High-Quality Primary Care Critical to Health Equity
Guest post by Dr. Tumaini Coker.
High-quality pediatric primary care provides continuous, integrated, whole-child, and family-centered care based on the needs and preferences of the child and their family. Yet, many children and families in low-resource communities do not have access to high-quality pediatric primary care — which exacerbates current inequities in health and well-being for children.
As a general pediatrician, I see children whose families have a whole host of issues that I might not be able to address in the time available for a typical primary care visit. Families, particularly those impacted most by structural racism and poverty, need an interprofessional primary care team that can tailor care to the whole child and family, in partnership with the community.
As a researcher, I work with community practices and clinics that serve children and families in low-resource communities. Together, we design, implement and test new models for primary care delivery that can lead to more equitable care. These new models rely on adding non-clinician members to the primary care team — such as health coaches or community health workers — who can expand the breadth of services available to families, and provide community-oriented, relationship-based, and culturally relevant care that leads to greater health equity.
In 2019, I was invited to serve on the Committee on Implementing High-Quality Primary Care, convened by the National Academies of Sciences, Engineering, and Medicine (NASEM). Our charge was to examine the current state of primary care in the United States and develop an implementation plan to build upon the recommendations from the 1996 Institute of Medicine report, Primary Care: America's Health in a New Era.
After launching a consensus study to define high-quality primary care, the committee proposed an evidence-based plan with actionable objectives and recommendations for implementing that definition.
We first identified the well-documented challenges of our current primary care system. It lacks an accountable and unified voice within our federal government, has no dedicated research support, and is chronically underfunded — leading to health inequity, financial pressure on practices, clinician burnout, and suboptimal care. These challenges, of course, are even more salient for pediatrics. For example, Medicaid payments for primary care are just 66% of Medicare payment levels, and only 12% of NIH research funding goes toward child health, although children represent double that as proportion of the population.
WHAT IS HIGH-QUALITY PRIMARY CARE?
The provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.
The committee’s definition of high-quality primary care will feel very familiar to pediatricians. It is based in the foundations of the pediatric medical home and prioritizes the relationship-based and family-centered orientation that is fundamental to pediatrics. So, we know very well what high-quality primary care is for pediatrics. We just need the payment, interprofessional teams, child health workforce, training, and information technology to implement it to scale.
The committee’s report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, provides a clear implementation plan for each of these elements. It proposes ways to balance our national needs for scalable solutions, while allowing for adaptations to meet local needs.
The report provides five implementation objectives for making high-quality primary care available to all people in the United States:
- Pay for primary care teams to care for people, not doctors to deliver services.
- Ensure that high-quality primary care is available to every individual and family in every community.
- Train primary care teams where people live and work.
- Design information technology that serves the patient, family, and the interprofessional care team.
- Ensure that high-quality primary care is implemented in the United States. (This recommendation requires clear and meaningful measures, ongoing research, and federal government leadership.)
To build awareness of the report and its recommendations, NASEM is hosting a series of webinars each Tuesday in June, and I encourage you to attend one or more of them.
I hope to see you at one or more of the webinars, and I look forward to working with the pediatric community to operationalize these recommendations for children and their families.
About the Author
Tumaini Rucker Coker, MD, MBA, is the Chief of General Pediatrics and Associate Professor of Pediatrics at the University of Washington School of Medicine and Seattle Children’s Hospital. She is the former founding Research Director of Seattle Children’s Center for Diversity and Health Equity Research Program and serves as the co-director of the University of Washington’s NIH-funded Child Health Equity Research Fellowship. A nationally recognized expert in preventive care delivery, Dr. Coker’s research focuses on community partnerships and pediatric primary care design to promote health equity for children in low-resource communities. She is board certified and maintaining certification in General Pediatrics.