Primary Care

The term primary care has some conflicting interpretations. For the purposes of this book it is defined as the care provided to patients by the caregiver they consider to be the individual they are most likely to present to when they develop an illness or concern regarding their health care status.

The term primary care first appeared in the literature in the early 1960s and appears to have been most often used within the context of the “primary care practitioner.” In more technical literature, however, it was often used to refer to the initial contact with the health care system, whether that actually was a physician or another service provider such as the emergency room in a hospital.

Part of the difficulty of defining the term and its use results from two divergent definitions of the word primary. This word may be interpreted as meaning the first in time or order, and in that context narrows the definition of primary care to the initial contact with the system. The other use of primary is to imply main or principal, which allows a much broader description of primary care. Within that second frame of reference, primary care may refer to the initial contact with the system, or as is more commonly perceived today, it may refer to the care provided by the individual patients consider their principal caregiver or by the people principally responsible for managing and coordinating care during their current episode of illness.

According to WHO, primary care is defined as the first point of entry into the health care system for all patients of all ages with all diseases. Primary care providers traditionally were physicians, such as family practitioners, pediatricians, internists, or obstetricians, but today they frequently are nurse practitioners or physician's assistants.

It is important to understand that primary care practitioners typically see a patient population that is broad based in many ways, such as age, sex, ethnicity, and degree of illness. Patients presenting to a primary care practitioner may have a specific complaint related to a particular diagnosis. They are, however, much more likely to present nonspecific complaints influenced by multiple factors in their life such as ethnicity, religion, prior experience, allergies, current medications, and even other current, concomitant illness. These practitioners must therefore be multidisciplinary in their approach, widely educated in a variety of types of illnesses, and open to a large variety of inputs to be used in their approach to diagnosis and disease management. They must be prepared to coordinate the use of specialists and subspecialists, to interpret the results of various forms of diagnostic studies, and to facilitate the patient's progress through the diagnostic and management process.

Primary care should be differentiated from secondary and tertiary care. Secondary care typically involves the use of consultants who help resolve a diagnostic dilemma and then return the patient to the primary care practitioner. Tertiary care is care provided at highly technical, subspecialized levels most often related to complex illnesses (e.g., organ transplants). In its best form tertiary care also incorporates primary care physicians utilizing their broad knowledge of the patient.

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