PCP-centered care more efficient, less costly than specialists without loss of quality
Although health outcomes of older adults with multimorbidity were similar among those who used a primary care provider or a specialist as their main doctor, seeing a PCP contributed to fewer hospitalizations, lower costs and fewer visits to other health care providers, according to research published in the Journal of the American Geriatrics Society.
“In the United States, family practice and general internal medicine are commonly considered primary care providers for adults, although other specialties have advocated for taking on that role,” Julie P. W. Bynum, MD, MPH, from the Geisel School of Medicine at Dartmouth College and colleagues, wrote.
“Although the idea that primary care providers are better positioned to coordinate care and generate better outcomes at lower costs is appealing, the evidence suggesting that specialty matters in achieving those outcomes is controversial,” they added.
From 2011 to 2012, Bynum and colleagues conducted an observational study of 3,924,942 Medicare fee-for-service beneficiaries aged 65 years and older with at least two or more chronic conditions to assess whether receiving predominant care from a PCP or a specialty provider is associated with better outcomes. They used propensity score matching and compared 1-year mortality, hospitalizations, standardized expenditures and ambulatory visit patterns for having a PCP vs. a specialist as the predominant provider of care. Two-thirds of participants had a PCP as their predominant provider of care, whereas 32% used a specialist. A total of 14% of the study population saw only a PCP, while 18% only saw a specialist.
The researchers found that more hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) were observed in individuals with a specialist as their predominant provider of care compared with those with a PCP. However, similar mortality rates (0.2% higher in those with a specialist) and preventable hospitalizations was seen between the two groups. Moreover, individuals with a specialist as their predominant provider of care visited more health care providers and had lower continuity of care.
“This study suggests that expansion of new models of care that encourage concentration of visits in primary care may not be associated with better clinical outcomes but may achieve cost savings in elderly adults with multimorbidity,” Bynum and colleagues concluded. – by Alaina Tedesco
Disclosure: The researchers report funding from the John A. Hartford Foundation and National Institute on Aging.