From 2000 to 2002, researchers at the University of California, San Francisco, School of Medicine studied innovations in primary care that have the potential to reshape primary care delivery and the physician-patient relationship.

The project was part of the Robert Wood Johnson Foundation (RWJF) Strengthening the Patient-Provider Relationship in a Changing Health Care Environment national program.

Key Findings: Among the project's key findings, as discussed in part in an article published in the British Medical Journal in 2003, are the following:

• Primary care in the United States suffers from serious shortcomings, including inadequate care for chronic illness, poor accessibility to timely appointments, short and rushed medical visits, and severe physician stress and burnout.
• Integrated delivery systems—which pull together separate pieces of the health care delivery system into a single streamlined system that provides primary, chronic and acute care—appear to be the most innovative of health care provider organizations in the country in improving primary care.
• Many obstacles stand in the way of health care organizations making a convincing business case for chronic care improvement. Among them:
  • Chronic disease programs cost money to develop and operate.
  • Information systems represent a huge initial expenditure.
  • Extra personnel are needed to operate most chronic disease programs.
• A movement to assist patients with self-management of their illnesses has made headway in some health care organizations and is spreading.
• A number of primary care practices have attempted to institute same-day appointment access systems; some have been successful, others have not.
• Group medical visits—which allow physicians to initially see patients with chronic illness in a small group and later offer private care—are being organized in some health care institutions; they appear to improve care, raise patient satisfaction and, in some cases, reduce costs.
• Primary care teams—which are groups of primary care clinicians who care for a defined group of patients and communicate regularly about that care—are still in their infancy but are being attempted by a handful of health care organizations.