Policy issue
A Re-emerging Political Space for Linking Person and Community Through Primary Health Care

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Purpose

The goal of the study was to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities.

Methods

Thirteen semistructured interviews were conducted in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over healthcare reform policies and implementation. Interviews were recorded; an editing and immersion–crystallization analysis approach was used to identify themes.

Results

Four themes were identified: (1) affirmation of primary care as the foundation of a more effective healthcare system, (2) the patient-centered medical home as a transitional step to foster practice innovation and payment reform, (3) the urgent need for an increased focus on community and population health in primary care, and (4) the ongoing need for advocacy and research efforts to keep primary care on public and policy agendas.

Conclusions

Current efforts to reform primary care are only intermediate steps toward a system with a greater focus on community and population health. Transformed and policy-enabled primary care is an essential link between personalized care and population health.

Section snippets

Methods

The research protocol was approved by the Case Western Reserve University IRB. Thirteen semistructured interviews were conducted in May 2011 with individuals in leadership positions in health-related Washington, DC–based federal agencies, think tanks, nonprofits, and quality standard–defining organizations. Organizations were selected for their important roles in defining the implementation phase of recent health reform measures related to primary care and in defining the next set of national

Results

Four major themes emerged from the analysis: (1) an affirmation of the current relevance of the fundamental tenets of primary care as a foundation for the U.S. healthcare system, (2) an understanding of the patient-centered medical home as a transitional step to foster innovation and payment reform that enable high-level primary care, (3) a call for an immediate focus on community-based solutions integrating primary care and public health, and (4) an urgent call for continued advocacy to push

Discussion

The informants of this study reinforced and expanded beyond the fundamental tenets of primary care.31, 32, 33, 34, 35 As defined more than a decade ago by the IOM:

Primary care is 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.36

In an era of fragmentation37, 38, 39 of the healthcare

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