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Achieving health equity in primary care: VCU Health doctors weigh in on NASEM report

Two VCU Health physicians participated in recommendations published in Annals of Family Medicine.

Scales and a stethoscope Illustration: Getty Images

By Esther Benenson

The future of primary care depends on health equity, and that equity depends on health care providers engaging local communities and advocating on their behalf, asserts a new paper published in The Annals of Family Medicine co-authored by two Virginia Commonwealth University primary care physicians, Jacqueline B. Britz and Alison N. Huffstetler.

 “Health Equity: The Only Path Forward for Primary Care,” was written in response to a 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on implementation of high-quality primary care

In its report, NASEM authors described high-quality primary care as the foundation of the health care system:

“Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels,” the report authors write.

“Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that … high-quality primary care might have reduced,” they add. “Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.”

Early career primary care physicians respond

The response published in The Annals of Family Medicine was written to take into account the viewpoints of early career primary care physicians from a variety of backgrounds.

The physicians write that the four C’s of patient care (contact, continuity, coordination and comprehensiveness) may not be inclusive of the needs of under-resourced communities, and that diverse individuals are not sufficiently recruited or maintained in health care settings. Regarding payment reform, they argue that risk adjustment and value-based care will support equitable access and high-quality care to all communities.

Britz, Huffstetler and the other authors propose that health care systems:

  1. Structure their systems to better meet the needs, values and priorities of their underserved communities

  2. Invest in local communities and preparatory programs to encourage diverse individuals to serve in health care

  3. Support a blended, value-based care model with risk adjustment to address the social complexity of underserved communities.

“Health equity as an afterthought is a threat to the sustainability of any high-functioning primary care system,” the authors write. “We need a concerted effort across the health care system, across all primary care specialties and members of the health care team, including advanced practice providers, social workers, nursing, and behavioral health among others to help advance these directives.”

Authors challenge peers to become leader-advocates

Britz, Huffstetler and fellow authors encourage early career physicians to become involved in leadership at the local and national levels to advocate for the patients and communities they serve.

“Ultimately, equity in primary care can only be rightfully achieved when we have a more equitable, just society in all systems: social, economic, educational, and criminal justice,” they write. “If we early career physicians want to see change in the decades to come, we have to be involved where we are.”

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