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Editorials |

Primary Care, Specialist Care, and Chronic Care: Can They Interlock?

Barbara Starfield, MD
Author and Funding Information

From Johns Hopkins University.

Correspondence to: Barbara Starfield, MD, Johns Hopkins University, 624 North Broadway, Room 452, Baltimore, MD 21205; e-mail: bstarfie@jhsph.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):8-10. doi:10.1378/chest.09-1441
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Extract

In this issue of CHEST (see page 200), Kirschner and Barr1 present the concept of the Patient-Centered Medical Home (PCMH) in the context of the opportunities it presents to specialists to contribute to advances in the organization and delivery of health services in the United States. It is only recently that the challenge of coordination of care when patients move from inpatient to outpatient and from doctor to doctor has been appreciated.2 The challenge is considerable: in the United States, most patients see both primary care physicians and specialists in any given period of time. For example, a recent study showed that 64% and 95% of the elderly see a generalist or a specialist, respectively, in a year, with an average of almost nine visits to specialists and four different specialists seen. The corresponding figures for the nonelderly (including children as well as adults) are 81% and 69% for seeing one or more primary care doctors or specialists, respectively, and 1.3 and 3.3 different primary care physicians and specialists, respectively, seen in a year.3 Almost half of all visits to specialists are for routine follow-up initiated by the specialist.4 In view of the very high use of specialist services in the United States (compared with other Organisation for Economic Cooperation and Development [OECD] countries), any proposals to revamp primary care must consider the role specialists play in ongoing (as well as consultative) care of patients.

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