Evidence lacking for identifying optimal primary care panel size
There is insufficient evidence for making recommendations about the optimal primary care panel size for achieving the most beneficial health outcomes, according to a review published online Jan. 21 in the Annals of Internal Medicine.
Neil M. Paige, M.D., from the West Los Angeles Veterans Affairs Medical Center and David Geffen School of Medicine at the University of California, and colleagues reviewed evidence for the association between primary care panel size and health care outcomes and provider burnout. Data were included from 16 hypothesis-testing studies and 12 simulation modeling studies.
The researchers found that low-certainty evidence provided by three studies demonstrated that increasing panel size was associated with no or modestly adverse effects on patient-centered and effective care. Increasing panel size was associated with variable effects on timely care, based on low-certainty evidence from eight studies. The effect of panel size on safety, efficiency, or equity was not assessed in any studies. Very low-certainty evidence of an association between increased panel size and provider burnout was provided by one study. Five models were assessed in the 12 simulation studies. Moderate-certainty evidence was provided by five and two studies showing that adjusting panel size for case mix and adding clinical conditions to the case mix resulted in better access.
"The evidence about the association between primary care panel size and the aims of health care is modest at best," the authors write. "Current recommendations about panel size are based more on historical experience than on evidence."
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