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Randomized controlled trial of residents as gatekeepers
T J Meyer1, A V Prochazka, M Hannaford
1Denver Veterans Affairs Medical Center, USA.
Archives of Internal Medicine
|November 25, 1996
Summary
Internal medicine residents can effectively act as gatekeepers for complex patients, potentially reducing drug costs without negatively impacting patient satisfaction or care utilization. This training is crucial for managed care.
Area of Science:
- Internal Medicine
- Healthcare Management
- Patient Care Coordination
Background:
- Managed care models propose primary care gatekeepers can enhance patient care and lower costs.
- Internal medicine residency programs have historically not prioritized training in gatekeeping functions.
Purpose of the Study:
- To assess the capability of internal medicine residents to perform gatekeeper roles.
- To evaluate the impact of resident-led gatekeeping on patient costs and satisfaction.
Main Methods:
- A controlled study involving 254 patients and 26 residents in continuity clinics.
- Intervention group patients required resident approval for referrals; control group had no restrictions.
- Monitoring of resource utilization, patient satisfaction, and health status over one year.
Main Results:
- The intervention group showed a minor reduction in resource utilization, notably in medication use.
- Patients managed by gatekeeper residents had significantly more primary care visits (3.01 vs 2.59).
- Patient satisfaction and health status were comparable between groups, with a trend towards better satisfaction in the intervention group.
Conclusions:
- Internal medicine residents can successfully function as gatekeepers for complex patient populations.
- Gatekeeping by residents did not compromise patient satisfaction or resource utilization.
- Implementing gatekeeper roles may lead to reduced drug costs and overall healthcare expenditure.