Patient preferences for care by general internists and specialists in the ambulatory setting

Abstract

OBJECTIVE:To investigate patients' preferences for care by general internists and specialists for common medical conditions. DESIGN: Telephone interview.SETTING: A convenience sample of general internal medicine practices at 10 eastern academic medical centers.PATIENT/PARTICIPANTS: A probability sample of 314 participants who had at least one visit with their primary care physician during the preceding 2 years. MEASUREMENTS AND MAIN RESULTS:Items addressed patients' attitudes concerning continuity of care, preferences for care by general internists or specialists for common medical problems, and perceptions about the competency of general internists and specialists to manage these problems. Continuity was important to participants, with 63% reporting they preferred having one doctor. Respondents were willing to wait 3 or 4 days to see their regular doctor (85%) and wanted their doctor to see them in the emergency department (77%) and monitor their care while in the hospital (94%). A majority ( Ͼ 60%) preferred care from their regular doctor for a variety of new conditions. Though respondents valued continuity, 84% felt it was important to be able to seek medical care from any type of physician without a referral, and 74% responded that if they needed to see a specialist, they were willing to pay out-ofpocket to do so. Although most participants (98%) thought their regular doctor was able to take care of usual medical problems, the majority thought that specialists were better able to care for allergies (79%) and better able to prescribe medications for depression (65%) and low-back pain (72%). CONCLUSIONS:Participants preferred to see their general internist despite their perceptions that specialists were more competent in caring for the conditions we examined. However, they wanted unrestricted access to specialists to supplement care provided by general internists.

Patients' Perceptions of Interpersonal Continuity of Care

“…The studies utilized quantitative (19/36) 11,12 One study of patients at eastern United States academic medical center faculty practices found that nearly two thirds of patients preferred having one doctor take care of them. 11 Another study of HMO patients from New England reported that over 90% of respondents thought it was important or very important to have the same primary care physician take care of them over time.…”

“…11 Another study of HMO patients from New England reported that over 90% of respondents thought it was important or very important to have the same primary care physician take care of them over time. 12 Few studies have looked at practice characteristics and patients' preference for site continuity versus interpersonal continuity.…”

“…8 Interpersonal continuity has been studied in patients with specific chronic conditions and found to be important to parents of children with cleft lip and palate, 26 asthma, 28 and to patients with rheumatic diseases. 30 Other studies have found that the majority of patients state a preference for their regular doctor for potentially chronic conditions such as back pain, 11,31 seasonal allergies, and depression. 11 Patients with chronic illness were found to value regular visits with their physician to check the progression of their disease.…”

“…30 Other studies have found that the majority of patients state a preference for their regular doctor for potentially chronic conditions such as back pain, 11,31 seasonal allergies, and depression. 11 Patients with chronic illness were found to value regular visits with their physician to check the progression of their disease. 32 Besides interpersonal continuity, chronic disease patients seem to value the transfer of their medical information between providers, which has been termed informational continuity.…”

Older Patients Perceptions of “Unnecessary” Tests and Referrals

“…This finding is consistent with previous work. 13 At the same time, our findings suggest that older patients may hold fast to their ideas that more tests and referrals are needed even when their generalist provides advice to the contrary. In response to our vignettes, 30% to 75% of patients said they would want a diagnostic test or specialty referral that their generalist thought was unnecessary.…”