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ABSTRACT: Background
It is not uncommon for medical specialists to predominantly care for patients with certain chronic conditions rather than primary care physicians (PCPs), yet the resource implications from such patterns of care are not well understood.Objective
To assess resource use of diabetes patients who predominantly visit a PCP versus a medical specialist.Design
Retrospective cohort study of diabetes patients aging into the traditional Medicare program. Patients were attributed to a PCP or medical specialist annually based on a preponderance of ambulatory care visits and categorized according to whether attribution changed year to year. Propensity score weighting was used to balance baseline demographic characteristics, diabetes complications, and underlying health conditions between patients attributed to PCPs and to medical specialists. Spending and utilization were measured up to 3 patient-years.Subjects
A total of 141,558 patient-years.Main measures
Total visits, unique physicians, hospital admissions, emergency department visits, procedures, imaging, and tests.Key results
Each year, roughly 70% of patients maintained attribution to a PCP and 15% to a medical specialist relative to the previous year. After propensity weighting, patients continuously attributed to a PCP versus medical specialist from 1 year to the next had lower average total payer payments ($10,326 [SD $57,386] versus $14,971 [SD $74,112], P<0.0001) and lower total patient out-of-pocket payments ($1,707 [SD $6,020] versus $2,443 [SD $7,984], P<0.0001). Rates of hospitalization, emergency department visits, procedures, imaging, and tests were lower among patients attributed to PCPs as well.Conclusions
Older adults with diabetes who receive more of their ambulatory care from a PCP instead of a medical specialist show evidence of lower resource use.
SUBMITTER: Nyweide DJ
PROVIDER: S-EPMC8811114 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Nyweide David J DJ Austin Andrea M AM Bynum Julie P W JPW
Journal of general internal medicine 20210401 2
<h4>Background</h4>It is not uncommon for medical specialists to predominantly care for patients with certain chronic conditions rather than primary care physicians (PCPs), yet the resource implications from such patterns of care are not well understood.<h4>Objective</h4>To assess resource use of diabetes patients who predominantly visit a PCP versus a medical specialist.<h4>Design</h4>Retrospective cohort study of diabetes patients aging into the traditional Medicare program. Patients were attr ...[more]