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Doody's Review ServiceReviewer: David Meltzer, MD, PhD (University of Chicago Pritzker School of Medicine)
Description: This book reports the results of a study of the future of primary care by the Institute of Medicine (IOM). It begins by updating the definition of primary care developed by the IOM in 1978. It then proceeds to discuss the value and process of primary care, including chapters on primary care delivery, workforce, training, and research needs. It concludes with detailed recommendations to improve primary care and a discussion of challenges to their implementation.
Purpose: It is intended to provide a detailed definition of primary care and make policy recommendations to improve primary care in the United States.
Audience: Health policy specialists or physicians interested in primary care comprise the audience for this work.
Features: The most valuable section of the book is the chapter that defines primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community." Although this definition is more a statement of a vision for the future of primary care than a description of primary care as it now exists, the definition describes several features of primary care that provide a valuable framework for analyzing its quality and working toward its improvement. The majority of the volume is then devoted to recommendations to improve primary care. Although no recommendation is made concerning the contentious issue of who should be considered a primary care physician, there are important recommendations concerning workforce policy, all-payer funding for graduate medical education, and the promotion of research in primary care.
Assessment: Perhaps reflecting its emphasis on defining an ideal model of primary care and making policy recommendations, the least satisfying part of the book is the chapter devoted to documenting the value of primary care, which relies heavily on anecdotes and contains only a brief and uncritical review of the academic literature. Although not as scholarly as more academic volumes such as Barbara Starfield's Primary Care, this IOM report devotes greater attention to constructing a policy agenda for primary care, and its recommendations are worthy of attention by policymakers and practitioners devoted to primary care. Because nearly every national health care organization of any note provided testimony for the study, the report is likely to be widely cited. The fact that those organizations and others providing testimony were generally given only 5 or 10 minutes to testify suggests there was little room to probe deeply into the most difficult issues in primary care. Accordingly, the report's recommendations for further research deserve high priority.