Is general practice effective? A systematic literature review.

OBJECTIVE: To find evidence of the effectiveness of physicians working in primary care.
DESIGN: Systematic literature search in the Medline and Cochrane databases. MATERIAL: Out of 7223 titles found in the search, 45 studies, comparing, from different aspects, primary care with specialist care, were extracted. MAIN OUTCOME MEASURES: Health indicators, health care costs, quality of health care.
RESULTS: Primary care contributed to improved public health, as expressed through different health parameters, and a lower utilisation of medical care leading to lower costs. Physicians working in primary care, in comparison with other specialists, took care of many diseases without loss of quality and often at lower cost. The organisation of primary care was important in respect of reimbursement by capitation, more group practices, higher personal continuity, and having generalists as primary care physicians.
CONCLUSIONS: To compare the effectiveness of primary care and specialist care is a complex task and there are limitations in all studies. However, we have found evidence that increased accessibility to physicians working in primary care contributes to better health and lower total costs in the health care system. It is also clear that studies with evaluation of how to most effectively organise primary care are far too few. There is an extensive need for future research in this area, a suitable task for collaborative research between the Nordic countries.