Managed care controls and physicians' perception of their ability to deliver quality care and maintain continuing relationships with patients.

摘要

Study aim. To assess whether managed care cost and utilization control measures are associated with physicians' perception regarding their ability to deliver quality health care and their perceived ability to maintain continuing relationships with patients.; Methods. Cross sectional analysis of the 1998-1999 Community Tracking Study (CTS) Physician Survey was conducted. The CTS data were used to study how primary care physicians subjected to cost and utilization control measures perceive their ability to deliver quality health care given these experiences. In an attempt to select the explanatory variables to be used in a multivariate model, simple logistic regression was used to assess relationships between the explanatory variables and the dependent variables, perceived ability to deliver high quality care and perceived ability to maintain a continuing relationship with patients. Multiple logistic regressions were used to determine the multiple explanatory covariates that are significantly associated with the dependent variables.; Results. Physicians' professional autonomy and the amount of time they are able to spend with their patients during a patient visit were crucial indicators of their perceived ability to deliver quality care and maintain a continuing relationship with their patients. The results indicate, after controlling for physician and practice setting characteristics those physicians who agreed strongly with the statement "I have the freedom to make patient care decisions" had increased odds (OR. 9.61, CI 6.37-14.51) of agreeing with the statement "It's possible to provide high quality care to all my patients" and had increased odds (OR. 6.95, CI 4.81-10.04) of agreeing with the statement "I have the ability to maintain a continuing relationship with patients" than physicians who disagree strongly with the freedom statement. In addition, physicians that agreed strongly with the statement "I have adequate time to spend with my patients during a patient visit" had four times the odds of agreeing with the quality statement (OR 4.59, CI 3.25-6.48) and the continuity relationship statement (OR 4.02, CI 2.88-5.62) than physicians who disagreed strongly with the adequate amount of time statement.; Study limitations. Estimates regarding physicians' ability to deliver high quality health care were derived from physicians' perceptions and were not verified.; Conclusions. The study suggests that physicians perceive that their ability to adequately care for patients could be compromised by managed care's control over their professional autonomy and the lack of time available to see patients. (Abstract shortened by UMI.)