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Patients in managed care plans want primary care physicians to be coordinators, not gatekeepers

Nine of every 10 California patients in managed care plans say that they value having a primary care doctor provide their everyday care, and 89 percent say they value having a primary care doctor coordinate their specialty care. These are the findings of a recent study supported by the Agency for Health Care Policy and Research. But nearly one-fourth of the patients studied had difficulty getting referrals to specialty care, which according to researchers is a reason why some may lose trust and confidence in their primary care doctors.

The study team, led by Kevin Grumbach, M.D. of the University of California, San Francisco, and Joe V. Selby, M.D., M.P.H., of Kaiser Permanente Medical Care Program of Northern California, Oakland, asked approximately 7,700 patients in managed care plans who received care from one of several large medical groups in California about their attitudes toward their primary care physicians and their perceptions of barriers to specialty care. Patients were also asked to rate the performance of their primary care physicians on three dimensions: trust, confidence in quality of care, and overall satisfaction.

The study also revealed that 75 to 91 percent of patients studied preferred to seek care first from their primary care physicians, depending on the specific medical problem. Most patients wanted their primary care physicians to assist in coordinating referrals to specialists when needed. The majority of patients (85 percent) reported that all or most of the time they trusted their primary care physicians to do the best for them.

Patients want their primary care physicians to have the freedom to refer them to a specialist when needed. However, as Dr. Grumbach points out, many managed care plans have financial incentives and other "gatekeeper" policies that may discourage primary care physicians from making these referrals.

For more information, see "Resolving the gatekeeper conundrum: What patients value in primary care and referrals to specialists," by Drs. Grumbach and Selby, Cheryl Damberg, Ph.D., and others, in the July 21, 1999 issue of the Journal of the American Medical Association 282, pp. 261-266.

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