Overserviced but Underserved Patients Burden Primary Care

August 12, 2005

Madeline Vann
Phone: 504-247-1425

Two percent of patients visit their primary care doctor 10 or more times a year, but that seemingly small number of people represents 18 percent of all primary care visits, say researchers from Tulane University and the Mayo Clinic College of Medicine (Rochester, Minn.). That two percent also accounts for 11 percent of paid insurance claims, notes lead author James Naessens, a doctoral student at Tulane and clinical associate in Health Care Policy and Research at the Mayo Clinic.

"Our concern is that the patients who are visiting their primary care doctors frequently may have underlying needs that should be addressed in a different manner. If we can predict which patients are likely to place a high demand on primary care services, we can offer more cost-effective alternatives such as disease management, case management group visits or patient education," says Claudia Campbell, professor and chair of the department of health systems management at the Tulane University School of Public Health and Tropical Medicine, senior author on the publication.

Research results indicate that patients who visit their doctors 10 or more times a year are likely to fall into one of four diagnosis categories: unstable chronic medical conditions, minor time-limited psychosocial conditions, minor signs and symptoms, and "see and reassure" conditions. The researchers used the data to develop a model to effectively predict future high-use patients.

The research team analyzed data from outpatient visits to family medicine, general internal medicine, general pediatrics and obstetrics clinics involving 54,074 patients between 1997 and 1999. All patients belonged to a fee-for-service plan with no co- payments to physicians and no requirement for referrals for specialty care. On average, each patient made 1.7 primary care visits per year.

The study findings are published in the July/August edition of the Annals of Family Medicine. Study co-authors include Holly Van Houten, Mayo Clinic College of Medicine; Macaran Baird, University of Minnesota; and David Vanness, University of Wisconsin.

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