Open research questions in Primary Care and Health Outcomes
56 unresolved questions extracted from the limitations and future-work sections of 1,067 Primary Care and Health Outcomes papers in our library. Each links back to the study that raised it.
What the literature leaves open
Advocacy and community mobilisation efforts should be through Ward-Based Outreach Teams, strengthened community health workers, traditional leaders, and civil society organisations. These stakeholders should conduct structured community dialogues, household visits, and health education sessions to improve understanding of the referral system, including when and how patients should access PHC facilities before seeking hospital-based care. Clear, culturally appropriate messaging, delivered through community meetings, local radio, faith-based gatherings, facilities In addition, coordinated multidisciplinary and clinic open days, should emphasise the role of PHC as the first point of contact and clarify pathways for referral to higher levels of care. Mobilisation efforts should explicitly address stigma related to HIV, TB, and mental illness. This can be achieved by integrating anti-stigma messaging into routine health promotion activities, facilitating safe spaces for open discussion, engaging peer educators and community champions, and incorporating lived experience. individuals with testimonies from Strengthening confidentiality practices at clinics and improving respectful patient-provider communication should accompany these community-based interventions to build trust between communities and the health system. Improved health literacy and reduced stigma are expected to promote earlier care-seeking and more appropriate utilisation of PHC services. To address long waiting times and fragmented care, PHC facilities should implement structured appointment systems for stable chronic patients, including scheduled time slots, differentiated booking days, and reminder mechanisms (e.g. Short Message Service [SMS] or community health worker follow-up). should promote integrated consultations for patients with comorbid conditions, whereby multiple chronic conditions are managed during a single visit by the same provider or through care. These approaches can improve continuity of care, reduce unnecessary repeat visits, streamline patient flow, and ease congestion in facilities, thereby enhancing both operational efficiency and patient experience. Clinical support at the PHC level should be strengthened by expanding structured doctor outreach services to highburden and remote clinics, with scheduled visits (e.g. monthly or bi-monthly) prioritising facilities with high referral rates or limited on-site clinical expertise. Outreach activities joint consultations, case discussions, and on-site skills transfer. These visits should be complemented by regular multidisciplinary case review meetings and ongoing clinical mentoring, either in person or through virtual platforms, to support nurses and other frontline decision-making. Strengthening on-site capacity in this manner may improve the quality of care, enhance provider confidence, and reduce avoidable referrals to higher levels of the health system. Staff performance and supervision should be in-service training on strengthened through regular respectful communication, confidentiality, and stigma reduction. These efforts should be reinforced by structured supervisory visits that monitor staff conduct, referral practices, queue management, and patient experience to promote quality improvement. Medicine availability can be improved by implementing a DHIS-linked stock-monitoring dashboard to provide real-time visibility of stock levels, supported by buffer stock and emergency resupply mechanisms at facility and district levels.
Healthcare workers’ perspectives on patient bypassing of Primary Health Care facilities in Mpumalanga province, South Africa · 2026 · DOITo achieve balanced geographic representation across all three districts in Mpumalanga province, hospitals were initially selected using routine DHIS data, with both main and back-up logistical constraints, particularly delays in obtaining site-level permissions, necessitated the inclusion of the first 10 hospitals that granted approval. The study was qualitative in nature, which means findings are often context-specific and based on small, non-random samples; this restricts the ability to generalise results to broader populations. Social desirability bias is another limitation that may have affected data accuracy. The HCWs may have been hesitant to disclose negative institutional practices because of concerns about professional repercussions. While confidentiality and voluntary participation were emphasised, such biases are inherent risks in facility-based studies involving sensitive service delivery themes. While the study provides important insights into patient behaviour and referral dynamics at the facility level, the findings are not generalisable to the wider Mpumalanga population. The sample was drawn exclusively from public-sector hospitals and therefore may not reflect the perspectives and experiences of individuals who exclusively utilise PHC clinics, private providers or traditional healers. The study focused on HCWs from selected public hospitals, but it could have broadened the understanding of bypassing if HCWs from PHC facilities had also been interviewed.
Healthcare workers’ perspectives on patient bypassing of Primary Health Care facilities in Mpumalanga province, South Africa · 2026 · DOIFamily medicine–specific; rooted in continuity clinic, resident education, and community partnerships Modular “Know/Do” framework with basics, timelines, barriers, and resources Collection of concise pearls, reflections, and practical advice Early career family medicine faculty; program directors and mentors Early career faculty in academic medicine across disciplines Actionable checklists, barrier-mitigation tips, curated resources; strong mentorship guidance Breadth of advice, variety of perspectives, timeless lessons from seasoned educators Supportive and practical, with strategies for navigating the hidden curriculum Inspirational, reflective, and pragmatic, emphasizing career wisdom Departmental orientation, mentorship programs, structured faculty development First chapters dense; limited depth on advanced research/dissemination; no…
New Faculty Guide to Academic Family Medicine: A Collaboration of STFM Collaboratives: Faculty Development and New Faculty · 2026 · DOIEstablishing formal cooperation with family medicine board and fellowship programs in GCC countries, Arab countries, and recognized international institutions would provide opportunities for knowledge exchange, curriculum development, and faculty capacity building.
Future efforts should continue to update FM training curricula and augment candidate numbers in the FMRP to fulfill the quota of 3 family doctors to 10,000 population.
The paper acknowledges that most problems started gradually and progressively being resolved because of greater awareness of PHC's benefits, but does not provide detailed empirical data on the extent or pace of these resolutions.
We address a gap in the literature and pose the question, how are the rank and file of allied healthcare professions governed by professional elites to become responsibilized subjects who will adopt state/profession agendas? Using a Foucauldian governmentality framework, our findings reveal that the rank and file are governed by elites through two technologies: resilience and value making possible a new “legitimate” pharmacist subjectivity related to the market and health care sustainability.
Governing Professionals Through Discourses of Resilience and Value: A New Legitimation for Ontario Pharmacists · 2023 · DOIThere is inconsistency across AFMRD member programs regarding whether new competency areas (Advocacy and Leadership, Population Health, Genomics, POCUS, Telehealth, Lifestyle Medicine, Transitions of Care, Team Based Care) should be required for all graduates, some graduates, or handled through CAQ/added time pathways.
Shaping the Future of Family Medicine: Reenvisioning Family Medicine Residency Education · 2021 · DOIUnlike civic apprenticeships in surgery and pharmacy, in early modern England there was no standard procedure for obtaining education in the practical aspects of the physician’s role, a very uncertain process of certification, and little regulation to ensure a suitable reward for their educational investment.
The paper does not address how the privileging framework should be implemented in health organizations that currently lack formalized credentialing processes or do not employ board-certified preventive medicine physicians. Specific implementation pathways and transition strategies for resource-limited or under-resourced public health departments are absent.
The relationship between the proposed preventive medicine privileging framework and actual licensure outcomes at state medical boards has not been explored. The authors mention that physician licensure without practice privileges may hinder preventive medicine credentialing at regulatory agencies, but no data demonstrates whether implementing the privilege framework would measurably improve licensure recognition across different state jurisdictions.
The authors propose that the American College of Preventive Medicine should develop a standardized privileging template but provide no guidance on how this template should account for variation in organizational context, regional public health priorities, or resource constraints across different health departments and health care systems.
The paper claims that physician leadership of health organizations improves outcomes (citing Sarto and Veronesi, 2016) but does not empirically demonstrate whether preventive medicine physicians specifically deliver superior outcomes compared to other physician specialties in non-clinical leadership positions. Research is needed to quantify outcome differences when preventive medicine-privileged versus non-privileged physicians lead public health organizations.
The framework for non-clinical preventive medicine privileges presented in Table 2 lacks empirical validation across diverse health organization settings. The authors acknowledge these sample privileges are "suggestions" that "do not necessarily reflect expert opinion or professional consensus," indicating the need for systematic testing of the proposed privileging criteria against actual preventive medicine physician competencies and organizational outcomes.
The paper acknowledges increased reliance on international medical graduates in primary care but lacks specific analysis of how many IMG positions could be replaced by domestically trained physicians under different medical school expansion and specialty preference scenarios, or what threshold of IMG dependence creates exacerbated health challenges in source countries.
While telehealth services are identified as increasingly important for expanding primary care access through team-based care models, the paper does not address what evidence exists for effectiveness of telehealth in reducing wait times, improving outcomes, or supporting scope of practice expansion for non-physician providers in distributed or rural settings.
The paper asserts that academic medicine should emphasize primary care training over specialties but provides no framework for measuring how curriculum redesign, faculty recruitment patterns, and institutional resource allocation affect medical school enrollment trends in primary care versus subspecialty tracks.
The paper proposes that financial incentives for primary care providers must shift to reverse the decline from 50% to 33% of physicians in primary care, but does not specify which payment models (fee-for-service modifications, capitation structures, value-based arrangements) have been tested in academic medicine settings or what outcome metrics should evaluate their effectiveness in specialty preference shifts among medical trainees.
The paper identifies that over 50,000 additional primary care physicians will be needed within 10 years due to 30 million newly insured Americans, but lacks empirical analysis of whether scope of practice expansion for nurse practitioners, physician assistants, and licensed pharmacists can quantitatively fill this workforce gap, or what specific metrics should measure their contribution to primary care delivery.
However, few studies were completed after the passage of the 2018 MISSION Act, which significantly shifted hospitalizations to non-VA care.
Quality of hospital medicine care in Veterans Affairs hospitals versus non‐Veterans Affairs hospitals: A systematic review of comparative studies · 2026 · DOIWhile the distinction between research and innovation has been discussed theoretically, little is known about how doctors working in different specialty areas define and understand clinical innovation and how they distinguish it from other related practices.
A Multidisciplinary Model for the Governance of Clinical Innovation: Insights From a Qualitative Study of Australian Doctors · 2025 · DOIThe field requires expanded approaches connecting institutional dimensions of social medicine involving the state, academe, the medical profession, and the medical complex with broader people's health struggles.
Social medicine history needs more sustained focus on social movements, including sociopolitical incorporation of marginalized peoples and struggles around health justice, Indigenous rights, workers' rights, racial justice, gender justice, and environmental justice.
Health movements that challenge capitalist and imperialist hegemony yet fail to confront patriarchy in their own practices represent analogous moments worthy of historian's analytic examination.
The involvement of social medicine in Pink Tide administrations presents dilemmas when redistribution is extractivism-based and leads to destruction of Indigenous communities and lands; historians of social medicine should examine such contradictions.
Most-cited papers in Primary Care and Health Outcomes
- Concentration and Quality of Hospitals That Care for Elderly Black Patients · Archives of Internal Medicine · 2007 · 255 citations
- Defining Family-Centered Rounds · Teaching and Learning in Medicine · 2007 · 146 citations
- A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance · International Journal of Nursing Studies · 2024 · 107 citations
- Developing and introducing evidence based clinical practice guidelines for serious illness in Kenya · Archives of Disease in Childhood · 2008 · 78 citations
- National survey highlights worsening primary care access · Canadian Medical Association Journal · 2023 · 74 citations
- Medication as Infrastructure: Decentring Self-care · Culture Unbound Journal of Current Cultural Research · 2012 · 66 citations
- Effectiveness of nurse–led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review · International Journal of Nursing Studies · 2021 · 59 citations
- Changing Logics in Healthcare and Their Effects on the Identity Motives and Identity Work of Doctors · Organization Studies · 2020 · 51 citations
- Health care administrative burdens: Centering patient experiences · Health Services Research · 2021 · 49 citations
- Medical Care Delivery in U.S. Nursing Homes: Current and Future Practice · The Gerontologist · 2020 · 46 citations
Most recent work
- Has denigration of career choice within medicine improved in the UK over the last decade? · Education for Primary Care · 2026
- Advancing Clinical Mastery: An Essential Element of Primary Care Revitalization · Annals of Internal Medicine · 2026
- Incentivizing Deprescribing for Health Care Quality Not Quantity · Annals of Internal Medicine · 2026
- New Faculty Guide to Academic Family Medicine: A Collaboration of STFM Collaboratives: Faculty Development and New Faculty · Family Medicine · 2026
- MED AGENCY · International Research Journal of Modernization in Engineering Technology & Science · 2026
- Family medicine and primary health care in Liberia · African Journal of Primary Health Care & Family Medicine · 2026
- Contextualization of Clinical Care in General Medicine · Journal of Diseases Disorders & Treatments · 2026
- Healthcare workers’ perspectives on patient bypassing of Primary Health Care facilities in Mpumalanga province, South Africa · African Journal of Primary Health Care & Family Medicine · 2026
- Revitalizing Primary Care Internal Medicine: Addressing the Hidden Curriculum · Annals of Internal Medicine · 2026
- From private office to locker room: how corporate America is transforming academic family medicine · Frontiers in Medicine · 2026
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