Primary care patient visits more complex than specialty care

By Matt Kuhrt

If it seems that primary care physicians have less-than-adequate time to deal with all of their patients as thoroughly as they'd like, new research suggests the increased complexity of their patients' conditions could be a factor, according to a story in AAFP News.

A recent study published in Primary Care Diabetes sought to quantify the increased complexity of care required for visits to primary care offices by diabetes patients. To do so, it looked at a combination of the number of reasons for a given office visit, as well as the number of chronic conditions reported by patients.

Due to the chronic and varied nature of diabetes complications, this population served as a reasonable case study to highlight the differences between visits to specialists, which tend to be intense yet focused on a specific diagnosis, versus the multiple diagnoses one might expect from a trip to a primary care physician (PCP) spurred by a more general complaint.

In general, patients with multiple diagnoses were more likely to see a PCP. While 80 percent of visits to subspecialist physicians dealt with care for a single diagnosis, 90 percent of the visits dealing with four diagnoses went to PCPs. This suggests the overall complexity of an office visit is likely to be higher for patients who see PCPs than for those who see subspecialists, according to the report's authors.

This suggests primary care doctors under the current fee-for-service reimbursement model are feeling the squeeze, since it pays "based on volume of care, not necessarily on multiple dimensions of complexity related to the cognitive ability needed to provide whole-person care," says Miranda Moore, Ph.D., the study's lead author. She goes on to advocate that this sort of complexity be taken into account as policymakers create new payment models, such as those that pay for performance.

To learn more:
- read the AAFP News article
- dig into the study results in Primary Care Diabetes