Fewer Adults Have Dedicated Primary Care

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From 2002 through 2015, the proportion of Americans with an identified source of primary care decreased, particularly among younger and less medically complex individuals.

“Despite the benefits of primary care, Americans’ receipt of primary care, changes in receipt of primary care over time, and differences in receipt of primary care according to sociodemographic and clinical characteristics are not well known,” the authors wrote.

They analyzed data from the Medical Expenditure Panel Survey (2002 through 2015), defining primary care using the 4 C’s: first contact, comprehensive, coordinated, and continuous. They sought to estimate factors associated with the likelihood of receiving primary care, including sociodemographic and clinical variables.

Overall, the number of adults with an identified source of primary care decreased from 77% in 2002 to 75% in 2015. This decrease was observed in adults of every decade of age except for those in their 80s, with those in their 30s, 40s, and 50s seeing a significant reduction. Decreases were seen in every decade of age among adults with no comorbidities.

Factors associated with a lower likelihood of primary care included male sex, Latino race/ethnicity, black race/ethnicity, Asian race/ethnicity, not having insurance, and living in the South.

“The decrease in receipt of primary care, particularly among younger patients or patients with no chronic medical conditions, may be related to their choosing nonlongitudinal interactions over continuity, perhaps related to the convenience revolution and a perception that primary care has failed to adopt new modes of delivering treatment that might be more accessible to patients,” the authors concluded.

“Financial barriers, especially among uninsured Americans, may prevent some people from accessing primary care. Shortages in the availability of primary care may pose access barriers even to insured people, with the result that fewer younger and healthier patients have a regular source of care.”

—Michael Potts

Reference:

Levine DM, Linder JA, Landon BE, et al. Characteristics of Americans with primary care and changes over time, 2002-2015 [published online December 16, 2019]. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2019.6282.