Health Services Researcher Lu Ann Aday: Primary Care and Health Services Researchers as Partners

John G. Ryan

Lu Ann Aday, PhD, Lorne Bain Distinguished Professor in Public Health and Medicine at the University of Texas School of Public Health, shared her thoughts on the synergy of health services research and primary care research in an interview with NAPCRG Newsletter Editor John G. Ryan, DrPH. The complete interview is published in the February 2003 NAPCRG Newsletter, available online at www.napcrg.org.

Dr. Aday’s comments were apropos the theme of the 2002 Annual Meeting of the North American Primary Care Research Group, “Building Research Infrastructure.” Many primary care researchers recognize the urgency of establishing a nonparochial, transdisciplinary approach to health care research, as suggested by Dr. Aday. But more important, Dr. Aday was addressing the underlying subtheme of the 2002 Annual Meeting, “Health and Health Care Disparities: Geographic, Racial, Economic, and International.” Kurt Stange, MD, PhD, NAPCRG president, called disparities in health care “an indisputable problem that has defied quick-fix solutions. ...” NAPCRG’s 2003 Meeting, Oct 25–28, at the Fairmont Banff Springs, in Banff, Alberta, builds on these twin themes by addressing the benefits of linking researchers, communities, and funders.

JR: What motivated you to pursue the study of health care access and equity?

LA: I was inspired by John F. Kennedy’s invitation to, “Ask not what your country can do for you, but what you can do for your country.” After completing my masters, I joined Volunteers in Service to America. This experience provided a strong experiential base for undertaking my doctoral studies in health services research on access to care for vulnerable populations. Upon receiving my doctorate in 1973, I joined the Center for Health Administration Studies of the University of Chicago. At CHAS, I was privileged to work with Odin Anderson and Ronald Andersen, who had done much of the foundational conceptual and empirical work at that time on the predictors and indicators of equity of access to health care.

JR: How do you see disparities at the primary-health-care level increasing as a result of the current malpractice insurance crisis in the United States?

LA: Whether the malpractice crisis has increased in intensity; and, if so, why, and who is most likely to bring suit – middle class or socioeconomically disadvantaged clients – are questions that have been pursued by health services researchers over the last several decades. One perspective, however, is that the perceived crisis is probably best viewed as a sentinel indicator of deeper problems with the US health care system. Health services research has documented that patient adherence and satisfaction are enhanced by effective patient-provider communication, continuity in the doctor-patient relationship, time spent in the clinical encounter, and associated trust of medical care providers. The increasing “corporatization” of medical care and associated transformations in the systems of organizing and financing services have presented major challenges to maintaining these qualitative dimensions of the patient-provider encounter. These aspects of care may be particularly compromised, because of either system or interpersonal factors, in health care for minorities and socially disadvantaged populations. The question then becomes, How should more fundamental system problems, which may be signaled by malpractice insurance rates and claims, be addressed?

JR: How do you see health services research and primary care research linking more closely and effectively in the next 5 to 10 years?

LA: Primary care research brings a unique and important perspective to illuminating timely and important health services research questions. This IOM definition of primary care aptly reflects the essential elements of primary care that also present the biggest challenges in addressing many of the issues of health and health care disparities discussed earlier: the quality and characteristics of the doctor-patient partnership and the role of family and related cultural and community context in health care. Primary care researchers can be full and insightful partners in the design and conduct of research to identify the role of these factors in influencing the quality and outcomes of care.