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1st
appeared 21 July 1999
Most Patients Trust Primary Care Doctors, 23
Percent Report Gatekeeping
In the first systematic study of what Americans value
in primary health care, patients overwhelmingly value primary care physicians, but nearly
a quarter of them felt they limited their access to specialists, according to new research
headed by UCSF.
Almost all of the patients surveyed said they valued having a primary care physician who
could coordinate their care and serve as a first point of contact. Ratings of primary care
physicians revealed high levels of patient trust, confidence, and satisfaction.
But trust and satisfaction eroded for nearly a quarter of patients who felt their primary
care physician or medical group limited their access to specialists.
"Patients value primary care physicians, but don't want managed care plans forcing
primary care physicians to be 'gatekeepers' who ration their access to specialists,"
said Kevin Grumbach, MD, UCSF associate professor and chief of the Department of Family
and Community Medicine at San Francisco General Hospital Medical Center. Some managed care
groups use financial incentives and other "gatekeeper" policies to limit
specialty referrals, said Grumbach, who is also director of the UCSF Center for California
Health Workforce Studies and research director of the UCSF Center for the Health
Professions. This can weaken the relationship between primary care physicians and their
patients and potentially result in poorer quality of care, said Grumbach.
"Policymakers should consider these results in light of the current debate over
'Patients' Bill of Rights' legislation," said Joe Selby, MD, MPH, director of the
Division of Research at Kaiser Permanente Medical Program of Northern California.
"Patients want protection from overly restrictive policies that limit access to care.
But they don't necessarily want to return to a haphazard system that reduces their primary
care physician's role as a coordinator of specialty services."
In order to assess attitudes about the ease of receiving specialty care, researchers
targeted patients who were likely to need referrals. The 7,718 respondents had one of
three age-related medical conditions - congestive heart failure, prostate disease, or
stomach ulcers - and had a mean age of 67. The study appears in the July 21 issue of the
Journal of the American Medical Association (JAMA).
Source: Rebecca Sladek Nowlis, News
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