Higher levels of primary care physicians in area associated with favorable outcomes for patients

May 24, 2011 in Health

Medicare beneficiaries residing in areas with higher levels of primary care physicians per population have modestly lower death rates and fewer preventable hospitalizations, according to a study in the May 25 issue of JAMA.

"Strengthening the role of primary care is a key element in most proposals to improve the outcomes and efficiency of in the United States. With the and the waning interest in primary care by U.S. medical school graduates, some have projected a large shortage of general internists and family physicians to care for a growing number of elderly patients," according to background information in the article. "Despite a widespread interest in increasing the numbers of to improve care and to moderate costs, the relationship of the primary care physician workforce to patient-level outcomes remains poorly understood."

Chiang-Hua Chang, Ph.D., of Dartmouth Medical School, Hanover, N.H., and colleagues conducted a study to examine whether high levels of primary care physician workforce are associated with lower mortality, fewer ambulatory care sensitive condition (ACSC) hospitalizations, and lower spending in Medicare beneficiaries. ACSC hospitalizations are regarded as largely preventable admissions when adequate and timely ambulatory (outpatient) care is provided. The study consisted of an analysis of the outcomes of a 20 percent sample of fee-for-service Medicare beneficiaries age 65 years or older (n = 5,132,936) in 2007, and used 2 measures of adult primary care physicians (general internists and ) across Primary Care Service Areas (n = 6,542): (AMA) Masterfile nonfederal, office-based physicians per total population; and full-time equivalents (FTEs), a workforce measure that is an estimate of the ambulatory clinical FTEs of primary care physicians, derived from Medicare office- and clinic-based claims of primary care physicians.

The researchers found marked variation in the primary care across areas, but low correlation was observed between the 2 primary care workforce measures. After adjusting for certain patient and area variables, only small differences were observed in mortality and Medicare program spending across quintiles (one of five groups) of primary care physicians per population. However, beneficiaries residing in areas with the highest quintile of primary care physicians per population had 6 percent lower rates of ACSC hospitalizations, with adjusted rates of 74.90 vs. 79.61 per 1,000 beneficiaries, respectively, for highest vs. lowest quintile of primary care workforce.

Stronger associations were observed in models that used primary care physician FTEs as the measure of primary care workforce. "For example, not only did beneficiaries residing in the highest quintile of primary care FTEs have 5 percent lower mortality, but also 9 percent fewer ACSC hospitalizations and 1 percent higher total Medicare program spending. The adjusted rates of the highest compared with lowest quintile were 5.19 vs. 5.49 deaths per 100 beneficiaries, 72.53 vs. 79.48 ACSC hospitalizations per 1,000 beneficiaries, and $8,857 vs. $8,769 total Medicare spending per beneficiary, respectively. There were significant trends in the association of primary care FTEs with mortality, ACSC hospitalizations, and acute care facility Medicare spending," the authors write.

"Our findings suggest that a higher local workforce of primary care physicians has a generally positive benefit for Medicare populations, but that this association may not simply be the result of having more physicians trained in primary care in an area. Instead, associations were much stronger with a measure of primary care activity that was linked to a central concept of primary care—ambulatory care delivered in an office or clinic setting by physicians trained in primary care. The FTEs measure also more accurately reflected physician retirement or part-time effort."

"The benefits of primary care workforce appear quite sensitive to the accurate discrimination of those physicians trained in primary care with those practicing ambulatory primary care. Recognizing this difference is important not just to improve primary care clinician measurement, but also as an indication of the drift of physicians trained as primary care physicians to nonprimary care careers. Increasing the training capacity of family medicine and internal medicine may have disappointing patient benefits if the resulting physicians are primary care in name only," the researchers conclude.

More information: JAMA. 2011;305[20]2096-2105.

Provided by JAMA and Archives Journals search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

Driving and hands-free talking lead to spike in errors, study shows

Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.

Health created 15 hours ago | popularity not rated yet | comments 0

About one in four uninsured could be excluded from ACA

(HealthDay)—More than one in four of those eligible for new premium assistance tax credits under the Affordable Care Act (ACA) do not have a checking account and will not be able to receive premiums from ...

Health created 17 hours ago | popularity not rated yet | comments 0

Audiologists recommend smart phone apps to monitor noise levels

After studying noise in one French Quarter neighborhood of New Orleans to determine whether or not noise levels exceeded municipal ordinances, Annette Hurley, PhD, Assistant Professor of Audiology at LSU Health Sciences Center ...

Health created 19 hours ago | popularity not rated yet | comments 0

Young children who miss well-child visits are more likely to be hospitalized

Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits, according to a study published today in the American Jo ...

Health created 19 hours ago | popularity not rated yet | comments 0

Do doctors understand the individualisation of treatments?

The individualisation of drug treatments to support patients to self-manage their conditions is a concept that sits at the heart of policy, but a recent study in BMJ Open shows that there is no concrete defini ...

Health created 21 hours ago | popularity 3 / 5 (1) | comments 0


Heart failure accelerates male 'menopause'

Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...

First drug to improve heart failure mortality in over a decade

Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...

Feds fight morning-after pill age ruling in NY

(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...

Death highest in heart failure patients admitted in January, on Friday, and overnight

Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...

Engineered cytomegalovirus protects monkeys from HIV equivalent

(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...

Researchers identify first drug targets in childhood genetic tumor disorder

Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...