [95%CI, 0.0-0.0]; P = .92), or emergency department visits (0.2 for both; difference, 0.0 [95%CI, −0.1 to 0.0]; P = .17). Primary care was associated with improved high-value care for 4 of 5 measures, while low-value care was the same for most measures and increased for low-value antibiotics (59% vs 48%, p < .001). Patient reported experience were improved for those with primary care.

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