Introduction: Primary care in the United States today

Abstract

Where does geriatrics fit into the challenges being faced by primary care providers in the United States? There is clearly a paucity of geriatric expertise in primary care. In the known setting of a shortfall of primary care physicians, the hallmarks of primary care are also the key elements of a geriatric approach to care. The Centers for Medicare and Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation (CMMI), began the Comprehensive Primary Care (CPC) initiative, based on the concept of the patient-centered medical home. The CPC implemented five key functions in the delivery of care: (1) access and continuity, (2) planned care for chronic conditions and preventive care, (3) risk-stratified care management, (4) patient and caregiver engagement, and (5) coordination of care across the medical neighborhood. This book will view the geriatric primary care challenge from this and other vantage points. It will look at some of the more robust initiatives that have been set forward in the past several years, with a particular focus on the patient-centered medical home. The most problematic aspect of impacting primary care in older adults may have more to do with a lack of adequate expertise in geriatric medicine among the clinicians in the healthcare workforce.