Blog | Wednesday, March 11, 2009

In absence of medical home, routine care migrates to specialists


A study in the March/April Annals of Family Medicine reports that specialists are increasingly providing routine follow-up and preventive care that would be better suited to the primary care setting. With no medical home to anchor them, it seems that patients easily drift away from their PCPs.

Researchers looked at more than 1 billion ambulatory visits to U.S. office-based specialists in 2002-04 and found that 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist, while referrals accounted for only 30.4% of all visits. "The results of our study suggest now that not all activity performed by specialists when in a specialist role may require specialized care," the authors commented.

The findings strengthen the case for the medical home model of care, the authors continue, where greater efficiencies are achieved by having PCPs handle routine follow-up of chronic diseases and preventive services, such as cervical cancer screening -- leaving specialists to focus on their own areas of expertise.

(Make sure to check out our April ACP Internist cover story featuring some of the first payer-supported patient-centered medical homes in the country, part of a pilot project in southeastern Pennsylvania.)