Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.


“Good Insurance”

It all started innocuously enough in the week leading up to Christmas in 2019 with a runny nose, a cough, and some fussiness. All pretty standard for our one-year-old daughter, who spends time with other kids at daycare sharing germs more readily than toys. Over the next few days, however, the cough got worse and the fussiness increased. We were still thinking it was just a cold until the lethargy hit. She wasn’t eating or drinking well, she had spiked a fever that wouldn’t level out, and seeing our normally active child—a girl who wasn’t even still when she slept—lying down listlessly ...

Here’s Why Mental Healthcare Is So Unaffordable & How COVID-19 Might Help Change This

If you ask a patient to describe their experience finding a therapist or psychiatrist in the community, don’t be surprised if ‘expensive,’ ‘difficult,’ and ‘discouraging’ are some of the first words that come to mind. The decades-long separation of mental healthcare from physical health has left patients and clinicians alike with serious challenges navigating options for care. And the cost has been much more than just inconvenience—our poorly integrated system is responsible for

Practice Optimization Amidst COVID-19: A Note from Our Patient Partner

The impacts of the COVID-19 pandemic continue to be felt across the United States, and this includes the ways in which we interact with the healthcare system. As the mother of a daughter with complex medical needs and a diabetic patient myself—what many would refer to as “super-users” of the medical system—we had to quickly adjust and adapt to the ways we’d need to manage our health conditions throughout the pandemic, as COVID has not stopped our need for ongoing care management. So, when I was asked to serve as faculty for the Harvard Medical School Center for Primary Care

The Impacts of Racism on the Health of our Nation

Dr. Martin Luther King, Jr. once said, “Our lives begin to end the day we become silent about things that matter.” The American Academy of Family Physicians (AAFP) has a legacy of being outspoken on issues that matter to our patients and the communities in which our members serve. We advocate loudly for our most marginalized patients, including those who are transgender, those with limited English proficiency, those with disabilities and, of course, people of color. It is in that spirit we issued a

Primary Care Transformation in a COVID-19 World

Access to comprehensive primary care has long been a challenge in the United States, and the economic and social impacts of the COVID-19 pandemic will have far reaching implications on our healthcare system. Sixty percent of Americans have at least one chronic condition, and many patients have complex needs that require additional coordination, time and resources than what traditional models of care ...

Primary Care and COVID: Our Role in Flattening the Curve

As it became apparent in early March that COVID would become a global and not only local problem, health systems had to transition from a focus on individual patients who might have been exposed to thinking about a population-guided response. Thus, Cambridge Health Alliance (CHA), an academic community healthcare system based in the Boston area, developed a comprehensive plan for COVID guided by the goal of “most lives and life years saved” that spanned both the hospital and the ambulatory space. This transition happened urgently and iteratively: in a few short weeks, we went from ...

Moving Upstream: Addressing Social Determinants of Health

The Primary Care Improvement Network (PCIN) is a membership-based network focused on supporting practice transformation, quality improvement, leadership skills, and the dissemination and spread of best practices. The program brings together important primary care stakeholders to address ongoing health care challenges. The goal of the program is to develop high-performing interdisciplinary teams to engage the PCIN themes of 2019-2020, which include effective implementation of telemedicine and effectively address health-related social needs. In the Primary Care sphere, there ...

Where does the individual physician fit in the new medicine?

By Steven A. Barrett, MD, FAAFP I am realizing that practice management in the new medicine is derived more from “group-think” than individual initiative. While this might work well for large medical organizations, where does it leave the imaginative individual physician trying to create improved medical care delivery systems? Of course, I am speaking from personal experience and raising this issue as a challenge to our medical system to be more open and inclusive and take advantage of all available bright ideas for improvement. ...

P2P+E: Understanding the employer role in an improved patient-to-primary care physician relationship

Creating sustainable, timely care delivery models designed to help patients achieve improved health outcomes is a challenge. The complex, chronic conditions of America’s workforce are driving the need for these models forcing employers into the position of leading health care delivery innovation. Employers, the primary source of insurance for 55.7% of Americans[i], have found themselves tasked with reducing healthcare’s unprecedented, rising costs to protect employee health, talent retention, productivity, and ...
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