THE VALUE OF A FAMILY PHYSICIAN

BACKGROUND. Most efforts to improve health care have been made without a full understanding of the value of a primary care approach. METHODS . This article synthesizes the observations from the Direct Observatio n of Primary Care (DOPC) study. This multimethod study of 138 family p hysicians in 84 practices included direct observation of 4454 patient visits were used to describe aspects of family practice that may provi de value for patients. RESULTS. Family physicians provide and coordina te care for a wide variety of patient problems, prioritizing these com peting demands on the basis of relationships developed during multiple patient visits over time. They use acute and chronic illness visits a s opportunities to integrate care for specific diseases, mental health , and preventive care in ways that are tailored to the specific needs of patients and families. Higher rates of delivery of core attributes of family practice are associated with patient satisfaction and preven tive services delivery, and are diminished by forced discontinuity of care. CONCLUSIONS. Family physicians prioritize and deliver care accor ding to a broad agenda based on patient needs. These needs are underst ood within ongoing relationships with the patient, family, larger heal th care system, and community. This integrative approach includes nume rous avenues for affecting important patient outcomes that are unlikel y to be optimally met by less integrated models of medical care. Expan ding the value of family practice will require the development and app lication of new knowledge of the core structures, processes, and conte xts of family practice, and their effects on patient outcomes.