Abstract
To test the contention that patients in outpatient departments and private practices differ, variables were assessed that might affect both the process and the outcome of medical care. Two groups of 60 patients consulting nine Montreal internists who worked in both private practice and in an outpatient department of a university teaching hospital were surveyed. The internists served as their own controls. The two groups of patients were compared for 57 demographic, socioeconomic, access, utilization, attitudinal and current medical status variables. Financial factors were minimized by the existence of universal health insurance. The outpatient group was found to be older, less fluent in English, less likely to be employed, less educated, less wealthy, more dependent on public transportation, more disabled, more likely to use ambulatory services, more anxious about health, and more sceptical about physicians, yet more dependent on them than the private practice group. The outpatient group tended to have more active, significant medical conditions and to receive more prescriptions for medication than the private practice group, in contrast to the national patterns in the practice of internal medicine in the United States. Medical educators, researchers, administrators and providers of health care who have assumed that these two groups of patients are comparable must re-evaluate their practices.
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Selected References
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- Beck R. G. Economic class and access to physician services under public medical care insurance. Int J Health Serv. 1973;3(3):341–355. doi: 10.2190/9J37-6TD1-P1PE-4FN4. [DOI] [PubMed] [Google Scholar]
- Burnum J. F. What one internist does in his practice. Implications for the internist's disputed role and education. Ann Intern Med. 1973 Mar;78(3):437–444. doi: 10.7326/0003-4819-78-3-437. [DOI] [PubMed] [Google Scholar]
- Duff R. S., Rowe D. S., Anderson F. P. Patient care and student learning in a pediatric clinic. Pediatrics. 1972 Dec;50(6):839–846. [PubMed] [Google Scholar]
- Eisenberg J., Mackie A., Kahn L., Perkoff G. T. Patterns of pediatric practice by the same physicians in a prepaid and a fee-for-service setting. Clin Pediatr (Phila) 1974 Apr;13(4):352–passim. doi: 10.1177/000992287401300417. [DOI] [PubMed] [Google Scholar]
- Enterline P. E., Salter V., McDonald A. D., McDonald J. C. The distribution of medical services before and after "free" medical care--the Quebec experience. N Engl J Med. 1973 Nov 29;289(22):1174–1178. doi: 10.1056/NEJM197311292892206. [DOI] [PubMed] [Google Scholar]
- Fletcher R. H., Fletcher S. W. The Medical Polyclinic: an approach to conflicting needs in a teaching hospital. J Med Educ. 1976 Aug;51(8):634–643. [PubMed] [Google Scholar]
- Goetzl E. J., Cohen P., Downing E., Erat K., Jessiman A. G. Quality of diagnostic examinations in a university hospital outpatient clinic. Ann Intern Med. 1973 Apr;78(4):481–489. doi: 10.7326/0003-4819-78-4-481. [DOI] [PubMed] [Google Scholar]
- Hulka B. S., Zyzanski S. J., Cassel J. C., Thompson S. J. Satisfaction with medical care in a low income population. J Chronic Dis. 1971 Nov;24(10):661–673. doi: 10.1016/0021-9681(71)90069-5. [DOI] [PubMed] [Google Scholar]
- JOHNSON A. C., KROEGER H. H., ALTMAN I., CLARK D. A., SHEPS C. G. THE OFFICE PRACTICE OF INTERNISTS. 3. CHARACTERISTICS OF PATIENTS. JAMA. 1965 Sep 13;193:916–922. doi: 10.1001/jama.1965.03090110054014. [DOI] [PubMed] [Google Scholar]
- Kelley C. R., Mamlin J. J. Ambulatory medical care quality. Determination by diagnostic outcome. JAMA. 1974 Mar 11;227(10):1155–1157. [PubMed] [Google Scholar]
- Lee S. S. Health insurance in Canada--an overview and commentary. N Engl J Med. 1974 Mar 28;290(13):713–716. doi: 10.1056/NEJM197403282901305. [DOI] [PubMed] [Google Scholar]
- Patrick D. L., Bush J. W., Chen M. M. Toward an operational definition of health. J Health Soc Behav. 1973 Mar;14(1):6–23. [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]
- Vorzimer J. J., Metz D. Modifying the disease-oriented outpatient department. N Y State J Med. 1974 Aug;74(9):1660–1664. [PubMed] [Google Scholar]