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Family medicine and primary care face ongoing pressures for access, with demand for care overwhelming the capacity to deliver it. Common strategies to maximize access often operate to the exclusion or detriment of continuity of care. During the August 2025 Family Medicine Leadership Consortium meeting, rather than presuming a tradeoff between the two as inevitable, the proposition that family medicine is committed to improving access to continuity of care was put forth.
This article summarizes concepts and models for improving access that simultaneously preserve or elevate continuity of care. A full understanding of access requires nuanced data around demand and capacity at the day-to-day level. This data can be used to prioritize both access and continuity by incorporating both into appointment templates, right-sizing panels, and directing capacity to the times of greatest demand. Investing in innovative team models such as those incorporating upskilled medical assistants, or panels shared among small teams of physicians and advanced practice practitioners, allow expanded capacity to deliver access while maintaining continuity. Advanced access scheduling models build on foundations of managing demand and capacity to most efficiently match day-to-day visit capacity to demand and maximize access to the continuity clinician.
Improving access and continuity of care do not have to be a zero-sum game—by valuing and centering continuity among access interventions, healthcare systems can shift the paradigm between access and continuity from “either/or” to a symbiotic relationship, with access meaning access to continuity of care.
Hand eczema is an inflammation of the skin of the hands that tends to run a chronic, relapsing course. This common condition is often associated with itch, social stigma, and impairment in employment. Many different interventions of unknown effectiveness are used to treat hand eczema.
OBJECTIVES:
To assess the effects of topical and systemic interventions for hand eczema in adults and children.
SEARCH METHODS:
We searched the following up to April 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, AMED, LILACS, GREAT, and four trials registries. We checked the reference lists of included studies for further references to relevant trials.
SELECTION CRITERIA:
We included randomised controlled trials (RCTs) that compared interventions for hand eczema, regardless of handeczema type and other affected sites, versus no treatment, placebo, vehicle, or active treatments.
DATA COLLECTION AND ANALYSIS:
We used standard methodological procedures expected by Cochrane. Primary outcomes were participant- and investigator-rated good/excellent control of symptoms, and adverse events.
Health care spending in the United States totaled $3.3 trillion in 2016, more than double the amount spent in 2000. Twenty percent of the cost went toward physician services, with primary care accounting for approximately 7 percent.
These rising costs have real consequences for patients. A Kaiser Family Foundation survey found that, because of cost, 67 percent of the uninsured and 21 percent of the insured had forgone needed medical care. To address costs, payers are increasingly adopting reimbursement models that reward or penalize physicians based on their ability to keep costs down.
Now here’s the good news: When it comes to rising health care costs, we in primary care are not the main problem, but we are a key part of the solution. This article will explain how improving access to primary care can reduce costs and the steps practices should begin taking now.
