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Primary Care Research

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Both general internists and family physicians provide primary care, but their practice styles and resource use differ

For the most part, family physicians and general internists (who usually care for older, sicker patients) coordinate primary care in the United States. However, they have different practice styles, which in turn affect medical charges, conclude two studies by Klea D. Bertakis, M.D., M.P.H., of the University of California, Davis (UCD) School of Medicine. In a study supported by the Agency for Health Care Policy and Research (HS06167), Dr. Bertakis and her colleagues randomized 509 adults requesting an outpatient appointment between 1990 and 1994 at the UCD Medical Center to either a family practice clinic or a general medicine clinic.

Even after controlling for differences in patients' initial health status, a technically oriented style of care by general internists was associated with significantly more specialty care, emergency department (ED), diagnostic, and total charges over 1 year of care. The technically oriented practices included structuring the doctor-patient interaction, history taking, asking for family information, performing a physical exam, giving evaluation feedback, planning treatment and discussing its effects, and performing in-office procedures. Caring for sicker patients often calls for the more technical style of care shown by general internists. However, training physicians to use such a style for all patients is expensive and possibly unnecessary, note the researchers.

Family practice patients had significantly more primary care clinic visits, perhaps preempting ED visits, and tended to have fewer diagnostic tests than patients seen by general internists. There were no significant differences in charges for specialty clinic visits, hospitalizations, or diagnostic services. Even for the healthiest patients, those randomized to general internal medicine had significantly higher charges for primary care than those assigned to family practice. General internists might consider using fewer health resources for their healthiest patients, suggest the researchers.

Details are in "Differences between family physicians' and general internists' medical charges," by Dr. Bertakis, L. Jay Helms, Ph.D., Dr. Rahman Azari, Ph.D., and others, in Medical Care 37(1), pp. 78-82, 1999; and "The impact of physician practice style on medical charges," by Dr. Bertakis, Dr. Azari, Edward J. Callahan, Ph.D., and others, in the January 1999 Journal of Family Practice 48(1), pp. 31-36.

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