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

Disclosures

Ann Fam Med. 2017;15(1):10-13. 

In This Article

Abstract and Introduction

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.

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