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Effect of physician specialty on use of necessary coronary angiography
S J Borowsky1, R L Kravitz, M Laouri
1Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minnesota 55417, USA.
Insights
Patients with a regular cardiologist are more likely to receive timely coronary angiography. This highlights the importance of specialist care in managing ischemic heart disease effectively.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Quality Improvement
Background:
- Debate on primary care vs. specialist roles in healthcare.
- Limited data on interspecialty quality of care for ischemic heart disease.
Purpose of the Study:
- To determine if having a cardiologist influences the likelihood of undergoing necessary coronary angiography.
- Investigate the impact of specialist care on timely cardiac procedures.
Main Methods:
- Survey of 243 patients with positive stress tests.
- Random sampling from university and public hospitals (1990-1991).
- Assessed regular source of care (cardiologist vs. other).
Main Results:
- 47% underwent angiography within 3 months, 61% within 12 months.
- Patients with a cardiologist were more likely to undergo angiography (52% vs. 38% at 3 months; 74% vs. 44% at 12 months).
- Trend for stronger effect in public hospitals.
Conclusions:
- Regular cardiologist care increases likelihood of timely, necessary coronary angiography.
- Specialist access is crucial for optimal management of ischemic heart disease.
Objectives:
This study sought to determine whether having a cardiologist as a regular source of care influences likelihood of undergoing necessary coronary angiography.
Background:
An important element of the current health policy debate is the respective roles of primary care and specialist physicians. However, there are few data on interspecialty differences in quality of care for patients with ischemic heart disease.
Methods:
We contacted 243 patients by telephone (response rate 72%) who had positive (or very positive) exercise stress test results and met additional clinical criteria for necessary coronary angiography. Study patients were randomly sampled from those undergoing exercise stress testing at one university and three public hospitals in Los Angeles between January 1, 1990 and June 30, 1991. Patients were asked whether they had a regular source of care during the time after their exercise stress test and, if so, whether that provider was a cardiologist or cardiology clinic.
Results:
Among survey responders, 47% underwent necessary coronary angiography within 3 months of exercise testing and 61% within 12 months. After adjustment for sociodemographics and clinical presentation, patients with a cardiologist as a regular source of care were more likely than all other patients to have undergone necessary angiography within 3 months (52% vs. 38%, p = 0.05) and within 12 months (74% vs. 44%, p = 0.0001) of the exercise test. At 3 months, there was a trend toward a more pronounced effect of ongoing cardiologic care within the public hospitals compared with the private hospital (p = 0.09 for interaction between hospital types).
Conclusions:
Patients with a cardiologist as a regular source of care were more likely than all other patients to undergo clinically necessary coronary angiography within both 3 and 12 months of exercise stress testing.