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Patient preferences for care by general internists and specialists in the ambulatory setting

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OBJECTIVE: To investigate patients’ preferences for care by general internists and specialists for common medical conditions.

DESIGN: Telephone interview.

SETTING: A convenience sample of general internal medicine practices at 10 eastern academic medical centers.

PATIENT/PARTICIPANTS: A probability sample of 314 participants who had at least one visit with their primary care physician during the preceding 2 years.

MEASUREMENTS AND MAIN RESULTS: Items addressed patients’ attitudes concerning continuity of care, preferences for care by general internists or specialists for common medical problems, and perceptions about the competency of general internists and specialists to manage these problems. Continuity was important to participants, with 63% reporting they preferred having one doctor. Respondents were willing to wait 3 or 4 days to see their regular doctor (85%) and wanted their doctor to see them in the emergency department (77%) and monitor their care while in the hospital (94%). A majority (>60%) preferred care from their regular doctor for a variety of new conditions. Though respondents valued continuity, 84% felt it was important to be able to seek medical care from any type of physician without a referral, and 74% responded that if they needed to see a specialist, they were willing to pay out-of-pocket to do so. Although most participants (98%) thought their regular doctor was able to take care of usual medical problems, the majority through that specialists were better able to care for allergies (79%) and better able to prescribe medications for depression (65%) and low-back pain (72%).

CONCLUSIONS: Participants preferred to see their general internist despite their perceptions that specialists were more competent in caring for the conditions we examined. However, they wanted unrestricted access to specialists to supplement care provided by general internists.

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Correspondence to Carmen L. Lewis MD.

Additional information

This work was supported in part by grant 2D28PE54004 from the Bureau of Health Professions, Health Resources and Services Administration, to the Faculty Development Program for General Internal Medicine, University of North Carolina at Chapel Hill, and by grant 52285 from the Summa Health System, Akron, Ohio.

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Lewis, C.L., Wickstrom, G.C., Kolar, M.M. et al. Patient preferences for care by general internists and specialists in the ambulatory setting. J GEN INTERN MED 15, 75–83 (2000).

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