Managed Care, Access to Specialists, and Outcomes among Primary Care Patients with Pain

• Published in: Health services research 2003-02, Vol.38 (1p1), p.1-19
• Main Authors: Grembowski, David E., Martin, Diane, Diehr, Paula, Patrick, Donald L., Williams, Barbara, Novak, Louise, Deyo, Richard, Katon, Wayne, Dickstein, Deborah, Engelberg, Ruth, Goldberg, Harold
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cohort Studies; consultation; Female; Forecasts and trends; Health care access; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Humans; Influence; Male; Managed care; Managed care plans (Medical care); Managed care programs; Managed Care Programs - standards; Managed Care Programs - statistics & numerical data; Market trend/market analysis; Medical referrals; Middle Aged; outcome assessment; Outcome Assessment (Health Care); pain; Pain - epidemiology; Pain Management; pain, primary care; Patient Satisfaction - statistics & numerical data; Primary care; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data; Program Evaluation; Prospective Studies; Quality and Outcomes of Care; referral; Referral and Consultation - organization & administration; Referrals; Specialists; specialties (medical); Statistics; Studies; Surveys and Questionnaires; United States - epidemiology; Washington - epidemiology
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.00102

Objective. To determine whether managed care controls were associated with reduced access to specialists and worse outcomes among primary care patients with pain. Data Sources/Study Setting. Patient, physician, and office manager questionnaires collected in the Seattle area in 1996–1997, plus data ed from patient records and health plans. Study Design. A prospective cohort study of 2,275 adult patients with common pain problems recruited in the offices of 261 primary care physicians in Seattle. Data Collection. Patients completed a waiting room questionnaire and follow‐up surveys at the end of the first and sixth months to measure access to specialists and outcomes. Intensity of managed care controls measured by plan managed care index and benefit/cost‐sharing indexes, office managed care index, physician compensation, financial incentives, and use of clinical guidelines. Principal Findings. A financial withhold for referral was associated with a lower likelihood of referral to a physician specialist, a greater likelihood of seeing a specialist without referral, and a lower patient rating of care from the primary physician. Otherwise, patients in more managed offices and with greater out‐of‐network plan benefits had greater access to specialists. Patients with more versus less managed care had similar health outcomes, but patients in more managed offices had lower ratings of care provided by their primary physicians. Conclusions. Increased managed care controls were generally not associated with reduced access to specialists and worse health outcomes for primary care patients with pain, but patients in more managed offices had lower ratings of care provided by their primary physicians.