The analysis of consultation as a practice pattern.

摘要

Relatively little is known about the patterns, correlates or consequences of physician referrals in the United States. Even less is known about patterns of physician consultation. Therefore the primary objective of this study is to identify correlates associated with the likelihood of a consultation focusing on ischemic heart disease (IHD), which has substantial implications in terms of prevalence, practice patterns, resource utilization and costs. As a secondary objective, it also identifies correlates associated with the likelihood of other practice patterns for IHD, including referral and treatment by the usual physician. In addition, the study examines the interventions and related costs for IHD across these different practice patterns.; The study extrapolates the theoretical and descriptive evidence available on referrals to develop a model of the consultation process. This model includes physician, patient, and community health system characteristics and their influence on the decision making process (of both physicians and patients) involved in seeking care, and initiating and complying with a consultation (which results in the occurrence of a consultation).; The data used in this study consist of patient, usual physician, and health system characteristics, which have been compiled by linking together three data sources. These include information on patient characteristics as well as claims data on medical conditions, procedures, and costs for individual patients from the Medicare Current Beneficiary Survey for the years 1992 to 1995. This is combined with physician data (including specialty, practice type, age, and number of years in practice) from the Physician Identification Master Record file (1994) as well as information on county level descriptors (such as health facilities and health professions manpower) from the Area Resource File (based on the 1990 census).; The findings from this study indicate that practice patterns including consultation, referral, and treatment by the usual physician, are primarily influenced by the specialty type of the usual physician and patient need (IHD severity, self reported health status). Consultation and referral are less likely to occur if the usual physician is a specialist. On the other hand, higher IHD severity and poor or fair self reported health status increase the likelihood of these practice patterns. Referral and treatment by the usual physician are also directly related to the presence of supplemental insurance coverage (either obtained through Medicaid, privately purchased, or employer sponsored). Compared to treatment by the usual physician and even referral, consultation is associated with a higher likelihood of any IHD related intervention or multiple interventions. (Abstract shortened by UMI.)