Comprehensiveness: The Need to Resurrect a Sagging Pillar of Primary Care
The COVID-19 pandemic highlighted both the importance of primary care and the fragility of its current infrastructure in the United States (US). Within its first 2 months, stark reminders of racial injustice, unaddressed health disparities, and grossly inequitable access to healthcare further underscored the current lack and future importance of universal access to high-performing primary care. At the start of the pandemic, fewer than 1 in 5 Americans could identify a personal usual source of healthcare. In this time of uncertainty, many patients went without timely care due to a myriad of difficulties. Perhaps chief among these was the lack of an accessible, trusted personal clinician capable of and committed to delivering personalized advice and comprehensive care at a time of unprecedented medical and public health uncertainty. In response to this crisis, changes in actual and virtual visit accessibility to primary care were further complicated by the limited office hours or practice closures imposed by crises in provider organizational finances.
The value of comprehensive primary care has been documented for decades prior to the pandemic. Nonetheless, at its outset, most primary care in the USA occurred in settings adapted to traditional fee-for-service (FFS) payments where physicians provided highly focused face-to-face visits and would often “document and refer” (to specialists) patients with complex conditions. This is in contrast to the type of primary care described by Starfield to have the fundamental features of accessibility, continuity, coordination, and comprehensiveness.