Competing demands and opportunities in primary care

Historically, preventive interventions have yielded dramatic improvements in population health, with substantial benefits in patient-oriented outcomes including death from infectious disease and infant mortality. As medicine evolves, greater numbers of preventive and screening recommendations are encouraged, most often under the auspices of primary care. An aging population, often with multiple comorbidities, has also affected service delivery in primary care, with numerous recommendations for chronic disease management. Increasing time spent in one area must be balanced by a thoughtful review of what might be lost. The concept of competing demands in primary care is not a new one. Almost a quarter of a century ago, authors recognized that competing demands, including acute care, patient requests, chronic illnesses, psychosocial problems, screening, counseling for behavioural change, and administration and management of patient care, presented a substantial barrier to the provision of specific services to patients.1 In this paper, we estimate the feasibility of implementing current demands in primary care, as well as the relative benefits of these interventions, including screening and preventive health care, chronic disease management, and caring for patients with acute medical conditions