REUTERS: Many consequences for hospital patients — including how long they remain and their survival chances once they return — might depend on whether they’re cared for by their primary care doctor or another kind of physician, or a U.S. study indicates.
Researchers analyzed data on 560,651 admissions nationally for patients insured by Medicare, the U.S. health program for the elderly and disabled, who needed a wide variety of common clinical problems. Their hospital care has been overseen by one of 3 forms of general medicine doctors: their primary care doctor, a so-called hospitalist with special instruction in caring for psychiatric patients, or other generalists.
In comparison to patients observed by hospitalists, patients seen with their primary care physicians needed more expert consultations and more hospital stays, which can at times indicate less efficient care. However, these patients were more inclined to be discharged house instead of a rehab or nursing center, and they’re also less likely to die within 30 days of leaving the hospital.
“It’s likely that primary care physicians are not keen to release till they feel like there’s a more perfect plan for dwelling, which hospitalists are discharging previously, when individuals are clinically stable, with the premise that outpatient providers will operate on further refining the maintenance plan,” explained lead study author Dr. Jennifer Stevens of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.
The gap in survival outcomes is harder to explain, Stevens explained by email.
“We don’t know whether it is due to something that occurs in the hospital as a result of the primary care physician’s decisions, or due to a primary care physician’s presence in the hospital influences post-hospital maintenance,” Stevens added.
Hospitalists now outnumber any other specialization in internal medicine and also they care for about three in every four patients in U.S. physicians, researchers notice from JAMA Internal Medicine.
The hospitalist model of care has taken hold in the past few years as a means to shepherd increasingly sophisticated patients with numerous serious and chronic health problems through hospital remains. Because they know how things work inside the hospital, they could reevaluate evaluations, organize expert consultations, and work to enhance both the efficacy and quality of maintenance.
For the current study, researchers wanted to see if patient outcomes were distinct with hospitalists than using a primary care doctor or another general medicine physician that the individual did not already know.
Hospitalists cared for 60% of patients in the analysis, whereas primary care physicians saw 14 percent of their patients and other generalists treated 26 percent of their patients.
In comparison to hospitalists, primary care physicians used consultations 3 per cent more frequently as well as other generalists used consultations 6 per cent more frequently, the analysis found.
Lengths of hospital stays were 12 percent more using primary care physicians and 6 per cent more using other generalists than they were with hospitalists.
Primary care physicians were 14 percent more likely than hospitalists to release patients to their homes instead of institutional care settings, whereas generalists were 6 per cent less likely than hospitalists to do this.
Readmissions, or replicate hospitalizations, within one week or one month of release were like primary care physicians and hospitalists, however, happened more frequently with other generalists.
Patients cared for by primary care physicians were 6 per cent less likely to die within 30 days of release compared to people treated with hospitalists. However, with generalists, patients have been 9% more likely to die than with primary care physicians.
The research wasn’t a controlled experiment designed to establish whether or how the kind of physician treating hospital patients influences outcomes.
“This doesn’t show that the hospitalist model doesn’t work,” explained Dr. Seth Landefeld, author of an accompanying editorial and a researcher in the University of Alabama in Birmingham.
However, it does suggest there are advantages to sticking with one physician.
“A trusting relationship with a physician who will ‘orchestrate’ your care through the plan of sickness can be very valuable, as opposed to bouncing from 1 subspecialist into another without a ‘running’ physician,” Landefeld said via email.