Letters to the Editor
To the Editor:
We applaud Mazur and colleagues’1 analysis of the Patient-Centered Outcomes Research Institute’s (PCORI’s) grants and have three comments responding to Selby and Slutsky’s2 accompanying Commentary.
First, Selby and Slutsky inappropriately equate specialty care with complexity. We believe that to study complexity is to study primary care. In a recent analysis, primary care accounted for 90% of visits addressing four diagnoses, whereas subspecialists saw 70% of visits covering only one diagnosis.3
Second, the Commentary contends that patients seeking specialty care are still primary care patients, implying that research done in specialty settings applies to primary care. We agree that our patients are ours regardless of where they seek care but argue that most research done in specialty settings is not applicable to primary care. An Institute of Medicine report observed that “most [specialty-oriented research] is not relevant to primary care because of its focus on singly developed diseases [and] carefully selected patients.”4 Barbara Starfield5 added that it is “a fallacy to conclude … that primary care research can be done in anything other than primary care settings.”
Finally, Selby and Slutsky assert that “we do not believe … primary care research should be restricted to questions of a non-disease-specific nature.” We agree, and numerous primary care researchers study single diseases, often incorporating family and social contexts. However, we strongly contend that there is no reason PCORI should restrict its focus to single diseases. As comprehensivists, we see a need for research that focuses on whole patients.
When PCORI first launched, we were inspired by its charge to study care delivery from the patient perspective. PCORI has already yielded important work that has advanced primary care. Nevertheless, we hope Mazur and colleagues’ article inspires PCORI to examine its role in addressing the complex primary care needs of patients.1
Winston Liaw, MD, MPH
Medical director, Robert Graham Center, Washington, DC; firstname.lastname@example.org.
John M. Westfall, MD, MPH
Professor, Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
1. Mazur S, Bazemore A, Merenstein D. Characteristics of early recipients of Patient-Centered Outcomes Research Institute funding. Acad Med. 2016;91:491–496.
2. Selby JV, Slutsky JR. Primary care research in the Patient-Centered Outcomes Research Institute’s portfolio. Acad Med. 2016;91:453–454.
3. Moore M, Gibbons C, Cheng N, Coffman M, Petterson S, Bazemore A. Complexity of ambulatory care visits of patients with diabetes as reflected by diagnoses per visit. Prim Care Diabetes. 2016;10:281–286.
4. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Primary Care: America’s Health in a New Era. 1996. Washington, DC: National Academy Press; http://www.nap.edu/read/5152/chapter/1
. Accessed July 6, 2016.
5. Starfield B. A framework for primary care research. J Fam Pract. 1996;42:181–185.