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Health Serv Res. 1995 April; 30(1 Pt 2): 253–273.
PMCID: PMC1070053

The efficacy of primary care for vulnerable population groups.


This article reviews the existing literature on the efficacy of primary care with an emphasis on the evaluation of primary care for vulnerable populations: groups whose demographic, geographic, or economic characteristics impede or prevent their access to health care services. A significant portion of the literature derives from studies of poor and underserved populations. However, to construct a more complete evaluation of primary care services, the authors cite literature that has examined both advantaged and disadvantaged populations. Even then the literature is incomplete, at best. The article describes a definition of primary care suitable for policy analysis and formulation, reviews evidence on the efficacy of care that meets that definition, and concludes that widespread use of primary care services is likely to result in improved patient satisfaction and health status.

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Selected References

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  • Alpert JJ, Heagarty MC, Robertson L, Kosa J, Haggerty RJ. Effective use of comprehensive pediatric care. Utilization of health resources. Am J Dis Child. 1968 Nov;116(5):529–533. [PubMed]
  • Becker MH, Drachman RH, Kirscht JP. Continuity of pediatrician: new support for an old shibboleth. J Pediatr. 1974 Apr;84(4):599–605. [PubMed]
  • Brooks EF, Johnson SL. Nurse practitioner and physician assistant satellite health centers. The pending demise of an organizational form? Med Care. 1986 Oct;24(10):881–890. [PubMed]
  • Budetti PP. Achieving a uniform federal primary care policy. Opportunities presented by national health reform. JAMA. 1993 Jan 27;269(4):498–501. [PubMed]
  • Caplan EK, Sussman MB. Rank order of important variables for patient and staff satisfaction with outpatient service. J Health Hum Behav. 1966 Summer;7(2):133–137. [PubMed]
  • Carey TS, Weis K, Homer C. Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991 Jun;26(2):165–181. [PMC free article] [PubMed]
  • Charney E, Bynum R, Eldredge D, Frank D, MacWhinney JB, McNabb N, Scheiner A, Sumpter EA, Iker H. How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics. 1967 Aug;40(2):188–195. [PubMed]
  • Deprez RD, Pennell BE, Libby MA. The substitutability of outpatient primary care in rural community health centers for inpatient hospital care. Health Serv Res. 1987 Jun;22(2):207–233. [PMC free article] [PubMed]
  • Dietrich AJ, Marton KI. Does continuous care from a physician make a difference? J Fam Pract. 1982 Nov;15(5):929–937. [PubMed]
  • Dietrich AJ, Nelson EC, Kirk JW, Zubkoff M, O'Connor GT. Do primary physicians actually manage their patients' fee-for-service care? JAMA. 1988 Jun 3;259(21):3145–3149. [PubMed]
  • Dignan MB, Hall MB, Hastings DW. Effect of increased access to health care on mortality from cardiovascular disease in rural Tennessee. Public Health Rep. 1979 Mar-Apr;94(2):186–192. [PMC free article] [PubMed]
  • Ellwood PM, Enthoven AC, Etheredge L. The Jackson Hole initiatives for a twenty-first century American health care system. Health Econ. 1992 Oct;1(3):149–168. [PubMed]
  • Fihn SD, Wicher JB. Withdrawing routine outpatient medical services: effects on access and health. J Gen Intern Med. 1988 Jul-Aug;3(4):356–362. [PubMed]
  • Fleming GV, Andersen RM. The Municipal Health Services Program. Improving access to primary care without increasing expenditures. Med Care. 1986 Jul;24(7):565–579. [PubMed]
  • Fletcher RH, O'Malley MS, Fletcher SW, Earp JA, Alexander JP. Measuring the continuity and coordination of medical care in a system involving multiple providers. Med Care. 1984 May;22(5):403–411. [PubMed]
  • Franks P, Clancy CM, Nutting PA. Gatekeeping revisited--protecting patients from overtreatment. N Engl J Med. 1992 Aug 6;327(6):424–429. [PubMed]
  • Freeman HE, Kiecolt KJ, Allen HM., 2nd Community health centers: an initiative of enduring utility. Milbank Mem Fund Q Health Soc. 1982 Spring;60(2):245–267. [PubMed]
  • Fry J. An overview of primary health care. Int J Health Serv. 1976;6(2):309–314. [PubMed]
  • Goodrich TJ, Gorry GA. The process of ambulatory care: a comparison of the hospital and the community health center. Am J Public Health. 1980 Mar;70(3):251–255. [PubMed]
  • Gordis L. Effectiveness of comprehensive-care programs in preventing rheumatic fever. N Engl J Med. 1973 Aug 16;289(7):331–335. [PubMed]
  • Gordis L, Markowitz M. Evaluation of the effectiveness of comprehensive and continuous pediatric care. Pediatrics. 1971 Nov;48(5):766–776. [PubMed]
  • Graversen PH, Gasser TC, Wasson JH, Hinman F, Jr, Bruskewitz RC. Controversies about indications for transurethral resection of the prostate. J Urol. 1989 Mar;141(3):475–481. [PubMed]
  • Grossman M, Jacobowitz S. Variations in infant mortality rates among counties of the United States: the roles of public policies and programs. Demography. 1981 Nov;18(4):695–713. [PubMed]
  • Hochheiser LI, Woodward K, Charney E. Effect of the neighborhood health center on the use of pediatric emergency departments in Rochester, New York. N Engl J Med. 1971 Jul 15;285(3):148–152. [PubMed]
  • Holoweiko M. Health-care reform: what does Hawaii have to teach? Med Econ. 1992 Feb 3;69(3):158–174. [PubMed]
  • Hurley RE, Freund DA, Taylor DE. Emergency room use and primary care case management: evidence from four Medicaid demonstration programs. Am J Public Health. 1989 Jul;79(7):843–846. [PubMed]
  • Hurley RE, Gage BJ, Freund DA. Rollover effects in gatekeeper programs: cushioning the impact of restricted choice. Inquiry. 1991 Winter;28(4):375–384. [PubMed]
  • Hurley RE, Paul JE, Freund DA. Going into gatekeeping: an empirical assessment. QRB Qual Rev Bull. 1989 Oct;15(10):306–314. [PubMed]
  • Klein M, Roghmann K, Woodward K, Charney E. The impact of the Rochester Neighborhood Health Center on hospitalization of children, 1968 to 1970. Pediatrics. 1973 May;51(5):833–839. [PubMed]
  • Liptak GS, Hulka BS, Cassel JC. Effectiveness of physician-mother interactions during infancy. Pediatrics. 1977 Aug;60(2):186–192. [PubMed]
  • Lurie N, Ward NB, Shapiro MF, Brook RH. Termination from Medi-Cal--does it affect health? N Engl J Med. 1984 Aug 16;311(7):480–484. [PubMed]
  • Martin DP, Diehr P, Price KF, Richardson WC. Effect of a gatekeeper plan on health services use and charges: a randomized trial. Am J Public Health. 1989 Dec;79(12):1628–1632. [PubMed]
  • McPhee SJ, Lo B, Saika GY, Meltzer R. How good is communication between primary care physicians and subspecialty consultants? Arch Intern Med. 1984 Jun;144(6):1265–1268. [PubMed]
  • Moore GT, Bernstein R, Bonanno RA. Effect of a neighborhood health center on hospital emergency room use. Med Care. 1972 May-Jun;10(3):240–247. [PubMed]
  • Moore SH, Martin DP, Richardson WC. Does the primary-care gatekeeper control the costs of health care? Lessons from the SAFECO experience. N Engl J Med. 1983 Dec 1;309(22):1400–1404. [PubMed]
  • O'Connor PJ, Wagner EH, Strogatz DS. Hypertension control in a rural community. An assessment of community-oriented primary care. J Fam Pract. 1990 Apr;30(4):420–424. [PubMed]
  • Okada LM, Wan TT. Impact of community health centers and Medicaid on the use of health services. Public Health Rep. 1980 Nov-Dec;95(6):520–534. [PMC free article] [PubMed]
  • Patton LT. Community health centers at 25: a retrospective look at the first 10 years. J Ambul Care Manage. 1990 Oct;13(4):13–21. [PubMed]
  • Reynolds RA. Improving access to health care among the poor--the neighborhood health center experience. Milbank Mem Fund Q Health Soc. 1976 Winter;54(1):47–82. [PubMed]
  • Roos LL, Roos NP, Gilbert P, Nicol JP. Continuity of care: does it contribute to quality of care? Med Care. 1980 Feb;18(2):174–184. [PubMed]
  • Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Correlates of nonadherence to hypertension treatment in an inner-city minority population. Am J Public Health. 1992 Dec;82(12):1607–1612. [PubMed]
  • Shi L. The relationship between primary care and life chances. J Health Care Poor Underserved. 1992 Fall;3(2):321–335. [PubMed]
  • Simborg DW, Starfield BH, Horn SD, Yourtee SA. Information factors affecting problem follow-up in ambulatory care. Med Care. 1976 Oct;14(10):848–856. [PubMed]
  • Sparer G, Anderson A. Utilization and cost experience of low-income families in four prepaid group-practice plans. N Engl J Med. 1973 Jul 12;289(2):67–72. [PubMed]
  • Starfield B, Scheff D. Effectiveness of pediatric care: the relationship between processes and outcome. Pediatrics. 1972 Apr;49(4):547–552. [PubMed]
  • Starfield BH, Simborg DW, Horn SD, Yourtee SA. Continuity and coordination in primary care: their achievement and utility. Med Care. 1976 Jul;14(7):625–636. [PubMed]
  • Starfield B, Simborg D, Johns C, Horn S. Coordination of care and its relationship to continuity and medical records. Med Care. 1977 Nov;15(11):929–938. [PubMed]
  • Sussman EJ, Rosen HM, Siegel AJ, Witherspoon JM, Nesson HR. Can primary care deliver? J Ambul Care Manage. 1979 Aug;2(3):29–39. [PubMed]
  • Wasson JH, Sauvigne AE, Mogielnicki RP, Frey WG, Sox CH, Gaudette C, Rockwell A. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984 Nov 2;252(17):2413–2417. [PubMed]
  • Woolley FR, Kane RL, Hughes CC, Wright DD. The effects of doctor--patient communication on satisfaction and outcome of care. Soc Sci Med. 1978 Mar;12(2A):123–128. [PubMed]

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