If the United States just had more primary-care physicians and patients had access to them, Americans' health would improve. Right? Not so fast, say researchers working on the Dartmouth Atlas Project.

After examining national Medicare data from between 2003 and 2007, the team, led by Dr. David Goodman, reached the following counterintuitive conclusions:

• People on Medicare who saw a primary-care doctor at least once a year were just as likely to end up in the hospital for a chronic illness as those who didn't have a regular checkup or visit.
• A visit to a primary-care physician didn't make it any less likely that someone with serious diabetes or peripheral vascular disease would get a leg amputated.
• Nationally, 77.6 percent of beneficiaries saw a primary-care physician or nurse practitioner at least once a year.
• Regionally, about 60.2 percent of Medicare beneficiaries in the Bronx had an annual visit, while nearly 88 percent did so in Florence, S.C.
• Some areas with relatively few primary-care physicians, such as Wilmington, N.C., still had high rates of visits, while other areas with plenty of such doctors, such as White Plains, N.Y., had lower than average rates for annual visits.

Although the Dartmouth study appears to debunk a widely held tenet of health reform--that more primary care means better care--the research may bolster the government's argument in favor of medical group consolidation and collaboration.

"While primary care may be necessary for good care, it's not sufficient by itself," Goodman told Kaiser Health News. "Primary care is not always practiced effectively. It can be disorganized and disconnected from other parts of care."

Researchers added: "Primary care is most effective when it is embedded in a high-functioning system, where care is coordinated, where physicians communicate with one another about their patients, and where feedback is available about performance that allows physicians and local hospitals to continually improve."

To learn more:
- read the full article from Kaiser Health News
- see this Reuters piece
- check out this post in the Wall Street Journal Health Blog
- get more insights in this Health Beat Blog post
- review Dartmouth's study

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