What is Primary Care?
Primary care is the long-term relationship between a person and their clinician. The clinician provides care for most of their health needs and coordinates additional health care services beyond the clinician's area of expertise. The Institute of Medicine gave this definition for primary care in 1996: "Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."
This definition is derived from the 1960s-era: Primary care may also be thought of as a level of care in the larger health-care system, to be distinguished from secondary care (care provided by community-based specialists and local community hospitals) and tertiary care (care provided by specialists at regional or academic health centers). In non-industrialized nations with limited health resources, primary care may be provided by village health workers, nurse-auxiliaires, promotoras, community health advisors, barefoot-doctors, etc.
In this context, physicians would be a scarce enough resource to qualify as secondary care, while regional hospitals might represent tertiary care. The World Health Organization provided a definition of primary care useful in this context during the Alma Ata Conference of 1978: "Primary health care is essential health care … made universally accessible to individuals and families in the community … through their full participation and at a cost that the community and country can afford."
Who Practices Primary Care?
Both allopathic (M.D.) and osteopathic physicians (D.O.) in the disciplines of family practice, general internal medicine, and general pediatrics are universally acknowledged as primary care clinicians. Nurse practitioners (NPs, also known as Advanced-Practice Nurses) and physician assistants (PAs) practicing in these disciplines are also primary care clinicians. Physicians without residency training in a primary care discipline also may practice primary care as GPs (general practitioners). Specialists in preventive medicine sometimes also are listed as primary care clinicians, although these may consider the community to be their "patient."
Specialists in obstetrics and gynecology may or may not be listed as primary care clinicians, and here is the distinction - those who consider themselves to be the primary source of care for their female patients (i.e., they serve a person, not a cluster of female organs), and who can address the majority of those patients' needs (i.e., high blood pressure and osteoporosis as well as contraception and uterine fibroids), are practicing primary care. Those who consider themselves procedural specialists (delivering babies and doing GYN surgery) or specialists in problems of the female organs would not be practicing primary care.
What is Community-Oriented Primary Care?
In 1985 the Institute of Medicine addressed the emerging field of Community Oriented Primary Care (COPC). The concept of COPC was built on the early work of Sidney and Emily Kark in Kwazulu-Natal, who attempted to build a primary care practice based on community health assessments at the individual, family, and community levels, and then to assess its own effectiveness by a continuing surveillance of those health status indicators. Modern practitioners of COPC may work at the individual practice-level, assessing the needs of their patients' community and attempting to design interventions to improve that health status. COPC also may provide the conceptual framework for systems of care for an entire metropolitan area, as demonstrated by the Parkland Memorial Health System's COPC model in Dallas, Texas.
IOM gave the following definition of COPC: Community-oriented primary care is the provision of primary care services to a defined community, coupled with systematic efforts to identify and address the major health problems of that community through effective modifications in both the primary care services and other appropriate community health programs (IOM, 1984, p. 2).