Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

摘要

id="p1">Background: Comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings. id="p-2">Methods: Secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity. id="p-3">Results: There is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry. id="p-4">Conclusions: Care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care. class="kwd-group KWD">

>class="kwd-search" href="/search?fulltext=Family+Practice&sortspec=date&submit=Submit&andorexactfulltext=phrase">Family Practice

>class="kwd-search" href="/search?fulltext=Nonlinear+Dynamics&sortspec=date&submit=Submit&andorexactfulltext=phrase">Nonlinear Dynamics

>class="kwd-search" href="/search?fulltext=Quality+of+Care&sortspec=date&submit=Submit&andorexactfulltext=phrase">Quality of Care

>class="kwd-search" href="/search?fulltext=Specialization&sortspec=date&submit=Submit&andorexactfulltext=phrase">Specialization

>class="kwd-search" href="/search?fulltext=Systems+Theory&sortspec=date&submit=Submit&andorexactfulltext=phrase">Systems Theory id="p-5">Although ecological studies consistently find that the supply of primary care physicians is associated with better quality of care, better population health, and lower cost of care,id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1 there is a sizable body of literature suggesting that, compared with generalists, specialists are more likely to provide effective disease-specific care, but at a cost of increased resource use and hospital stays.id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2 Comparison studies suggest that the process quality of care provided for specific medical conditions is poorer in primary care than in specialty settings. id="p-6">Specifically, when comparing generalists with cardiologists, family physicians more often recommend therapies, which are less beneficial for acute myocardial infarction, than do cardiologists,id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3,id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 with an inconsistent finding of higher mortality.id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5,id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 Similarly, patients with unstable angina are less likely to receive effective treatments if treated by generalists rather than cardiologists.id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7,id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8 In addition, compared with generalists, cardiologists are less likely to order tests but prescribe more medications for hypertension and ischemic heart disease.id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9 Cardiologists also perform more cardiac catheterizations,id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10 more echocardiograms, and prescribe more evidence-based medications for patients with heart failure.id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11,id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12 Consequently, patients hospitalized for heart failure had higher short-termid="xref-ref-13-1" class="xref-bibr" href="#ref-13">13 and long-termid="xref-ref-14-1" class="xref-bibr" href="#ref-14">14 mortality rates if cared for by generalists. However, because the patients seen by family physicians often differed significantly from those seen by cardiologists in many demographic and clinica