Family medicine: Primary care practice model at a tertiary care centre.

Abstract

Tertiary care hospitals in India face an increasing patient load, much of which comprises conditions amenable to primary care management. Fragmented, specialist-centric health-seeking behaviour contributes to overcrowding, inefficient resource use, and poor continuity of care. Family medicine, as a comprehensive primary care discipline, offers a potential solution by integrating preventive, promotive, and curative services across the life course. To describe the conceptualisation, implementation, and functioning of a Family Medicine-led primary care practice model embedded within a tertiary care institution. A Family Medicine Outpatient Department (OPD) was established at AIIMS Rishikesh with a primary care orientation to serve as the first point of contact for patients presenting with common, chronic, and preventive health needs. The model was designed around the core principles of comprehensive, continuous, and coordinated care, with structured patient entry points, systematic baseline assessment, and a bidirectional referral mechanism linking family medicine with specialty departments. The practice also incorporated family- and community-oriented approaches through linkage with primary health centres and outreach services. More than 20,000 patients accessed the Family Medicine OPD, receiving longitudinal, family-centred care. The model enabled early risk identification, appropriate gatekeeping, and rational specialist referrals, with patients returning to family medicine for ongoing follow-up after specialised interventions. This approach improved continuity of care, reduced unnecessary specialist consultations, and optimised utilisation of tertiary care resources, while addressing biopsychosocial determinants of health. Embedding a Family Medicine-led primary care model within a tertiary care hospital is feasible and effective in addressing the dual challenges of overcrowding and fragmented care. This model demonstrates the potential of family medicine to function as a care continuum bridge between community-based primary care and tertiary services and offers a scalable framework for strengthening India's healthcare delivery system.