primary care physician

同

PCP

WordNet

1. feel concern or interest; "I really care about my work"; "I dont care"
2. the work of providing treatment for or attending to someone or something; "no medical care was required"; "the old car needs constant attention" (同)attention, aid, tending
3. attention and management implying responsibility for safety; "he is in the care of a bodyguard" (同)charge, tutelage, guardianship
4. activity involved in maintaining something in good working order; "he wrote the manual on car care" (同)maintenance, upkeep
5. a cause for feeling concern; "his major care was the illness of his wife"
6. provide care for; "The nurse was caring for the wounded" (同)give care
7. of first rank or importance or value; direct and immediate rather than secondary; "primary goals"; "a primary effect"; "primary sources"; "a primary interest"
8. a preliminary election where delegates or nominees are chosen (同)primary_election
9. one of the main flight feathers projecting along the outer edge of a birds wing (同)primary feather, primary quill
10. (astronomy) a celestial body (especially a star) relative to other objects in orbit around it
11. not derived from or reducible to something else; basic; "a primary instinct"
12. a motor vehicle with four wheels; usually propelled by an internal combustion engine; "he needs a car to get to work" (同)auto, automobile, machine, motorcar
13. where passengers ride up and down; "the car was on the top floor" (同)elevator car
14. the compartment that is suspended from an airship and that carries personnel and the cargo and the power plant (同)gondola
15. a wheeled vehicle adapted to the rails of railroad; "three cars had jumped the rails" (同)railcar, railway car, railroad car
16. feeling and exhibiting concern and empathy for others; "caring friends"

PrepTutorEJDIC

1. phencyclidine pill パラフェナスレン(強い幻覚剤)
2. 〈U〉『心配』,気がかり,悩み / 〈C〉《しばしば複数形で》心配事,苦労の種 / 〈U〉『細心の注意』,十二分の用心 / 〈U〉(…の)『世話』,監督,保護《+『for(of)+名』》 / 〈C〉関心事,気を配るべきこと / 『気にする』,心配する,関心がある / …『したいと思う』,欲する,好む
3. 『第一の』,『主要な』 / 『初期の』,『初等の』,初級の / 『根本的な』,基本的な,本来の,直接的な / 《名詞の前にのみ用いて》(回路・コイル・巻き・電流などが)一次の / 原色(三原色の一つ) / 《米》=primary election
4. 『自動車』(automobile)電車(streetcar) / 《米》(鉄道の)『車両』;客車,貨車 / (気球などの)かご;(エレベーターの)箱
5. 『医者』;(特に)『内科医』

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/09 05:01:03」(JST)

wiki en

[Wiki en表示]

A patient having his blood pressure measured

A primary care physician or primary care provider (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. This term is primarily used in the United States, although this is a recent occurrence. In years past in the US and in Britain (and many other English-speaking countries), the equivalent term was/is “general practitioner”.

All physicians first complete medical school (MD, MBBS, or DO). To become primary care physicians, medical school graduates then undertake postgraduate training in primary care programs, such as family medicine (also called family practice or general practice in some countries), pediatrics or internal medicine. Some HMOs consider gynecologists as PCPs for the care of women, and have allowed certain subspecialists to assume PCP responsibilities for selected patient types, such as allergists caring for people with asthma and nephrologists acting as PCPs for patients on kidney dialysis.

Emergency physicians are sometimes counted as primary care physicians. Emergency physicians see many primary care cases, but in contrast to family physicians, pediatricians and internists, are trained and organized to focus on episodic care, acute intervention, stabilization, and discharge or transfer or referral to definitive care, with less of a focus on chronic conditions and limited provision for continuing care.

Scope of practice

A set of skills and scope of practice may define a primary care physician, generally including basic diagnosis and treatment of common illnesses and medical conditions. Diagnostic techniques include interviewing the patient to collect information on the present symptoms, prior medical history and other health details, followed by a physical examination. Many PCPs are trained in basic medical testing, such as interpreting results of blood or other patient samples, electrocardiograms, or x-rays. More complex and time-intensive diagnostic procedures are usually obtained by referral to specialists, due to either special training with a technology, or increased experience and patient volume that renders a risky procedure safer for the patient. After collecting data, the PCP arrives at a differential diagnosis and, with the participation of the patient, formulates a plan including (if appropriate) components of further testing, specialist referral, medication, therapy, diet or life-style changes, patient education, and follow up results of treatment. Primary care physicians also counsel and educate patients on safe health behaviors, self-care skills and treatment options, and provide screening tests and immunizations.

Role in the health care system

A primary care physician is usually the first medical practitioner contacted by a patient, due to factors such as ease of communication, accessible location, familiarity, and increasingly issues of cost and managed care requirements. In some countries, for example Norway, residents are registered as patients of a (local) doctor, and must contact that doctor for referral to any other. Also many health maintenance organizations position PCPs as "gatekeepers", who regulate access to more costly procedures or specialists. Ideally, the primary care physician acts on behalf of the patient to collaborate with referral specialists, coordinate the care given by varied organizations such as hospitals or rehabilitation clinics, act as a comprehensive repository for the patient's records, and provide long-term management of chronic conditions. Continuous care is particularly important for patients with medical conditions that encompass multiple organ systems and require prolonged treatment and monitoring, such as diabetes and hypertension.

Studies of the quality of care provided by primary care physicians

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care. However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians.

Studies of the quality of preventive health care find the opposite results – primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination. In health promotion counseling, studies of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients and to screen for breast cancer.

Exceptions may be diseases that are so common that primary care physicians develop their own expertise. A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care, but at lower costs than orthopedic specialists.

Factors associated with quality of care by primary care doctors:

• The more experience the primary care physician has with a specific disease.
• Physician group affiliation with networks of multiple groups.

Dissemination of information to generalists compared to specialists

The dissemination of information to generalists compared to specialists is complicated. Two studies found specialists were more likely to adopt COX-2 drugs before the drugs were recalled by the FDA. One of the studies went on to state "using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication". Similarly, a separate study found that specialists were less discriminating in their choice of journal reading.

Challenges for primary care

Declining numbers

In the United States, the number of medical students entering family practice training dropped by 50% between 1997 and 2005. In 1998, half of internal medicine residents chose primary care, but by 2006, over 80% became specialists. A survey Research by the University of Missouri-Columbia (UMC) and the U.S. Department of Health and Human Services predicts that by 2025 the United States will be short 35,000 to 44,000 adult care primary care physicians.

Causes parallel the evolutionary changes occurring in the US medical system: payment based on quantity of services delivered, not quality; aging of the population increases the prevalence and complexity of chronic health conditions, most of which are handled in primary care settings; and increasing emphasis on life-style changes and preventative measures, often poorly covered by health insurance or not at all. In 2004, the median income of specialists in the US was twice that of PCPs, and the gap is widening. Discontent by practicing primary care internists is discouraging trainees from entering primary care; in a 2007 survey of 1,177 graduating US medical students, only 2% planned to enter a general internal medicine career, and lifestyle was emphasized over the higher subspecialty pay in their decision. Primary care practices in the United States increasingly depend on foreign medical graduates to fill depleted ranks.

Maldistribution

Developing countries face an even more critical disparity in primary care practitioners. The Pan American Health Organization reported in 2005 that "...the Americas region has made important progress in health, but significant challenges and disparities remain. Among the most important is the need to extend quality health care to all sectors of the population...Experience over the last 27 years shows that health systems that adhere to the principles of primary health care produce greater efficiency and better health outcomes in terms of both individual and public health..." The World Health Organization (WHO) has identified worsening trends in access to PCPs and other primary care workers, both in the developed and the developing nations:

• "Worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival"
• "The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular diseases"
• "In health systems, (primary care) workers function as gatekeepers and navigators for the effective, or wasteful, application of all other resources such as drugs, vaccines and supplies"
• "there are currently 57 countries with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and midwives"
• "In many countries, the skills of limited yet expensive professionals are not well matched to the local profile of health needs"
• "...all countries suffer from maldistribution characterized by urban concentration and rural deficits"
• "Richer countries face a future of low fertility and large populations of elderly people, which will cause a shift towards chronic and degenerative diseases with high care demands"
• "Growing gaps will exert even greater pressure on the outflow of health workers from poorer regions"

Lagging quality of care measures

A survey of 6,000 primary care doctors in seven countries revealed disparities in several areas that affect quality of care. Differences did not follow trends of the cost of care; primary care physicians in the United States lagged behind their counterparts in other countries, despite the fact that the US spends two to three times as much per capita. Arrangements for after-hours care were almost twice as common in the Netherlands, Germany and New Zealand as in Canada and the United States, where patients must rely on emergency facilities. Other major disparities include automated systems to remind patients about follow-up care, give patients test results or warn of harmful drug interactions. There were differences as well among primary care doctors, regarding financial incentives to improve the quality of care.

References

UpToDate Contents

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• 1. 集中治療後症候群（PICS） post intensive care syndrome pics
• 2. 在宅における緩和ケアの提供 palliative care delivery in the home
• 3. プライマリケア医および腫瘍専門医のための癌生存ケアの概要 overview of cancer survivorship care for primary care and oncology providers
• 4. 緩和ケア：人生最後の数時間 palliative care the last hours and days of life
• 5. 緩和ケア：ナーシングホーム palliative care nursing home

English Journal

• Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence.

• Schoenthaler A1, Montague E, Baier Manwell L, Brown R, Schwartz MD, Linzer M.
• Ethnicity & health.Ethn Health.2014 Oct;19(5):565-78. doi: 10.1080/13557858.2013.857764. Epub 2013 Nov 22.
• Objectives. To examine the associations between racial/ethnic concordance and blood pressure (BP) control, and to determine whether patient trust and medication adherence mediate these associations. Design. Cross-sectional study of 723 hypertensive African-American and white patients receiving care
• PMID 24266617

• Out-of-hospital follow-up after low risk breast cancer within a care network: 14-year results.

• Houzard S1, Dubot C2, Fridmann S3, Dagousset I3, Rousset-Jablonski C4, Callet N5, Nos C6, Villet R7, Thoury A8, Delaloge S9, Breuil Crockett F10, Fourquet A4.
• Breast (Edinburgh, Scotland).Breast.2014 Aug;23(4):407-12. doi: 10.1016/j.breast.2014.02.006. Epub 2014 Mar 20.
• The delegation of low-risk breast cancer patients' follow-up to non-hospital practitionners (NHP), including gynaecologists and general practitioners, has been assessed prospectively within a care network in the Paris region. Patients with early stage breast cancer were eligible. The follow-up proto
• PMID 24656635

• Follow-up of patients with early breast cancer: Is it time to rewrite the story?

• Puglisi F1, Fontanella C2, Numico G3, Sini V4, Evangelista L5, Monetti F6, Gori S7, Del Mastro L8.
• Critical reviews in oncology/hematology.Crit Rev Oncol Hematol.2014 Aug;91(2):130-141. doi: 10.1016/j.critrevonc.2014.03.001. Epub 2014 Mar 22.
• The guidelines for follow-up in breast cancer survivors support only performance of periodic physical examination and annual mammography. However, medical oncologists and primary care physicians routinely recommend both blood tests and non-mammographic imaging tests in asymptomatic patients, leading
• PMID 24726438

Japanese Journal

• Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma

• Wada Daiki,Nakamori Yasushi,Yamakawa Kazuma,Yoshikawa Yoshiaki,Kiguchi Takeyuki,Tasaki Osamu,Ogura Hiroshi,Kuwagata Yasuyuki,Shimazu Takeshi,Hamasaki Toshimitsu,Fujimi Satoshi
• Critical Care
• … Introduction: Whole-body computed tomography (CT) has gained importance in the early diagnostic phase of trauma care. … The primary inclusion criterion was patients with blunt trauma who required emergency bleeding control (surgery or transcatheter arterial embolization). …
• NAID 120005341844

• がん患者の在宅緩和ケアに関する病棟看護師の認識の現状

• 山本 恵子,四十竹 美千代,村上 真由美,泉 理美子,八塚 美樹
• 富山大学看護学会誌 13(1), 15-24, 2013-06-00
• … The purpose of this study was to elucidate the current understanding of home-basedpalliative care among ward nurses. … Thequestionnaire included subject attributes and 30 items related to nurses' understanding ofhome-based palliative care. …
• NAID 120005342969

• 喘息予防・管理ガイドラインと心身症診断・治療ガイドライン(<特集>呼吸器領域における心身症研究と診療の動向)

• 十川 博
• 心身医学 53(2), 120-129, 2013-02-01
• 気管支喘息(以下,喘息)の治療薬の大きな進展により喘息患者の入院は激減した.しかし,入退院を繰り返す難治性の喘息患者もいる.このような難治化の原因の一つに心理社会的ストレスによる発作の増悪が挙げられる.しかし,心理社会的ストレスは複雑であり,その全貌を把握しにくい.2002年に発刊された『心身症診断・治療ガイドライン』の中に問診表「喘息の発症と経過に関する調査表」が報告されているが,これを用いると …
• NAID 110009578585

Related Links

• Primary care physician - Wikipedia, the free encyclopedia

A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.

• Primary Care - American Academy of Family Physicians

In defining primary care, it is necessary to describe the nature of services provided to patients, as well as to identify who are the primary care providers. The domain of primary care includes the primary care physician, other physicians who ...

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★リンクテーブル★

リンク元	「PCP」「プライマリ・ケア医」
関連記事	「care」「primary」「caring」「car」「physician」

「PCP」

　　[★]

• フェンシクリジン phenyclidine
• primary care physician
• Pneumocystis carinii pneumonia

　

「プライマリ・ケア医」

　　[★]

英

primary care physician

関

かかりつけ医

「care」

　　[★]

• n.

• 心配。心配事、煩労、心労、気苦労、気がかり、悩みのたね
• 関心、配慮、注意。世話、保護、介護、ケア。関心事、責任、用事

care should be taken in combining a beta-blocker with a nondihydropyridine calcium channel blocker.

• vi.

関

anxiety、anxious、anxiously、attend、attendance、attention、attentional、care for、caregiving、caring、caution、cautiously、concern、cure、curing、fear、heed、nervous、note、notice、nursing、nursing care、practice、precaution、remediation、remedy、therapeutic、therapy、treat、treatment、trouble、uneasy、watch、worrisome、worry

　 　 　 　 　 　 　

「primary」

　　[★]

• adj.

• 一次の、第一次の、主要な、(化学)第一級の、一級の、初生の、(病名)原発性の、原発の、プライマリーの

関

cardinal、chief、first-order、foremost、main、mainly、major、master、primarily、principal、principally

　 　 　 　 　 　

「caring」

　　[★]

n.

• 介護、看護、ケアリング

関

attendance、care、caregiving、compassion、empathy、nursing、nursing care

　

「car」

　　[★]

• n.

• 自動車

関

automobile、motor vehicle

　 　 　 　 　

「physician」

　　[★]

• n.

• 医者、医師(=doctor)、内科医