Health Equity: The Only Path Forward for Primary Care

Abstract

The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementation of High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield's original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report's priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.

The Quality of Migrant Patients’ Primary Healthcare Experiences and Patient-Centered Medical Home Achievement by Community Health Centers: Results from the China Greater Bay Area Study

“…Team-based care models are better equipped to address health and social inequities. [37] The experiences of migrant patients accessing PHC can be improved by improving continuity-of-care in CHCs, as per PCMH 2 ("Team-based Care") standards. To ensure ongoing demand for their available PHC services, CHCs should strive to provide personalized healthcare using a relatively xed team of GP physicians.…”

Editorial: Family medicine and primary care: Best practice to achieve health equity for western and traditional Chinese medicine

“…As the role of family physicians is to interact with patients from all groups, family medicine could provide the capability of collaborating with national stakeholders to reduce health disparities in the United States (14,15). Furthermore, the evidence on health disparities could act as a guide for family physicians as guidance in clinical practice to notice the disparities, thereby further achieving health equity for patients with different characteristics and socioeconomic statuses (15)(16)(17). At last, we expect more studies and research to be conducted to support the value-based healthcare scheme and to achieve health equity.…”

It Will Take a Million Primary Care Team Members

“…They are a bit rebellious, activists, much more diverse, and see family medicine as a calling. 8 That calling comes with attention to social issues: health equity, gun violence, women's health and abortion access, gender care, and wider political determinants of health. It is a relief there may be new energy to reinvigorate the values of primary care.…”