NEW ORLEANS – The cost of care may be more expensive at an internist’s office, but it appears that internists may do a better job than family physicians in offering preventive care services such as flu shots and cancer screenings.
That’s according to an observational study of some 30,000 adults who had an internist, family physician, or specialist as their usual source of care.
Alicia Ault/IMNG Medical Media
Dr. Joshua Fenton
Dr. Joshua J. Fenton of the department of family and community medicine at the University of California, Davis, and his colleagues analyzed data from the Medical Expenditures Panel Survey from 2000 to 2008 and selected adults who responded that they had one of those physicians as a usual source of care in the previous year. Surgeons and ob.gyns were excluded because the authors wanted to study prostate cancer screening, in addition to other outcomes.
Previous research has consistently shown that internists and specialists have higher costs than family physicians, but there have been few data showing whether those higher costs are justified through the delivery of better care – specifically, better preventive care. The authors hypothesized that preventive care delivery would be similar across the three physician groups, Dr. Fenton said at the annual meeting of the North American Primary Care Research Group.
Of the 29,503 adults who were selected, 73% had a family physician as their usual source of care, 23% had an internist, and 4% a specialist. Those who received their care from an internist or specialist were slightly older, had a greater illness burden, had a higher income, and were more likely to live in urban areas, he said.
On an unadjusted basis, the annual care expenditures were $4,682 for those seeing an FP, $6,356 for an internist, and $9,147 for specialist. After adjusting for a variety of factors, including use of care in the previous year, the cost for internists was 10% more and for specialists was 33% more than the cost for family physicians.
People seeing an internist had significantly increased odds of receiving a flu shot in the study year, when compared with a family physician. The odds of getting a shot with a specialist were similar to those with a family physician.
For mammograms – 11,806 women had one during the study year – those with an internist were slightly more likely to get the screen. About 82% of those seeing an internist had a mammogram, compared with 79% of those seeing a family physician and 78% of those seeing a specialist. Pap smear screening rates were similar across the three physician groups, with about 82% getting the test.
Some 15,000 patients had an up-to-date colorectal screen – defined as a fecal occult test within the prior year or lower endoscopy within the previous 5 years. Rates were highest for internists, at 53%, compared with 48% of those seeing a family physician and 44% of those using a specialist.
Patients seeing an internist also had significantly increased odds of having a prostate-specific antigen test.
The study was limited by its cross-sectional and observational design, said Dr. Fenton, who also noted that it’s possible that some preventive care may have been delivered by providers other than the usual source of care.
The finding that internists delivered more preventive services, however, "raises some questions about cost-effectiveness and value," he said.
Dr. Fenton reported no conflicts.