Strategies to Prioritize Clinical Options in Primary Care

Patrick J. O'Connor, MD, MA, MPH; JoAnn M. Sperl-Hillen, MD; Karen L. Margolis, MD, MPH; Thomas E. Kottke, MD, MSPH


Ann Fam Med. 2017;15(1):10-13. 

In This Article

Abstract and Introduction


In 2003, McGlynn and colleagues famously identified 439 clinical services recommended by subspecialists and others that, they argue, should be consistently delivered in primary care.[1] Based on lengthy patient interviews and detailed chart audits, they estimated that US adults receive only 55% of these 439 recommended clinical services. They noted that the patients did not receive recommended clinical services, on average, 16 times, and that 1 patient was deficient in recommended services 304 times.

Yarnall et al reviewed US Preventive Services Task Force-recommended preventive services and estimated that a primary care clinician would need to spend 7.4 hours per working day to deliver recommended preventive services to a panel of patients;[2] doing so would, of course, leave little time for anything else and lead to frustrated clinicians and dissatisfied patients. What is a primary care clinician to do? We are damned if we do not deliver all evidence-based preventive and chronic disease care services with robot-like consistency and sleepless if we do. Proposed remedies include off-loading delivery of preventive or chronic disease care services to office staff, nurse case managers, subspecialty clinics, or even attractive-looking multicolored smartphone apps.