Blog | Friday, June 7, 2013

QD: News Every Day--'Doctor shopping' may impair continuity, send patients to ER more

Frequently changing primary care providers may impair continuity and result in increased emergency room visits, a study found.

Researchers combined claims data from a health plan to uncover people who had outpatient claims with five or more different primary care physicians during a two-year span to evaluate the association between body-mass index categories, doctor shopping and emergency visits.

Results appeared online at Obesity.

Shoppers were more commonly women with higher BMIs, more comorbid disease severities, and more commonly with a mental health diagnosis.

Compared to normal weight beneficiaries (BMI 18.5 to 24.9), overweight (BMI 25 to 29.9) beneficiaries had 23% greater adjusted odds of doctor shopping (95% confidence interval [CI], 1.04 to 1.46). Obese (BMI 30 or more) beneficiaries had 52% greater adjusted odds of doctor shopping (95% CI, 1.26 to 1.82).

Compared to normal weight non-shoppers, overweight shoppers had more emergency room visits (incidence rate ratio [IRR] 1.85; 95% CI, 1.37 to 2.45), as did obese ones (IRR, 1.83; 95% CI, 1.34 to 2.50).

Researcher noted that while only 4% of people in the study saw five or more doctors in a two-year period, 23% saw three or more in the same time span, which may be the more common scenario given the national shortage of primary care doctors.

Researchers noted that women have reported in previous studies that negative interactions with staff and "weight bias" have driven them to seek out other providers, so, "Patients may benefit from doctor shopping in this scenario, as we hope that they would find providers that better meet their needs."

Still, with the net effect of more frequent emergency visits, "... novel care systems such as the patient-centered medical home (PCMH) may be uniquely suited to improve the care patterns of overweight and obese patients. The most commonly used definitions of PCMH emphasize continuity of care with a primary care provider. Patients enrolled in PCMH have significantly decreased their utilization of outpatient, inpatient and emergency department care along with associated decreases in costs."