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More Primary Care, Lower Death Rate

Medicare beneficiaries who live in an area with more primary care had better outcomes and are less likely to end up in the hospital with a preventable disease, say researchers from the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth Medical School.

Previous studies had mixed results. The new research looked at how much primary care was actually delivered to patients and not just how many primary care physicians were in a certain area. Researchers linked age-adjusted death rates, hospitalizations, and Medicare spending to the number of primary care physicians across the United States, based on counts from the American Medical Association. They found that in areas that had the top 20 percent of number of primary care physicians, tiny improvements were seen in preventable diseases over those in the bottom fifth. That finding did not hold when the number of deaths was examined.

When the researchers focused on how many doctors in the AMA were actually practicing primary care, the differences became larger. Those areas in the top fifth had 5.19 deaths per 100 Medicare beneficiaries annually compared to 5.49 per 100 for the bottom fifth. For preventable hospitalizations attributed to asthma and diabetes, the rates were 73 per 1,000 beneficiaries and 79 per 1,000, respectively.

The researchers suggest that having more primary care physicians available has a generally positive health benefit for this population, but that this association may not simply be the result of having more physicians trained in primary care in an area. Instead, associations were much stronger when primary care was delivered in an ambulatory setting such as a physician’s office or clinic by a physician trained in primary care.

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