Abstract
We studied British general practitioners' use of ambulatory resources to determine whether the quantities of different resources used were related to each other, and whether these quantities were associated with their personal characteristics. Rates of laboratory requests, referrals for specialty opinion, prescriptions, and visits per patient per year were examined for 21 physicians in seven practices over one year. Physicians who more frequently saw their patients referred and prescribed for them more often and ordered more tests, once the number of years they had practiced was taken into account. Doctors who ordered more tests referred their patients more frequently, regardless of how often they saw them. Doctors longer in practice saw and prescribed for their patients more frequently. Resource use was not related to other personal characteristics we studied. Greater frequency of patient-physician contact appears to increase costs not only through use of more professional time but also through greater use of other ambulatory resources. Attention to the use of only one type of resource may result in a distorted picture of how physicians care for their patients and the costs that such care incurs.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Childs A. W., Hunter E. D. Non-medical factors influencing use of diagnostic x-ray by physicians. Med Care. 1972 Jul-Aug;10(4):323–335. doi: 10.1097/00005650-197207000-00005. [DOI] [PubMed] [Google Scholar]
- Cummins R. O., Jarman B., White P. M. Do general practitioners have different "referral thresholds"? Br Med J (Clin Res Ed) 1981 Mar 28;282(6269):1037–1039. doi: 10.1136/bmj.282.6269.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eisenberg J. M., Nicklin D. Use of diagnostic services by physicians in community practice. Med Care. 1981 Mar;19(3):297–309. doi: 10.1097/00005650-198103000-00005. [DOI] [PubMed] [Google Scholar]
- Epstein A. M., Hartley R. M., Charlton J. R., Harris C. M., Jarman B., McNeil B. J. A comparison of ambulatory test ordering for hypertensive patients in the United States and England. JAMA. 1984 Oct 5;252(13):1723–1726. [PubMed] [Google Scholar]
- Freeborn D. K., Baer D., Greenlick M. R., Bailey J. W. Determinants of medical care utilization: physicians' use of laboratory services. Am J Public Health. 1972 Jun;62(6):846–853. doi: 10.2105/ajph.62.6.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Green R. H. General practitioners and open-access pathology services. J R Coll Gen Pract. 1973 May;23(130):316–325. [PMC free article] [PubMed] [Google Scholar]
- Hartley R. M., Charlton J. R., Harris C. M., Jarman B. Influence of patient characteristics on test ordering in general practice. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):735–738. doi: 10.1136/bmj.289.6447.735. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keeler E. B., Brook R. H., Goldberg G. A., Kamberg C. J., Newhouse J. P. How free care reduced hypertension in the health insurance experiment. JAMA. 1985 Oct 11;254(14):1926–1931. [PubMed] [Google Scholar]
- Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
- Myers L. P., Schroeder S. A. Physician use of services for the hospitalized patient: a review, with implications for cost containment. Milbank Mem Fund Q Health Soc. 1981 Fall;59(4):481–507. [PubMed] [Google Scholar]
- Schroeder S. A., Kenders K., Cooper J. K., Piemme T. E. Use of laboratory tests and pharmaceuticals. Variation among physicians and effect of cost audit on subsequent use. JAMA. 1973 Aug 20;225(8):969–973. [PubMed] [Google Scholar]