Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes

Area of Science:

• Health Services Research
• Primary Care Delivery Models
• Health Policy Analysis

Background:

• Direct Primary Care (DPC) is a patient-centered model with fees for access.
• Proponents claim DPC enhances accessibility and care quality.
• Limited peer-reviewed evidence supports DPC's purported benefits.

Purpose of the Study:

• To evaluate primary care changes linked to DPC adoption using Starfield's model.
• To define expected DPC impacts at patient, clinic, and system levels.
• To assess DPC's alignment with primary care attributes.

Main Methods:

• Applied Starfield's adaptation of Donabedian's Structure-Process-Outcome model.
• Synthesized existing literature on primary care constructs.
• Defined theoretical expectations for DPC's impact.

Main Results:

• DPC may improve continuity and accessibility for participating patients.
• DPC financing models could exacerbate health inequities by excluding vulnerable populations.
• Theoretical support exists for DPC enhancing clinic-level primary care attributes.

Conclusions:

• DPC is theoretically sound for improving clinic-level primary care attributes.
• DPC's system-level impact on population health is questionable due to potential exclusion of vulnerable patients.
• Further research comparing included/excluded patients is crucial for policy and practice decisions.