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Do primary physicians actually manage their patients' fee-for-service care?
A J Dietrich1, E C Nelson, J W Kirk
1Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756.
JAMA
|June 3, 1988
Summary
Primary physicians manage a significant portion of patient healthcare, coordinating ambulatory visits, nonphysician provider care, hospitalizations, and prescriptions. This case management role extends beyond formal managed-care systems.
Area of Science:
- Primary Care Medicine
- Health Services Research
- Healthcare Management
Background:
- The role of primary care physicians in coordinating patient healthcare is crucial for effective health management.
- Understanding the extent of primary physician involvement in various healthcare services is essential for system evaluation.
Purpose of the Study:
- To determine the proportion of a patient's total healthcare managed by their primary physician.
- To assess the primary physician's role in coordinating ambulatory visits, nonphysician provider care, hospitalizations, and prescriptions.
Main Methods:
- Prospective study following 211 primary care patients for one year.
- Utilized calendar diaries and telephone interviews for data collection.
- Analyzed patient encounters, including physician visits, nonphysician provider visits, hospitalizations, and prescriptions.
Main Results:
- Primary physicians managed 75% of ambulatory physician visits and 33% of nonphysician provider visits.
- They were involved in 81% of nonemergency hospitalizations and 78% of prescriptions.
- Significant primary physician management occurred even outside formal managed-care systems.
Conclusions:
- Primary physicians play a substantial role in managing patient care across various healthcare settings.
- They function as de facto case managers, coordinating services and influencing healthcare utilization.
- Findings highlight the importance of primary care in integrated healthcare delivery.