THE IMPACT OF NOT HAVING A PRIMARY CARE PHYSICIAN AMONG PEOPLE WITH CHRONIC CONDITIONS: A SYSTEMATIC REVIEW

Abstract

Background: Chronic conditions represent a major global health burden, and primary care physicians (PCPs) play a central role in their prevention and management. However, declining PCP availability and lack of access remain pressing concerns.

Objective: To systematically review the evidence on the impact of not having a PCP among individuals with chronic conditions, examining health outcomes, healthcare utilization, and intervention effectiveness.

Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Embase, CINAHL, and grey literature sources for studies published between 2000 and 2024. Eligible studies included adults with chronic conditions, comparing those with and without PCP access, and reported outcomes such as morbidity, mortality, hospitalizations, or healthcare utilization. Data extraction and quality appraisal were performed independently by two reviewers.

Results: Twenty-two studies met inclusion criteria, comprising randomized controlled trials, cohort studies, cross-sectional surveys, and epidemiological analyses across multiple countries. Patients without PCPs consistently demonstrated higher ED use, hospital admissions, and polypharmacy risks. Population-level analyses showed that greater PCP density was associated with longer life expectancy and lower mortality. Interventions embedded in primary care improved diabetes control, slowed kidney disease progression, reduced COPD admissions, and mitigated frailty. Vulnerable populations experienced disproportionately negative outcomes in the absence of PCP access.

Conclusions: Lack of PCP access is strongly linked to adverse outcomes in chronic disease management, while continuity of care provides substantial clinical and system-level benefits. Strengthening PCP supply, ensuring equitable access, and adopting innovative care models are critical to addressing the rising global burden of chronic disease.