90 Evaluation Of Primary Vs. Specialist Physicians, Outcomes For Common Medical Problems

Author(s): 
SHVARTZMAN Pesach, PORTER Boaz, LISS Zvika, LAHAD Amnon, Ben-Gurion University of the Negev, Beer-Sheva, Israel, e-mail: spesa@bgumail.bgu.ac.iI
Text: 
Background:
For marketing purposes, HMOs in Israel promoted the self-referral approach to specialists, physicians, not considering the effects on quality of care or the cost to the system.
Objectives:
1. To evaluate visits and outcomes for a defined set of problems to ENT; Dermatology and Orthopaedics specialists and to primary care physicians (PCP).
2. To compare outcomes' between these settings.
Methods: Patients visiting their PCP or a specialist during the study period, due to: ear pain, dizziness, loss of hearing, shoulder pain, knee pain; back pain, itch; rash; skin infection, or acne; and this is their first visit for this problem in the past three months, were included. Patients were interviewed by phone using a structured questionnaire regarding severity, tests or referrals and general health services utilization and socio-demographic characteristics. A follow-up interview took place one month later.
Results: 985 patients visiting the PCP and 779 patients visiting the specialists were included. Socio-demographic characteristics were similar. For ENT complaints, PCP saw significantly more severe cases, ordered more tests, prescribed more medications, solved the problem more often and patients satisfaction was higher. For orthopaedic complaints, specialists saw significantly more severe patients, ordered more tests, though PCP solved the problem more often. For dermatology complaints, severity distribution was similar, PCP ordered significantly more tests; prescribed fewer medications, and illness status at follow-up did not differ.
Conclusions:
the model of self-referral to the specialists needs to be re-evaluated specifically in subjects where the benefit of visiting the specialist is not clear.
Literature: 
90 EVALUATION OF PRIMARY VS. SPECIALIST PHYSICIANS, OUTCOMES FOR COMMON MEDICAL PROBLEMS