Conference Summary
Following are highlights from a September 1995 conference,
"Research at the Interface of Primary and Specialty
Care" sponsored by the Agency for Health Care Policy and
Research's Center for Primary Care Research (CPCR).
The complete Conference Summary Report (AHCPR Pub. No.
96-0034) is available from the AHRQ Publications Clearinghouse.
A list of potential research topics and a bibliography to help
readers locate more information are included. Call toll free 800-358-9295.
Purpose
The purpose of AHCPR's conference was two-fold: (1) to assess
the current state of research related to the integration of
primary and specialty health care services, including referrals
and consultation, and (2) to obtain suggestions regarding the
most important questions in this area for future research to
address.
Plenary session topics were Conceptual Models and
Methodological Issues of Referrals Research, Provider Issues,
Consumers and other Issues, Lessons Learned from Referrals
Research in Great Britain, and Quality of Care and Referral
Decisions.
Overview
In the U.S. health care system, the roles and responsibilities
of primary care and specialist providers have traditionally
overlapped, often resulting in confusion among providers and
patients, as well as redundant or inadequate care. Newer health
care plans and reimbursement mechanisms are requiring clinicians
to assume more clearly defined roles as either primary care or
specialist providers, and they are attempting to limit patient
access to specialists, who have been found to use significantly
more resources than primary care providers. These organizational
changes appear to be aimed at reducing costs while improving the
effectiveness of care.
Conclusion
There is a conspicuous absence of scientific data on the
costs, outcomes, and the quality of the care being delivered as a
result of changes occurring at the interface of primary and
specialty care. More information is urgently needed to help
define appropriate use of primary and specialty services.
Research Recommendations
Categories and questions for future research include:
Economic Incentives and Referral Decisions
How do specific economic incentives affect the referral
behavior of primary care and specialty clinicians?
Do changing economic incentives to refer more or less
frequently lead to changes in patient outcomes?
Effective Communications and Teamwork
Is it desirable or even possible to standardize the content
and language of the information transferred between referring
clinician and consultant into communication protocols? What would
be the effect of such protocols on the process and outcomes of
referrals?
How can newer technologies be used most effectively to improve
the process and outcomes of communication at the interface of
primary and specialty care?
Provider Roles and Responsibilities
Which specific provider competencies (in both knowledge and
skills) have a proven impact on patient outcomes?
Can the effect of these competencies be separated from the
effects of practice organization and health care system?
Can the role of providers in managed care organizations be
expanded to include traditional pubic health functions?
Patient Demand and Satisfaction
How do patients evaluate the referral process?
Which factors shape, and how does one measure, patient
expectations, preference, attitudes, and understanding about
referrals?
Internet Citation:
Research at the Interface of Primary and Specialty Care: Conference Summary. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/interovr.htm
540 Gaither Road Rockville, MD 20850