Among fee-for-service Medicare beneficiaries 65 and older, chances are their health status is about the same whether they visit only a generalist or only a specialist.
That is one conclusion of a study based on interviews with 7,928 beneficiaries and on their 1998 Medicare claims data. The subjects who saw a generalist only were younger, had lower incomes and less education, and were less likely to live in a metropolitan area than were those who saw a specialist only, the study found.
"The health status measures were not significantly different between subjects who visited a generalist only" and those who visited a specialist only, said FP George Xakellis, M.D., M.B.A., of Lancaster, Pa. He reported on the study in "Are Patients Who Use a Generalist Physician Healthier Than Those Who Seek Specialty Care Directly?" in the November-December issue of Family Medicine.
"One of the more worrisome findings of our study for advocates of a primary medical home is that subjects with higher levels of education and income were more likely to visit specialists only," said Xakellis. "Enticing this more-educated, affluent group into the office of a generalist physician may require better articulation of the value a generalist physician brings to this patient's health and health care needs."
For the study, Xakellis defined generalist as a GP, FP, general internist, nurse practitioner, preventive medicine provider or geriatrician. He limited the study to beneficiaries who weren't in HMOs and who lived in communities rather than facilities. The 969 subjects who saw no physician in 1998 were the study's healthiest participants. The 4,921 subjects who saw both generalists and specialists had the poorest health status and most chronic diseases. The 916 subjects who saw only a generalist and the 1,122 who saw only a specialist had intermediate levels of health status.
"This model suggests that as Americans experience increasing levels of disease burden, they are more likely to see a physician, and as their disease burden increases further, they have an increased likelihood of accessing multiple physicians," said Xakellis. "The act of visiting a specialist or a generalist as their only source of care is, however, more associated with income, level of education and location of residence than it is with health status."
He advised, "Before every American will be willing to have a personal primary care medical home, their care-seeking behaviors and the underlying preferences associated with these actions will need to be better understood."
The Future of Family Medicine report calls for each American to have a personal medical home.
