Objective - To find evidence of the effectiveness of physicians working in
primary care.
Design - Systematic literature search in the Medline and Cochrane databases
.
Material - Out of 7223 titles found in the search, 45 studies, comparing, f
rom different aspects, primary care with specialist care, were extracted.
Main outcome measures - Health indicators, health care costs, quality of he
alth care.
Results - Primary care contributed to improved public health, as expressed
through different health parameters, and a lower utilisation of medical car
e leading to lower costs. Physicians working in primary care, in comparison
with other specialists, took care of many diseases without loss of quality
and often at lower cost. The organisation of primary care was important in
respect of reimbursement by capitation, more group practices, higher perso
nal continuity, and having generalists as primary care physicians.
Conclusions - To compare the effectiveness of primary care and specialist c
are is a complex task and there are limitations in all studies. However, we
have found evidence that increased accessibility to physicians working in
primary care contributes to better health and lower total costs in the heal
th care system. It is also clear that studies with evaluation of how to mos
t effectively organise primary care are far too few. There is an extensive
need for future research in this area, a suitable task for collaborative re
search between the Nordic countries.