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BMC Health Services Research

, 7:22

First Online: 16 February 2007Received: 21 September 2006Accepted: 16 February 2007DOI: 10.1186-1472-6963-7-22

Cite this article as: Grembowski, D., Paschane, D., Diehr, P. et al. BMC Health Serv Res 2007 7: 22. doi:10.1186-1472-6963-7-22

Abstract

BackgroundManaged care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions.

MethodsA prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients N = 17,187 were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients n = 1,995 completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient-s health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days.

ResultsThe intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers.

ConclusionFor primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-7-22 contains supplementary material, which is available to authorized users.

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Autor: David Grembowski - David Paschane - Paula Diehr - Wayne Katon - Diane Martin - Donald L Patrick

Fuente: https://link.springer.com/







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