2015/4/7

19GP
Lancet

Flexner Report(1910)

The Committee on the Costs of Medical Care(CCMC), a private group established with
support from foundations, carried out the rst comprehensive study of health care in
this country and, in 1932, stated that ''each patient would be primarily under the charge
of the family practitioner [and] would look to his physician for guidance and
counsel on health matters and ordinarily would receive attention from specialists when
referred" (CCMC, 1932, p. 63).
WWII

Coggeshall report (1965)AAMCBlue Ribbon Committee

Millis Commission report (1966)AMA

A physician who focuses not upon individual organs and systems but upon the whole
man, who lives in a complex setting knows that diagnosis or treatment of a part often
overlooks major causative factors and therapeutic opportunities.
http://www.aafpfoundation.org/online/etc/medialib/found/documents/programs/chfm/
millisreport.Par.0001.File.tmp/Millis_Report.pdf

Folsom Report(1966)American Public Health Association and the National

Health Council
Every individual should have a personal physician who is the central point for
integration and continuity of all medical services to his patient. Such physician will 0
emphasize the practice of preventive medicine He will be aware of the many and
varied social, emotional and environmental factors that inuence the health of his
patient and his family His concern will be for the patient as a whole, and his
relationship with the patient must be a continuity one
Willard Committee report (1966)
The American public does want and need large numbers of qualied Family Physicians

1960

1979

(44)7.1960

1980

1963

1985

1978

1986

1969AAFP

2002
1993

1972WONCA

2000
2010

1976

Classics in Family MedicineAAFP

http://www.aafpfoundation.org/online/foundation/home/programs/center-history/
classics.html
The History of Family Medicine and Its Impact in US Health Care Delivery, Cecilia
Gutierrez, MD & Peter Scheid, MD
http://www.aafpfoundation.org/online/etc/medialib/found/documents/programs/chfm/
foundationgutierrezpaper.Par.0001.File.tmp/foundation-gutierrezpaper.pdf

http://www.hcfm.jp/family/history.html

http://hcfmdr.blogspot.jp/2010/11/blog-post.html

2012, Vol.35, no.2, p120124

https://www.jstage.jst.go.jp/article/generalist/35/2/35_120/_pdf

Tie-up 2003 .11

http://square.umin.ac.jp/masashi/pc.PDF


AAFP

consultant

Biomedical

Denition of Primary Care: AMA Policy H-200.969 Denition of Primary Care

(1) The AMA rejects the denition of primary care as stated in the March 1996 report
of the Institute of Medicine as "the provision of integrated accessible health care
services by clinicians." The AMA believes that primary care consists of the provision
of a broad range of personal medical care (preventive, diagnostic, palliative,
therapeutic, curative, counseling and rehabilitative) in a manner that is accessible,
comprehensive and coordinated by a licensed MD/DO physician over time. Care may
be provided to an age-specic or gender-specic group of patients, as long as the
care of the individual patient meets the above criteria.
(2) The AMA encourages the eorts to dene what constitutes primary care services.
Data should be collected on which specialties currently provide these services, and
how these services are integrated into the practice of physicians. Such data are
essential to determine future physician workforce needs in primary care.
(3) The AMA encourages that training programs for physicians who will practice
primary care include appropriate educational experiences to introduce physicians to
the required knowledge and skills, as well as to the types of services and the modes
of practice that characterize primary care.
(4) Where case management or coordination might limit access to appropriate medical
care, patients should have the freedom to see a physician appropriate for the
services they need, regardless of specialty. Above all, the best interests of the
patient must be paramount.
IOM
patientcentered medicine

Institute of Medicine(IOM)
Primary care as the provision of integrated, accessible health care services by clinicians
who are accountable for addressing a large majority of personal health care needs,
developing a sustained partnership with patients, and practicing in the context of family
and community.
IOM5
1. Primary care is the logical foundation of an eective health care system because it
can address the large majority of the health problems present in the population.
2. Primary care is essential to achieving the objectives that together constitute value in
health care: high quality of care, including achievement of desired health outcomes;
patient satisfaction; and ecient use of resources.
3. Personal interactions that include trust and partnership between patients and
clinicians are central to primary care.
4. Primary care is an important instrument for achieving stronger emphasis on both
ends of the spectrum of care: (a) health promotion and disease prevention and (b) care
of the chronically ill, especially among the elderly with multiple problems.
5. The trend toward integrated health care systems in a managed care environment will
continue and will provide both opportunities and challenges for primary care.

managed careAMA

1.
2.

3.
4.
5.

6.
7.
8.
9.
10.
11.
12.

1.
2.

3.
4.
McWhinney9
1.
2.
3.
4.Population at risk

5.

6.
7.
8.
9.
McWhinney IR, Freeman T. Textbook of Family Medicine. New York: Oxford University
Press, 2009
IOM
1.Access to Care
2.Continuity of Care
3.Comprehensive Care
4.Coordination of Care
5.Accountability
http://www.primary-care.or.jp/paramedic/index.html
JPCA
http://www.primary-care.or.jp/public/primarycare_iryo.pdf

BPS

EBMNBMPOEM

BPSPOEM

(capitation)

FPGP

FPFM

Generalist6McWhinney

Generalist

Generalist

2.Generalist
CommonGeneralist

gate-keeping

http://www.ipp.hit-u.ac.jp/consultingproject/2012/CP12Masubuchi.pdf

Introduction

QOL

McWhinney IR, Freeman T. Textbook of Family Medicine. New York: Oxford University
Press, 2009
Family Practice Family
Practice Residency 2004 Vol.11 No.1
http://plaza.umin.ac.jp/jafm/journal/pdf/vol11no1/11_1_66.pdf