Managed care, access to specialists, and outcomes among primary care patients with pain

David E. Grembowski, Diane Martin, Paula Diehr, Donald L. Patrick, Barbara Williams, Louise Novak, Richard (Rick) Deyo, Wayne Katon, Deborah Dickstein, Ruth Engelberg, Harold Goldberg

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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 abstracted 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.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalHealth Services Research
Volume38
Issue number1 I
StatePublished - Feb 2003
Externally publishedYes

Fingerprint

Managed Care Programs
managed care
patient care
pain
Primary Health Care
physician
Pain
Physicians
rating
Referral and Consultation
health
cost sharing
questionnaire
Cost Sharing
Physicians' Offices
Information Storage and Retrieval
Health
Primary Care Physicians
incentive
manager

Keywords

  • Consultation
  • Managed care programs
  • Outcome assessment
  • Pain
  • Primary care
  • Referral
  • Specialties (medical)

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Grembowski, D. E., Martin, D., Diehr, P., Patrick, D. L., Williams, B., Novak, L., ... Goldberg, H. (2003). Managed care, access to specialists, and outcomes among primary care patients with pain. Health Services Research, 38(1 I), 1-19.

Managed care, access to specialists, and outcomes among primary care patients with pain. / Grembowski, David E.; Martin, Diane; Diehr, Paula; Patrick, Donald L.; Williams, Barbara; Novak, Louise; Deyo, Richard (Rick); Katon, Wayne; Dickstein, Deborah; Engelberg, Ruth; Goldberg, Harold.

In: Health Services Research, Vol. 38, No. 1 I, 02.2003, p. 1-19.

Research output: Contribution to journalArticle

Grembowski, DE, Martin, D, Diehr, P, Patrick, DL, Williams, B, Novak, L, Deyo, RR, Katon, W, Dickstein, D, Engelberg, R & Goldberg, H 2003, 'Managed care, access to specialists, and outcomes among primary care patients with pain', Health Services Research, vol. 38, no. 1 I, pp. 1-19.
Grembowski DE, Martin D, Diehr P, Patrick DL, Williams B, Novak L et al. Managed care, access to specialists, and outcomes among primary care patients with pain. Health Services Research. 2003 Feb;38(1 I):1-19.
Grembowski, David E. ; Martin, Diane ; Diehr, Paula ; Patrick, Donald L. ; Williams, Barbara ; Novak, Louise ; Deyo, Richard (Rick) ; Katon, Wayne ; Dickstein, Deborah ; Engelberg, Ruth ; Goldberg, Harold. / Managed care, access to specialists, and outcomes among primary care patients with pain. In: Health Services Research. 2003 ; Vol. 38, No. 1 I. pp. 1-19.
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